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80 Gestational Diabetes Mellitus
and Cardiovascular Disease

who developed GDM were also more likely to report history of GDM itself can be considered a risk factor
a history of dyslipidemia(33.9% vs 26.9 %; p<0.05); for atherosclerosis even before the onset of diabetes
increased history of intake of medicines for dyslipid- or metabolic syndrome. The flow-mediated dilation
emia (18.4%vs13.7%; p<0.05) and were diagnosed with (FMD) of the brachial artery is an indicator of endo-
dyslipidemia at an younger age (47.6 vs 51.9; p= 0.01) thelial dysfunction and is one of the earliest signs of
3 . Another study analysed cases who had GDM and atherosclerosis 12,13. Anastasiou et al. measured FMD
those who were euglycemic in their index pregnancy,- 3–6 months postnatally in women with a history of
from two to four months after their pregnancy. They GDM, and found it to be significantly lower in both
reported that women with history of GDM had a high- nonobese and obese GDM women than in control
er total cholesterol (5.06 vs 4.56 mmol/Lp=0.001),, women . It was seen that FMD correlated inversely
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LDL cholesterol(3.17 vs 2.57mmmol/L;p=0.001) and with BMI, serum total cholesterol, and basal insulin
triglyceride levels (1.02 vs 0.86mmol/L).The HDL cho- resistance (assessed with a homeostasis model). But
lesterolwas lower (1.53 vs 1.73 mmol/L; p =0.001) . 6 Hannemann et al. And Brewster have found no differ-
ences in FMD between women who had experienced
Retnakaran et al too have concluded that GDM is an GDM five years earlier and control women matched
independent predictor of total cholesterol, LDL-cho- for age, BMI, and smoking habits 15,16 . Therefore, there
lesterol, and triglyceride levels measured 3 months is no sureity of impairment of FMD in later years in
after delivery. The authors have demonstrated a women with history of GDM. Impairment of FMD may
stronger correlation between the area under the be an early vascular function abnormality influenced
curve on the antepartum oral glucose tolerance test by hyperglycemia, which normalises once the wom-
and postpartum lipid profile. 7
en is normoglycemic .hence, it may work as a mark-
er in tests donein the early years following delivery.
Metabolic Syndrome The authors of a multivariate analysis have found
Metabolic syndrome (abdominal obesity, hyperten- an independent association between the coronary
sion, dyslipidemia, and abnormal glucose tolerance flow velocity reserve (CFVR); which reflects coronary
)carries a six- to eightfold higher risk of CVD and a microvascular function,and GDM
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two- to threefold higher CVD-related mortality rate
by comparison with healthy controls . Women who New Markers:
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have had GDM are at high risk of developing meta- Apelin,produced by the adipose tissue, is a recently
bolic syndrome
discovered adipocytokine . It is an endogenous li-
A recent hospital-based cohort study reported that gand of the G protein-coupled receptor APJ and is
the risk of metabolic syndrome 2–6 years after deliv- expressed in various tissues (brain, lung, heart, pan-
ery was 2.4 times higher in women with a history of creas, kidney, and endothelial cells).It is postulated
GDM as compared to those who had normal glucose to have a role in the cardiovascular system . Sup-
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tolerance in pregnancy. In a multivariate analysis it pressed apelin levels are therefore associated with
was seen that a history of GDM predicted the onset a higher cardiovascular risk in women with a history
of metabolic syndrome with an OR of 2.83 of GDM. Osteoprotegerin (OPG), a soluble member
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of the tumor necrosis factor (TNF) receptor super-
4. Early Structural and Functional the Changes in
Vascular Structure in Women with history of prior family, inhibits osteoclast maturation and protects
GDM Women with a history of GDM , without any bone from normal osteoclast remodeling OPG has
cardiovascular risk factors are at a greater risk of an important role in lymphocyte production, apopto-
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CVD than those with normal glucose tolerance in sis, and its levels have been associated with CVD .
pregnancy. The effect of GDM on the endothelial In a cross-sectional case-control study, wommen
function and structure acts as a trigger for initiation who were confirmed to have metabolic syndrome
of atherosclerosis.It is well documented that carotid had higher OPG levels than those who were not, or
artery intima-media thickness (cIMT) is a measure healthy controls; and serum OPG levels were found
of early atherosclerosis and strongly predicts heart to be associated with obesity, insulin resistance, and
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disease and stroke, especially in women . Bo et al. cIMT .Pentraxin 3 (PTX3) is produced by endo-
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measured cIMT six and a half years after delivery in thelial cell macrophages and granulocytes at sites
82 women withGDM and 113 who were euglycemic of inflammation. Raised levels in patients with CVD
in pregnancy [25] . They reported a significantly higher denotes a beneficial response in terms of reduced
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cIMT in those with a history of GDM.these values immune activation . Low plasma concentrations of
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were independant of their BMI levels . Infact, a PTX3 in early pregnancy are therefore associated
with the subsequent onset of GDM and a higher risk

GCDC 2017