Increased large arterial stiffness and impaired acetylcholine induced skinvasodilatation in women with previous gestational diabetes mellitus

Objective Gestational diabetes is associated with increased risk of develop ing noninsulin-dependent diabetes (NIDDM) later in life. By the time that a diagnosis of NIDDM is established, functional disturbances in the vascular system may be observed. This study was planned to assess macro- and microv ascular function in nonpregnant women without signs of diabetes two to four years after a pregnancy complicated with gestational diabetes. Design Cross-sectional study. Setting Vascular research laboratory in the obstetric unit of a university hospital. Participants Seventeen nonpregnant, healthy women with a history of gestati onal diabetes and 20 nonpregnant control women of similar age without previ ous diabetes. Methods For quantification of the mechanical properties in large arterial v essels the wall movements of the abdominal aorta and left common carotid ar tery were recorded with an ultrasonic tracking system. Microvascular perfus ion in the skin of the hand and foot was recorded by a laser Doppler techni que to assess the vasodilatory response induced by transcutaneous acetylcho line. Results Women in the gestational diabetes group showed evidence of increase d wall stiffness in the common carotid artery and a lower maximum increment al velocity of the pulsatile vessel diameter change in both aorta and carot id artery compared with controls. Acetylcholine induced vasodilatation in b oth hand and foot was lower in women with previous gestational diabetes com pared with controls. Conclusion Abnormal vascular function was found in asymptomatic women with a history of gestational diabetes. It is speculated that these abnormalitie s might be early evidence of vascular complications associated with subsequ ent NIDDM.