IMPAIRED INDOTHELIUM-DEPENDENT VASODILATATION IN WOMEN WITH PREVIOUS GESTATIONAL DIABETES

OBJECTIVE - To assess whether otherwise healthy women with a history o f gestational diabetes mellitus (GDM) may have abnormalities in endoth elial function at a very early stage, before glucose intolerance occur s. RESEARCH DESIGN AND METHODS - A total of 33 women with previous GDM (17 nonobese [BMI <27] and 16 obese [BMI greater than or equal to 27] ) and 19 healthy nonobese women were examined. A 75-g oral glucose tol erance test was performed, and insulin levels and biochemical paramete rs were also measured. Using high-resolution ultrasound, we measured v asodilatory responses of the brachial artery during reactive hyperemia (endothelium-dependent vasodilatation), and after nitroglycerin admin istration, an endothelium-independent vasodilator. RESULTS-Flow-mediat ed dilatation (FMD) was significantly and equally decreased in both gr oups of women with previous GDM, compared with control subjects (1.6 /- 3.7% in the nonobese GDM group and 1.6 +/- 2.5% in the obese GDM gr oup vs. 10.3 +/- 4.4% in control subjects, P < 0.001). FMD correlated inversely with serum uric acid levels, BMI, serum total cholesterol, a nd basal insulin resistance (homeostasis model assessment). Nitrate-in duced dilatation was significantly decreased only in the obese GDM gro up compared with control subjects (21.4 +/- 5.1 vs. 27.9 +/- 9.5, P < 0.05). CONCLUSIONS - Endothelial dysfunction, which is considered as a very early index of atherogenesis, is already present in both obese a nd nonobese women with a history of GDM, even when they have normal gl ucose tolerance.