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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2013

Open Access 01-12-2013 | Research article

Need for insulin to control gestational diabetes is reflected in the ambulatory arterial stiffness index

Authors: Henna Kärkkäinen, Tomi Laitinen, Nonna Heiskanen, Heli Saarelainen, Pirjo Valtonen, Tiina Lyyra-Laitinen, Esko Vanninen, Seppo Heinonen

Published in: BMC Pregnancy and Childbirth | Issue 1/2013

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Abstract

Background

The aim was to evaluate the metabolic profile in conjunction with vascular function using the ambulatory arterial stiffness index (AASI) in women with uncomplicated pregnancies and in women with gestational diabetes mellitus (GDM).

Methods

Plasma glucose, lipids, HOMA –IR (homeostasis model assessment of insulin resistance) and AASI, as obtained from 24-hour ambulatory blood pressure monitoring in third trimester pregnancy and at three months postpartum, were measured in three groups of women: controls (N = 32), women with GDM on diet (N = 42) and women with GDM requiring insulin treatment (N = 10).

Results

Women with GDM had poorer glycemic control and higher HOMA-IR during and after pregnancy and their total and LDL (low density lipoprotein) cholesterol levels were significantly higher after pregnancy than in the controls. After delivery, there was an improvement in AASI from 0.26 ± 0.10 to 0.17 ± 0.09 (P = 0.002) in women with GDM on diet, but not in women with GDM receiving insulin whose AASI tended to worsen after delivery from 0.30 ± 0.23 to 0.33 ± 0.09 (NS), then being significantly higher than in the other groups (P = 0.001-0.047).

Conclusions

Women with GDM had more unfavorable lipid profile and higher blood glucose values at three months after delivery, the metabolic profile being worst in women requiring insulin. Interestingly, the metabolic disturbances at three months postpartum were accompanied by a tendency towards arterial stiffness to increase in women requiring insulin.
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Literature
1.
Alwan N, Tuffnell DJ, West J: Treatments for gestational diabetes. Cochrane Db Syst Rev. 2009, 8: CD003395-Review
2.
Working group established by the Finnish Medical Society Duodecim: The Medical Advisory Board of the Finnish Diabetes Association and the Finnish Gynecological Association: Gestational diabetes. 2008, Helsinki: Current care summary
3.
Kim C, Newton KM, Knopp RH: Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002, 25: 1862-1868. 10.2337/diacare.25.10.1862.CrossRefPubMed
4.
Krishnaveni GV, Hill JC, Veena SR, Geetha S, Javakumar MN, Karat CL, Fall CH: Gestational diabetes and the incidence of diabetes in the 5 years following the index pregnancy in South Indian women. Diabetes Res Clin Pract. 2007, 78: 398-404. 10.1016/j.diabres.2007.06.002.CrossRefPubMedPubMedCentral
5.
Carpenter MW: Gestational diabetes, pregnancy hypertension, and late vascular disease. Diabetes Care. 2007, 2 (Suppl 2): S246-S250. ReviewCrossRef
6.
Lauenborg J, Mathiesen E, Hansen T, Glümer C, Jørgensen T, Borch-Johnsen K, Hornnes P, Pedersen O, Damm P: The prevalence of the metabolic syndrome in a danish population of women with previous gestational diabetes mellitus is three-fold higher than in the general population. J Clin Endocrinol Metab. 2005, 90: 4004-4010. 10.1210/jc.2004-1713.CrossRefPubMed
7.
Verma A, Boney CM, Tucker R, Vohr BR: Insulin resistance syndrome in women with prior history of gestational diabetes mellitus. J Clin Endocrinol Metab. 2002, 87: 3227-3235. 10.1210/jc.87.7.3227.CrossRefPubMed
8.
Schaefer-Graf UM, Graf K, Kulbacka I, Kjos SL, Dudenhausen J, Vetter K, Herrera E: Maternal lipids as strong determinants of fetal environment and growth in pregnancies with gestational diabetes mellitus. Diabetes Care. 2008, 31: 1858-1863. 10.2337/dc08-0039.CrossRefPubMedPubMedCentral
9.
Banerjee M, Cruickshank JK: Pregnancy as the prodrome to vascular dysfunction and cardiovascular risk. Nat Clin Pract Cardiovasc Med. 2006, 3: 596-603. 10.1038/ncpcardio0683. ReviewCrossRefPubMed
10.
Paradisi G, Biaggi A, Ferrazzani S, De Carolis S, Caruso A: Abnormal carbohydrate metabolism during pregnancy: association with endothelial dysfunction. Diabetes Care. 2002, 25: 560-564. 10.2337/diacare.25.3.560.CrossRefPubMed
11.
Anastasiou E, Lekakis JP, Alevizaki M, Papamichael CM, Megas J, Souvatzoglou A, Stamatelopoulos SF: Impaired endothelium-dependent vasodilatation in women with previous gestational diabetes. Diabetes Care. 1998, 21: 2111-2115. 10.2337/diacare.21.12.2111.CrossRefPubMed
12.
Bo S, Valpreda S, Menato G, Bardelli C, Botto C, Gambino R, Rabbia C, Durazzo M, Cassader M, Massobrio M, Pagano G: Should we consider gestational diabetes a vascular risk factor?. Atherosclerosis. 2007, 194: e72-e79. 10.1016/j.atherosclerosis.2006.09.017.CrossRefPubMed
13.
Hu J, Norman M, Wallensteen M, Gennser G: Increased large arterial stiffness and impaired acetylcholine induced skin vasodilatation in women with previous gestational diabetes mellitus. Br J Obstet Gynaecol. 1998, 105: 1279-1287. 10.1111/j.1471-0528.1998.tb10006.x.CrossRefPubMed
14.
Schillaci G, Parati G: Ambulatory arterial stiffness index: Merits and limitations of a simple surrogate measure of arterial compliance. J Hypertens. 2008, 26: 182-185. 10.1097/HJH.0b013e3282f52fb9.CrossRefPubMed
15.
Dolan E, Thijs L, Li Y, Atkins N, McCormack P, McClory S, O’Brien E, Staessen JA, Stanton AV: Ambulatory arterial stiffness index as a predictor of cardiovascular mortality in the Dublin outcome study. Hypertension. 2006, 47: 365-370. 10.1161/01.HYP.0000200699.74641.c5.CrossRefPubMed
16.
Li Y, Wang JG, Dolan E, Gao PJ, Guo HF, Nawrot T, Stanton AV, Zhu DL, O’Brien E, Staessen JA: Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension. 2006, 47: 359-364. 10.1161/01.HYP.0000200695.34024.4c.CrossRefPubMed
17.
Kikuya M, Staessen JA, Ohkubo T, Thijs L, Metoki H, Asayama K, Obara T, Inoue R, Li Y, Dolan E, Hoshi H, Hashimoto J, Totsune K, Satoh H, Wang JG, O’Brien E, Imai Y: Ambulatory arterial stiffness index and 24-hour ambulatory pulse pressure as predictors of mortality in Ohasama, Japan. Stroke. 2007, 38: 1161-1166. 10.1161/01.STR.0000259604.67283.69.CrossRefPubMed
18.
Leoncini G, Ratto E, Viazzi F, Vaccaro V, Parodi A, Falqui V, Conti N, Tomolillo C, Deferrari G, Pontremoli R: Increased ambulatory arterial stiffness index is associated with target organ damage in primary hypertension. Hypertension. 2006, 48: 397-403. 10.1161/01.HYP.0000236599.91051.1e.CrossRefPubMed
19.
Mulè G, Cottone S, Cusimano P, Incalcaterra F, Giandalia M, Costanzo M, Nardi E, Palermo A, Geraci C, Costa R, Cerasola G: Inverse relationship between ambulatory arterial stiffness index and glomerular filtration rate in arterial hypertension. Am J Hypertens. 2008, 21: 35-40. 10.1038/ajh.2007.10.CrossRefPubMed
20.
Kärkkäinen H, Heiskanen N, Saarelainen H, Valtonen P, Lyyra-Laitinen T, Laitinen T, Vanninen E, Heinonen S: Ambulatory arterial stiffness index is unchanged in uncomplicated third-trimester singleton and twin pregnancies. Acta Obstet Gynecol Scand. 2011, 90: 516-523. 10.1111/j.1600-0412.2011.01101.x.CrossRefPubMed
21.
Izzedine H, Launay-Vacher V, Deray G: Abnormal blood pressure circadian rhythm: A target organ damage?. Int J Cardiol. 2006, 107: 343-349. 10.1016/j.ijcard.2005.03.046.CrossRefPubMed
22.
Ingelsson E, Bjorklund-Bodegard K, Lind L, Arnlov J, Sundstrom J: Diurnal blood pressure pattern and risk of congestive heart failure. JAMA. 2006, 295: 2859-2866. 10.1001/jama.295.24.2859.CrossRefPubMed
23.
Fagard RH, Celis H, Thijs L, Staessen JA, Clement DL, De Buyzere ML, De Bacquer DA: Daytime and nighttime blood pressure as predictors of death and cause-spesific cardiovascular events in hypertension. Hypertension. 2008, 51: 55-61. 10.1161/HYPERTENSIONAHA.108.112979.CrossRefPubMed
24.
Lekakis JP, Zakopoulos NA, Protogerou AD, Papaioannou TG, Kotsis VT, Pitiriga VC, Tsitsirikos MD, Stamatelopoulos KS, Papamichael CM, Mavrikakis ME: Arterial stiffness assessed by pulse wave analysis in essential hypertension: Relation to 24-h blood pressure profile. Int J Cardiol. 2005, 102: 391-395. 10.1016/j.ijcard.2004.04.014.CrossRefPubMed
25.
Hyvönen K: Gestaatiodiabeteksen esiintyvyys ja seulonta. 1991, University of Kuopio, Department of Obstetrics and Gynecology: PhD thesis
26.
Chaves H, De Souza FMC, Krieger EM: The reproducibility of dipping status: beyond the cutoff points. Blood Press Monit. 2005, 10: 201-205. 10.1097/01.mbp.0000172709.05158.59.CrossRefPubMed
27.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC: Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985, 28: 412-419. 10.1007/BF00280883.CrossRefPubMed
28.
Savvidou MD, Anderson JM, Kaihura C, Nicolaides KH: Maternal arterial stiffness in pregnancies complicated by gestational and type 2 diabetes mellitus. Am J Obstet Gynecol. 2010, 203: 274.el-7
29.
Davenport MH, Goswami R, Shoemaker JK, Mottola MF: Influence of hyperglycemia during and after pregnancy on postpartum vascular function. Am J Physiol Regul Integr Comp Physiol. 2012, 302: 768-775. 10.1152/ajpregu.00115.2011.CrossRef
30.
Schillaci G, Parati G, Pirro M, Pucci G, Mannarino MR, Sperandini L, Mannarino E: Ambulatory arterial stiffness index is not a specific marker of reduced arterial compliance. Hypertension. 2007, 49: 986-991. 10.1161/HYPERTENSIONAHA.106.082248.CrossRefPubMed
31.
Qvigstad E, Voldner N, Godang K, Henriksen T, Bollerslev J: Overweight is associated with impaired β-cell function during pregnancy: a longitudinal study of 553 normal pregnancies. Eur J Endocrinol. 2010, 162: 67-73. 10.1530/EJE-09-0416.CrossRefPubMed
32.
Westerbacka J, Wilkinson I, Cockcroft J, Utriainen T, Vehkavaara S, Yki-Järvinen H: Diminished wave reflection in the aorta. A novel physiological action of insulin on large blood vessels. Hypertension. 1999, 33: 1118-1122. 10.1161/01.HYP.33.5.1118.CrossRefPubMed
33.
Erkkola M, Salmenhaara M, Kronberg-Kippilä C, Ahonen S, Arkkola T, Uusitalo L, Pietinen P, Veijola R, Knip M, Virtanen SM: Determinants of breast-feeding in a Finnish birth cohort. Public Health Nutr. 2010, 13: 504-513. 10.1017/S1368980009991777.CrossRefPubMed
34.
Lovejoy JC, Sainsbury A & the Stock Conference 2008 Working Group: Sex differences in obesity and the regulation of energy homeostasis. Obes Rev. 2009, 10: 154-167. 10.1111/j.1467-789X.2008.00529.x.CrossRefPubMed
35.
O’Sullivan AJ: Does oestrogen allow women to store fat more efficiently? A biological advantage for fertility and gestation. Obes Rev. 2009, 10: 168-177. 10.1111/j.1467-789X.2008.00539.x.CrossRefPubMed
36.
Retnakaran R: Glucose tolerance status in pregnancy: a window to the future risk of diabetes and cardiovascular disease in young women. Curr Diabetes Rev. 2009, 4: 239-244.CrossRef
37.
Robb AO, Mills NL, Din JN, Smith IB, Paterson F, Newby DE, Denison FC: Influence of the menstrual cycle, pregnancy, and preeclampsia on arterial stiffness. Hypertension. 2009, 53: 952-958. 10.1161/HYPERTENSIONAHA.109.130898.CrossRefPubMed
38.
Khalil A, Jauniaux E, Cooper D, Harrington K: Pulse wave analysis in normal pregnancy: a prospective longitudinal study. PLoS One. 2009, 4: e6134-10.1371/journal.pone.0006134.CrossRefPubMedPubMedCentral
Metadata
Title
Need for insulin to control gestational diabetes is reflected in the ambulatory arterial stiffness index
Authors
Henna Kärkkäinen
Tomi Laitinen
Nonna Heiskanen
Heli Saarelainen
Pirjo Valtonen
Tiina Lyyra-Laitinen
Esko Vanninen
Seppo Heinonen
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2013
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-13-9

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