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Sharmaine Thirunavukarasu, MbCHB
Cardiology
University of Leeds
WILMSLOW, England, United Kingdom
Sharmaine Thirunavukarasu, MbCHB
Cardiology
University of Leeds
WILMSLOW, England, United Kingdom
Faiza Ansari, MD
Clinical Research Fellow
Leeds Institute of Cardiovascular and Metabolic Medicine, United Kingdom
Amrit Chowdhary, MD
Cardiology
University of Leeds
WAKEFIELD, England, United Kingdom
Nicholas Jex, MD
PhD Fellow
Leeds Institute of Cardiovascular and Metabolic Medicine, England, United Kingdom
Sindhoora Kotha, MD
Research Fellow
University of Leeds, United Kingdom
Marilena Giannoudi, MD
Research Fellow
University of Leeds, United Kingdom
Henry Procter, MD
Research Fellow
University of Leeds, United Kingdom
Hui Xue, PhD
Director, Imaging AI Program
National Institutes of Health
Bethesda, Maryland, United States
Peter P. Swoboda, PhD
Consultant Cardiologist & Senior Lecturer
University of Leeds
Leeds, England, United Kingdom
Peter Kellman, PhD
Senior Scientist
National Institutes of Health, Maryland, United States
John P. Greenwood, PhD
Professor
University of Leeds
Leeds, England, United Kingdom
Sven Plein, MD, PhD
Professor
University of Leeds
Leeds, England, United Kingdom
Thomas Everett
Consultant
Leeds Institute of Cardiovascular and Metabolic Medicine, United Kingdom
eleanor Scott, PhD
Consultant
Leeds Institute of Cardiovascular and Metabolic Medicine, United Kingdom
Eylem Levelt, PhD
Associate Professor and Honorary Consultant
University of Leeds
Leeds, England, United Kingdom
Gestational diabetes mellitus (GDM) is the most prevalent metabolic disorder during pregnancy and is associated with increased risks of cardiovascular morbidity and mortality in later life. We have shown that women with overweight/obesity and GDM manifest impaired myocardial contractility and higher left ventricular mass, associated with reductions in myocardial energetics compared to lean women with healthy pregnancy utilising phosphorus magnetic resonance spectroscopy (31P-MRS) and cardiovascular magnetic resonance (CMR) scans performed in the third trimester of pregnancy. This study assessed the reversibility of maternal myocardial changes in women with GDM with repeated imaging at 12 months postpartum.
Methods:
Thirty-eight healthy pregnant (HP) women and thirty women with GDM were recruited. Participants underwent 31P-MRS and CMR at baseline and 12 months postpartum.
Results:
Clinical data are shown in Table-1 and longitudinal CMR/31P-MRS changes are shown in Table-2.
GDM patients displayed more significant reductions in myocardial PCr/ATP ratio, lower LV end-diastolic volumes, lower GLS and higher LV mass in the third trimester of pregnancy. An improvement in myocardial energetics or GLS, significant change in LV end-diastolic volumes or LV mass was not observed in women with GDM at 12 months postpartum compared to the third trimester of pregnancy scan (Table-2).
There were no significant changes in the LV end diastolic volumes, function, mass or GLS in the HP group at 12 months postpartum compared to pregnancy scans.
Energetics (HP:2.4[2.2-2.5] versus GDM:1.9[1.6-2.2], p=0.003) and GLS (HP:21[20-23] versus GDM:18[17-19] %, p=0.0001) remained significantly lower and LV mass (HP:88[82-94] versus GDM:105[96-113] g, p=0.0005) higher in women with recent GDM pregnancy compared to women with HP respectively. ( Figure 3)
Conclusion:
In this longitudinal cohort study, women with recent GDM have demonstrated non-reversible reductions in energetics, global longitudinal shortening and higher LV mass 12 months’ post-partum with persistent significant differences compared to women with recent healthy pregnancy during and after pregnancy. In parallel, the healthy pregnancy cohort did not exhibit any significant changes in any of the cardiac parameters including cardiac volumes, mass, function or global longitudinal shortening 12 months’ post-partum compared to third trimester pregnancy scans, apart from significant elevation of myocardial energetics post-partum. Taken together, with post-partum scans considered to serve as a surrogate for the pre-pregnancy baseline values, our findings suggest that the women with GDM show persistent subtle cardiac abnormalities related to intrinsic metabolic alterations likely associated with pre-pregnancy overweight/obesity status as opposed to pregnancy related haemodynamic stresses. Future prospective studies should explore the implications of overweight/obesity in women who intend to get pregnant.