Cardiovascular haemodynamic changes in women diagnosed with gestational diabetes: A longitudinal case control study

Background: Pregnancy can be considered a predictor of future medical risk. Certain conditions that develop in pregnancy, such as, pregnancy induced hypertension and GDM evolve into chronic forms of the condition in subsequent years. GDM is observed in about 5% of pregnancies, is increasing in prevalence, and is associated with complications to the pregnancy and a long-term risk of diabetes in both mother and offspring. More than 60% of women with GDM develop type 2 diabetes mellitus (T2DM) within the following 15 years. Arterial stiffness is an independent predictor of CV mortality and morbidity, both in low and high risk populations. The link between arterial stiffness and GDM is unclear and debatable with only a handful of small case-controlled studies having investigated arterial stiffness in women with GDM in late pregnancy and in the immediate postpartum period Aim: The overall aims of the work to be presented in this thesis are to examine maternal cardiovascular changes among women diagnosed with Gestational diabetes mellitus (GDM). In order to examine the current hypothesis additional studies were performed to assess the diurnal changes and intra-observer repeatability and reproducibility in central cardiovascular haemodynamics during normal pregnancy among low-risk pregnant women. This thesis also explored the longitudinal changes in maternal haemodynamics among low-risk healthy pregnant women and then looked at the haemodynamic changes amongst women who were screened for GDM in comparison to low-risk healthy controls and finally demonstrated the maternal haemodynamics among pregnant women diagnosed with GDM and commenced on metformin in comparison to women diagnosed with GDM remaining on diet modification only. Conclusion: The null hypothesis that there was no difference in the maternal cardiovascular changes during pregnancy between pregnant women diagnosed with GDM, pregnant women at risk of developing GDM and low-risk healthy pregnant women was robustly rejected