Impaired endothelium-dependent vasodilatation in women with previous gestational diabetes.
OBJECTIVE
To assess whether otherwise healthy women with a history of gestational diabetes mellitus (GDM) may have abnormalities in endothelial function at a very early stage, before glucose intolerance occurs.


METHODS
A total of 33 women with previous GDM (17 nonobese [BMI < 27] and 16 obese [BMI > or = 27]) and 19 healthy nonobese women were examined. A 75-g oral glucose tolerance test was performed, and insulin levels and biochemical parameters were also measured. Using high-resolution ultrasound, we measured vasodilatory responses of the brachial artery during reactive hyperemia (endothelium-dependent vasodilatation), and after nitroglycerin administration, an endothelium-independent vasodilator.


RESULTS
Flow-mediated dilatation (FMD) was significantly and equally decreased in both groups of women with previous GDM, compared with control subjects (1.6 +/- 3.7% in the nonobese GDM group and 1.6 +/- 2.5% in the obese GDM group vs. 10.3 +/- 4.4% in control subjects, P < 0.001). FMD correlated inversely with serum uric acid levels, BMI, serum total cholesterol, and basal insulin resistance (homeostasis model assessment). Nitrate-induced dilatation was significantly decreased only in the obese GDM group compared with control subjects, (21.4 +/- 5.1 vs. 27.9 +/- 9.5, P < 0.05).


CONCLUSIONS
Endothelial dysfunction, which is considered as a very early index of atherogenesis, is already present in both obese and nonobese women with a history of GDM, even when they have normal glucose tolerance.
Anastasiou
E
E
1st Endocrine Section and Diabetes Centre, Alexandra University Hospital, Athens, Greece. mani@otenet.gr
Lekakis
J P
JP
Alevizaki
M
M
Papamichael
C M
CM
Megas
J
J
Souvatzoglou
A
A
Stamatelopoulos
S F
SF
D000328:Adult; D001794:Blood Pressure; D001916:Brachial Artery / Q000000981:diagnostic imaging* / Q000502:physiology / Q000503:physiopathology; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000503:physiopathology*; D016640:Diabetes, Gestational / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000502:physiology / Q000503:physiopathology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006940:Hyperemia; D007333:Insulin Resistance; D009765:Obesity / Q000097:blood / Q000503:physiopathology*; D011247:Pregnancy; D012016:Reference Values; D014280:Triglycerides / Q000097:blood; D014463:Ultrasonography; D014664:Vasodilation
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides; D002784:Cholesterol