目的:研究的目的首先是,比较妊娠期糖尿病(GDM)妇女母体血管功能的不同标志物,先兆子痫(PE),或妊娠高血压(GH)和妊娠未受这些并发症影响的妇女。第二,评估母体血管功能与胎盘灌注标志物之间的关联,母体血管-胎盘轴,在这四组妇女中。
方法:这是一项前瞻性观察性研究,对象是在国王学院医院妊娠35+0至36+6周进行常规住院就诊的妇女,伦敦,英国。这次访问包括记录产妇的人口统计学特征和病史,胎儿解剖和生长的超声检查,子宫动脉和眼动脉的多普勒研究,颈动脉-股动脉脉搏波速度(PWV)测量,增加指数(AIx)和总外周阻力的估计以及血清胎盘生长因子(PlGF)和可溶性fms样酪氨酸激酶-1(sFLT-1)的测量。对子宫动脉搏动指数(UtA-PI)中位数倍数(MoM)的结果进行线性回归,PLGFMoM和sFLT-1MoM。眼动脉收缩期峰值流速(PSV)比值,PWV,AIx和总外周血管阻力被评估为潜在预测因子。这项分析是在所有妇女中进行的,并分别在不同的组中进行。
结果:6502名女性的研究人群包括614(9.4%)患有GDM,140人(2.1%)随后发展为PE,129人(2.0%)发展为GH。GDM女性,与未受GDM影响的孕妇相比,PE或GH,增加了PWV。有PE或GH的女性,与那些怀孕未受影响的人相比,PlGFMoM较低,UtA-PIMoM较高,sFLT1MoM,AIx,PWV,总外周阻力和眼动脉PSV比率。在未受影响的怀孕中,眼动脉PSV比率可预测UtA-PIMoM,和眼动脉PSV比率,AIx,总外围阻力,PWV可预测PLGFMoM和sFLT-1MoM。在患有GDM的女性中,眼动脉PSV比率可预测UtA-PIMoM和眼动脉PSV比率,总外围阻力,和PWV预测PLGFMoM,总外周阻力可预测sFLT-1MoM。在有体育的女性中,眼动脉PSV比率可预测UtA-PIMoM,PLGFMoM和sFLT-1MoM。在不受GDM影响的女性中,PE或GH,眼动脉PSV比率可预测UtA-PIMoM和AIX,总外围阻力,PWV和眼动脉PSV比率可预测PLGFMoM和sFLT-1MoM。
结论:在妊娠晚期,有体育课的女性,GH,GDM表现为动脉僵硬度增加。此外,诊断为高血压并发症的患者外周血管阻力增加.眼动脉PSV比率为所有孕妇提供胎盘灌注和功能的预测信息,而血管指数对妊娠未受影响的女性和GDM患者的胎盘功能提供更多信息,比那些有PE或GH。这些数据表明,怀孕期间妇女的血管评估不仅可以提供有关母体血管健康的信息,而且可以用于提供有关胎盘功能不全的个体风险的信息。血管指数的选择必须根据孕妇的情况和妊娠并发症进行调整。
OBJECTIVE: The objectives of the study were first, to compare different markers of maternal vascular function in women with gestational diabetes mellitus (GDM), preeclampsia (PE), or gestational hypertension (GH) and women whose pregnancies were unaffected by these complications. Second, to assess the association between maternal vascular function and markers of placental perfusion, maternal vascular - placental axis, in these four groups of women.
METHODS: This was a prospective observational study of women attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks\' gestation at King\'s College Hospital, London, UK. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination for fetal anatomy and growth, Doppler studies of the uterine arteries and ophthalmic arteries, carotid-femoral pulse-wave velocity (PWV) measurements, estimation of augmentation index (AIx) and total peripheral resistance and measurements of serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFLT-1). Linear regression was performed for the outcomes of uterine artery pulsatility index (UtA-PI) multiples of median (MoM), PLGF MoM and sFLT-1 MoM. Ophthalmic artery peak systolic velocity (PSV) ratio, PWV , AIx and total peripheral vascular resistance were assessed as potential predictors. This analysis was carried out in all women and separately in the different groups.
RESULTS: The study population of 6502 women included 614 (9.4%) with GDM, 140 (2.1%) who subsequently developed PE and 129 (2.0%) who developed GH. Women with GDM, compared to those with pregnancies unaffected by GDM, PE or GH, had increased PWV. Women with PE or GH, compared to those with unaffected pregnancies, had lower PlGF MoM and higher UtA-PI MoM, sFLT1 MoM, AIx, PWV, total peripheral resistance and ophthalmic artery PSV ratio. In unaffected pregnancies, ophthalmic artery PSV ratio was predictive of UtA-PI MoM, and ophthalmic artery PSV ratio, AIx, total peripheral resistance, and PWV were predictive of PLGF MoM and sFLT-1 MoM. In women with GDM, ophthalmic artery PSV ratio was predictive of UtA-PI MoM and ophthalmic artery PSV ratio, total peripheral resistance, and PWV were predictive of PLGF MoM, and total peripheral resistance was predictive of sFLT-1 MoM. In women with PE, ophthalmic artery PSV ratio was predictive of UtA-PI MoM, PLGF MoM and sFLT-1 MoM. In women unaffected by GDM, PE or GH, ophthalmic artery PSV ratio was predictive of UtA-PI MoM and AIx, total peripheral resistance, PWV and ophthalmic artery PSV ratio were predictive of PLGF MoM and sFLT-1 MoM.
CONCLUSIONS: In the third trimester of pregnancy, women with PE, GH, and GDM present with increased arterial stiffness. In addition, those diagnosed with hypertensive complications show increased peripheral vascular resistance. Ophthalmic artery PSV ratio provides predictive information for placental perfusion and function for all pregnant women, whereas vascular indices are more informative for placental function in women with unaffected pregnancy and those with GDM, than in those with PE or GH. These data suggest that vascular assessment in women during pregnancy may not only provide information about maternal vascular health but can be used to offer information about individual risk for development of placental insufficiency. The selection of vascular index will have to be tailored according to maternal profile and pregnancy complication.