Maternal Cardiovascular and Metabolic Function Before Conception and Subsequent Development of Gestational Diabetes Mellitus

Aims To determine if maternal cardiovascular and metabolic indices before conception were different in women who in a subsequent singleton pregnancy developed gestational diabetes mellitus (GDM), compared to those without GDM. Methods This was a prospective observational study in women attending for infertility treatment in an in vitro fertilization clinic. This visit included recording of maternal demographic characteristics and medical history, assessment of maternal cardiovascular function by echocardiography and examination of metabolic profile. The inclusion criteria were attendance of the infertility clinic before the onset of treatment and subsequent singleton pregnancy delivering a non-malformed live birth. The pre-pregnancy results in women who developed GDM were compared to those without GDM. Results The study population of 287 women included 75 (26.1%) who developed GDM. In the GDM, compared to the non-GDM group, there was a higher mitral valve E/e’ (6.24[5.93, 6.55] vs 5.83[5.69, 5.93], mean intima media thickness(0.51[0.51,0.51] vs 0.49[0.49, 0.49] mm and left ventricular global longitudinal systolic strain (-19.9[-20.4, -19.6] vs -20.8[-21.1, -20.6]% and lower apolipoprotein A (113[105, 121] vs 136[121,134]mg/dl). In multivariable analysis, after accounting for differences in maternal characteristics, there was persistence of significant differences in E/e’ and apolipoprotein A. However, the performance of screening for GDM achieved by the use of maternal risk factors was not improved by the addition of cardiovascular and metabolic indices. Conclusion Women at risk to develop GDM during pregnancy have an adverse risk factor profile before conception. Further studies are needed to confirm whether optimization of cardiovascular and metabolic risk factors prior to conception might be beneficial in reducing the risk for subsequent development of GDM.