P5.06 NATURAL TIME COURSE OF AORTIC STIFFNESS AND WAVE REFLECTIONS IN NORMAL PREGNANCY AND IN GESTATIONAL DIABETES: A LONGITUDINAL STUDY

Abstract

Pregnancy is associated with profound vascular adaptive changes. Cross-sectional studies show greater arterial stiffness in gestational diabetes than in normal pregnancy. However, the time course of maternal cardiovascular hemodynamics in normal and diabetic pregnancy can only be appreciated in longitudinal studies. Thirty-six women with gestational diabetes (34±5 years, BP 111/69±13/8 mmHg) and 36 with normal pregnancy (33±3 years, BP 111/68±10/8 mmHg) were examined 3 times, at a gestational age of 30 and 35 weeks, and 12 weeks after delivery. On each occasion, tonometry-based carotid-femoral pulse wave velocity (cfPWV) and heart-rate corrected aortic augmentation index (AIx@75) were obtained (SphygmoCor). Compared to women with normal pregnancies, women with gestational diabetes had a higher age- and mean arterial pressure-adjusted cfPWV (p<0.001, Figure), both during pregnancy (6.2±0.9 vs 5.7±0.8 m/s at week 30, 6.3±0.9 vs 5.8±0.9 at week 35) and after delivery (p=7.1±1.0 vs 6.3±1.1 m/s). AIx did not differ between the two groups (p=0.51). In both groups, cfPWV was significantly lower at 30 and 35 weeks than after delivery (Figure, both p<0.001). AIx@75 and central SBP were markedly lower during pregnancy than after delivery (both p<0.001), despite unchanged brachial SBP. Conclusions: (1) compared with normal pregnancy, gestational diabetes is associated with a higher aortic stiffness, which remains elevated 3 months after delivery; (2) no significant differences in wave reflection are present in normal and diabetic pregnancies; and (3) aortic stiffness and augmentation are lower during the third trimester of gestation than after delivery, both in normal pregnancies and in gestational diabetes.