Role of impedance plethysmography in detecting dysautonomia and vascular changes in the dysglycemic milieu of gestational diabetes – A case–Control study

Abstract

Introduction: Gestational diabetes, which is defined as any degree of glucose intolerance first seen during pregnancy, is increasing in prevalence in India. Gestational diabetes and Type 2 diabetes share the common pathophysiological factor of insulin resistance; mothers with gestational diabetes are more prone to developing Type 2 diabetes. The hyperglycemia and metabolic abnormalities in Type 2 diabetes are associated with microvascular complications such as, retinopathy, nephropathy, and neuropathy, including autonomic neuropathy. Autonomic neuropathy, especially cardiac autonomic neuropathy because of diabetes, is an important cause of mortality and morbidity. Impedance Plethysmography (IPG) is based on the principle that the volume of the arterial and venous pulses can be derived from the electric properties of blood. The peripheral pulse thus analysed shows morphological patterns that are specific for different diseases. Although various morphological patterns have been mapped with different diseases, the waveform of gestational diabetes has not yet been explored. Hence, this study aimed to find whether gestational diabetes affected peripheral blood flow in a way that could be detected by IPG, resulting in a specific waveform pattern. Additionally, as previous research on the effect of gestational diabetes on the autonomic nervous system shows conflicting results, this study aimed to determine whether gestational diabetes is associated with autonomic dysfunction that can be detected by IPG. Materials and Methods: This was is a case–control study conducted on 98 antenatal mothers. The IPG patterns of 50 mothers with gestational diabetes were compared with demographic, clinical data, and IPG waveforms of 48 age-matched controls. Results: We found that the heart rate variability, an indicator of autonomic nervous system function, was impaired in mothers with gestational diabetes. We did not find that gestational diabetes was associated with a specific waveform on IPG. Conclusion: Gestational diabetes is associated with autonomic dysfunction in the form of impaired heart rate variability that can be detected by IPG.

Keywords

• diabetes
• dysautonomia
• dysglycemia
• gestational diabetes
• impedance plethysmography