Midgestation cardiovascular phenotype in women who develop gestational diabetes and hypertensive disorders of pregnancy: comparative study Article Swipe
S. Anzoategui
,
E. Gibbone
,
Alan Wright
,
K. H. Nicolaides
,
Marietta Charakida
·
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.1002/uog.24929
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.1002/uog.24929
Objective Women with gestational diabetes mellitus (GDM) and/or hypertensive disorders of pregnancy (HDP) are at increased long‐term cardiovascular risk. Mild cardiac functional alterations have been detected in women with GDM or HDP in midgestation, prior to clinical onset of the disease, but these functional alterations have not been found to be useful as screening tools. In contrast, increased impedance to peripheral blood flow, measured by echocardiography or ophthalmic artery Doppler, has been shown to provide incremental value to maternal characteristics for the prediction of pre‐eclampsia. However, it is unknown whether similar changes can be detected in women at risk of GDM. In this study, we performed detailed cardiovascular phenotyping in a large, unselected population of women in midgestation to identify similarities and differences in cardiovascular adaptation in women who are at risk of GDM and/or HDP. Methods This was a prospective observational study in women attending for a routine hospital visit at 19 + 1 to 23 + 3 weeks' gestation. This visit included assessment of flow velocity waveforms from the maternal ophthalmic arteries, echocardiography for assessment of maternal cardiovascular function and measurement of uterine artery pulsatility index and serum placental growth factor (PlGF) for assessment of placental perfusion and function. The measured indices were converted to either multiples of the median (MoM) values or deviation from the median (delta) after adjusting for maternal characteristics and elements of medical history. Biomarker delta or MoM values in the GDM and HDP groups were compared with those in the unaffected group using 95% CI and t ‐tests. Results The study population of 5214 pregnancies contained 4429 (84.9%) that were unaffected by GDM or HDP, 509 (9.8%) complicated by GDM without HDP, 41 (0.8%) with GDM and HDP, and 235 (4.5%) with HDP without GDM. In HDP cases, with or without GDM, there was evidence of impaired placentation, with a decrease in PlGF, and increased impedance to flow in the peripheral circulation, suggested by an increase in ophthalmic artery peak systolic velocity (PSV) ratio, peripheral vascular resistance assessed on echocardiography and mean arterial pressure. In the GDM group without HDP, there was no evidence of altered placental perfusion or function and ophthalmic artery PSV ratio was not significantly different from that in the unaffected group; peripheral vascular resistance and mean arterial pressure were increased but to a lesser degree than in the HDP group. In the HDP group, there was an increase in global longitudinal systolic strain and slight increase in isovolumic relaxation time, while in the GDM group, there was an increase in mitral valve E/e′, myocardial performance index and global longitudinal systolic strain. Conclusions In midgestation, women who subsequently develop HDP or GDM have a mild subclinical reduction in left ventricular function. In HDP cases, with or without GDM , there is evidence of impaired placentation and all biomarkers of impedance to peripheral blood flow are consistently increased. In contrast, in the GDM group without HDP , biomarkers of placental function are normal and those of impedance to peripheral blood flow are either marginally increased or not significantly different from those in normal pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Related Topics
Concepts
Medicine
Gestational diabetes
Pregnancy
Diabetes mellitus
Obstetrics
Population
Uterine artery
Gestation
Internal medicine
Cardiology
Gynecology
Endocrinology
Biology
Environmental health
Genetics
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1002/uog.24929
- OA Status
- gold
- Cited By
- 11
- References
- 33
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4225311999
All OpenAlex metadata
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https://openalex.org/W4225311999Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1002/uog.24929Digital Object Identifier
- Title
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Midgestation cardiovascular phenotype in women who develop gestational diabetes and hypertensive disorders of pregnancy: comparative studyWork title
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articleOpenAlex work type
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enPrimary language
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2022Year of publication
- Publication date
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2022-05-03Full publication date if available
- Authors
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S. Anzoategui, E. Gibbone, Alan Wright, K. H. Nicolaides, Marietta CharakidaList of authors in order
- Landing page
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https://doi.org/10.1002/uog.24929Publisher landing page
- Open access
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YesWhether a free full text is available
- OA status
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goldOpen access status per OpenAlex
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https://kclpure.kcl.ac.uk/portal/en/publications/47c73c59-b9b8-4bd7-963c-3c93e450d15eDirect OA link when available
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Medicine, Gestational diabetes, Pregnancy, Diabetes mellitus, Obstetrics, Population, Uterine artery, Gestation, Internal medicine, Cardiology, Gynecology, Endocrinology, Biology, Environmental health, GeneticsTop concepts (fields/topics) attached by OpenAlex
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11Total citation count in OpenAlex
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2025: 5, 2024: 3, 2023: 1, 2022: 2Per-year citation counts (last 5 years)
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33Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.long‐term | 17 |
| abstract_inverted_index.measurement | 183 |
| abstract_inverted_index.performance | 426 |
| abstract_inverted_index.phenotyping | 109 |
| abstract_inverted_index.pregnancies | 262 |
| abstract_inverted_index.prospective | 141 |
| abstract_inverted_index.pulsatility | 187 |
| abstract_inverted_index.subclinical | 446 |
| abstract_inverted_index.ventricular | 450 |
| abstract_inverted_index.circulation, | 319 |
| abstract_inverted_index.consistently | 476 |
| abstract_inverted_index.hypertensive | 9 |
| abstract_inverted_index.longitudinal | 402, 430 |
| abstract_inverted_index.midgestation | 118 |
| abstract_inverted_index.placentation | 465 |
| abstract_inverted_index.pregnancies. | 513 |
| abstract_inverted_index.similarities | 121 |
| abstract_inverted_index.subsequently | 438 |
| abstract_inverted_index.International | 516 |
| abstract_inverted_index.midgestation, | 34, 435 |
| abstract_inverted_index.observational | 142 |
| abstract_inverted_index.placentation, | 305 |
| abstract_inverted_index.significantly | 365, 507 |
| abstract_inverted_index.cardiovascular | 18, 108, 125, 180 |
| abstract_inverted_index.characteristics | 80, 225 |
| abstract_inverted_index.echocardiography | 66, 175, 337 |
| abstract_inverted_index.pre‐eclampsia. | 85 |
| cited_by_percentile_year.max | 98 |
| cited_by_percentile_year.min | 89 |
| corresponding_author_ids | https://openalex.org/A5080220991 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 5 |
| corresponding_institution_ids | https://openalex.org/I4210136526, https://openalex.org/I4210153400 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.8500000238418579 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.86991279 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |