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Maternal hemodynamic changes in gestational diabetes: a prospective case–control study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The aim of the study is to compare maternal hemodynamic adaptations in gestational diabetes (GDM) versus healthy pregnancies.

Methods

A prospective case–control study was conducted, comparing 69 singleton pregnancies with GDM and 128 controls, recruited between September 2018 and April 2019 in Maternal–Fetal Medicine Unit, Careggi University Hospital, Florence, Italy. Hemodynamic assessment by UltraSonic Cardiac Output Monitor (USCOM) was performed in both groups in four gestational age intervals: 17–20 weeks (only in early GDM cases), 26–30 weeks, 32–35 weeks and 36–39 weeks. We evaluated six hemodynamic parameters comparing GDM cases versus controls: cardiac output (CO), cardiac index (CI), stroke volume (SV), total vascular resistance (TVR), inotropy index (INO) and potential to kinetic energy ratio (PKR).

Results

GDM group had significantly lower values of CO and SV than controls from the early third trimester (26–30 weeks) until term (p < 0.001). CI is significantly lower in GDM women already at the first evaluation (p = 0.002), whereas TVR and PKR were significantly higher in GDM (p < 0.001). GDM women showed also lower INO values than controls in all assessments.

Conclusions

A hemodynamic maternal maladaptation to pregnancy can be detected in GDM women. The effect of hyperglycemia on vascular system or a poor pre-pregnancy cardiovascular (CV) reserve could explain this hemodynamic maladaptation. The abnormal CV response to pregnancy in GDM women may reveal a predisposition to develop CV disease later in life and might help in identifying patients who need a CV follow‐up.

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Acknowledgements

The authors have no acknowledgements to make.

Funding

The author declares no funding sources.

Author information

Author notes

  1. Felice Petraglia and Herbert Valensise have contributed equally to this work.

Authors and Affiliations

  1. Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Careggi University Hospital, Florence, Italy

    Federico Mecacci, Sara Clemenza, Federica Lisi & Felice Petraglia

  2. High Risk Pregnancy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy

    Federico Mecacci, Serena Ottanelli, Silvia Vannuccini, Caterina Serena, Marianna Pina Rambaldi & Serena Simeone

  3. Department of Surgery, University “Tor Vergata”, Policlinico Casilino, Rome, Italy

    Ilaria Pisani & Herbert Valensise

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  1. Federico Mecacci
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  3. Silvia Vannuccini
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Contributions

FM contributed to the conception and design of the study. SC, FL, GM, SC, MPR, SS, IP contributed to patient recruitment and collection of data. SO, SV, GM and SC collaborated on data analysis and first draft writing. FM substantially contributed to the interpretation of data. FM, FP and HV revised the manuscript for important intellectual content. All authors approved the final version.

Corresponding author

Correspondence to Silvia Vannuccini.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was approved by the Careggi University Hospital Research Ethics Committee in September 2018 (study number 13623).

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Mecacci, F., Ottanelli, S., Vannuccini, S. et al. Maternal hemodynamic changes in gestational diabetes: a prospective case–control study. Arch Gynecol Obstet 306, 357–363 (2022). https://doi.org/10.1007/s00404-021-06288-0

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  • DOI: https://doi.org/10.1007/s00404-021-06288-0

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