Cardiac structural, functional, and energetic assessments during and after pregnancy in women with gestational diabetes mellitus, preeclampsia, and healthy pregnancy - 27/05/25
Abstract |
Background |
Gestational diabetes mellitus (GDM) and preeclampsia are common complications of pregnancy, for which overweight/obesity is a common risk factor. Both conditions are associated with a two-to-four-fold increase in future incident heart failure, which may be linked to early maladaptive myocardial changes.
Objective |
To determine maternal myocardial structural, functional, and energetic responses to pregnancies complicated by GDM or preeclampsia compared to healthy pregnancies (HP) at third-trimester of pregnancy and 12-months postpartum.
Study Design |
Thirty-eight women with HP, 30 GDM, 20 preeclampsia, 10 nonpregnant controls with overweight (Overweight-NC), and 10 with normal-weight were recruited. Cardiovascular magnetic resonance spectroscopy and imaging were used to define myocardial energetics (phosphocreatine: ATP ratio [PCr/ATP]), left ventricular (LV) volumes, mass, and ejection fraction and global longitudinal shortening (GLS). Pregnancy groups underwent repeat scans 12-months postpartum, nulliparous-controls were assessed once.
Results |
During third-trimester, compared to HP, women with either GDM or preeclampsia displayed higher BMI, higher LV-mass (HP: 90 [85, 94] g, GDM: 103 [96, 112], Preeclampsia: 118 [111, 125] g; P=.001) and lower PCr/ATP (HP: 2.2 [2.1, 2.4], GDM: 1.9 [1.7, 2], Preeclampsia: 1.9 [1.8, 2.1]; P=.0004) and GLS (HP: 20 [18, 21]%, GDM: 18 [17, 19]%, Preeclampsia: 16 [14, 17]%; P=.01). Post-pregnancy, no group saw significant changes in LV-mass, PCr/ATP, or GLS. There were no significant differences in LV-mass, PCr/ATP or GLS between the GDM and preeclampsia groups during or post-pregnancy. Moreover, the Overweight-NC showed no significant differences in LV-mass (53 [43, 63])g, PCr/ATP (2.0 [1.8, 2.2]), or GLS (−19 [17, 21]%) compared to GDM or preeclampsia groups during or post-pregnancy.
Conclusion |
Women with GDM or preeclampsia exhibit similar myocardial phenotypes during pregnancy with persistent subclinical alterations in LV mass, energetics, and GLS 12-months postpartum. These myocardial alterations are similar to those detected in Overweight-NC, potentially suggesting the myocardial changes may predominantly be driven by overweight/obesity.
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Key words : pregnancy, gestational diabetes mellitus, preeclampsia, obesity, cardiovascular magnetic resonance imaging
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| All authors on this submission have adhered to all editorial policies for submission as described in the Information for Authors and attest to having met all authorship criteria. |
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| The study was jointly supported by the Wellcome Trust (grant number: 221690/Z/20/Z), Women as One and BHF (RG/16/1/32092). EL acknowledges support from the Wellcome Trust Clinical Career Development Fellowship (grant number: 221690/Z/20/Z), Diabetes UK (grant number: UK 18/0005908) and the National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre. SP received support from British Heart Foundation Chair (CH/16/2/32089) and British Heart Foundation programme grant BHF (RG/16/1/32092). LV is funded by a Sir Henry Dale Fellowship supported jointly by the Wellcome Trust and the Royal Society (#221805/Z/20/Z) and also acknowledges the support of the Slovak Grant Agencies VEGA (#2/0004/23) and APVV (#21-0299). Funding for open access charge: Wellcome Trust (grant number: 221690/Z/20/Z). NJ received support from Diabetes UK (grant number: 18/0005908). For the purpose of Open Access, the authors will apply a CC-BY public copyright license to any Author Accepted Manuscript version arising from this submission. The funding bodies played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. |
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| Cite this article as: Thirunavukarasu S, Ansari A, Kotha S, et al. Cardiac structural, functional, and energetic assessments during and after pregnancy in women with gestational diabetes mellitus, preeclampsia, and healthy pregnancy. Am J Obstet Gynecol 2025;232:565.e1-16. |
Vol 232 - N° 6
P. 565.e1-565.e16 - giugno 2025 Ritorno al numero
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