Abnormal Regulation of Maternal Cerebral Blood Flow Under Conditions of Gestational Diabetes Mellitus

Zusammenfassung

Studienziel: Der Gestationsdiabetes ist ein prädiabetischer Zustand, der zu endothelialer Dysfunktion und veränderter Organdurchblutung führt. Normalerweise wird die Hirndurchblutung rasch und präzise der jeweiligen Hirnaktivität angeglichen. Basierend auf dieser so genannten neurovaskulären Kopplung wurde der Einfluss des Gestationsdiabetes auf endothelial abhängige vasoregulative Eigenschaften des Mechanismus untersucht. Methode: Ein visueller Stimulus wurde verwendet, um das Kopplungsverhalten im Stromgebiet der Arteria cerebri posterior mittels Doppler zu messen. Evozierte peak-systolische und enddiastolische Flusskurven von 20 nicht-schwangeren Frauen (Alter 27 ± 6 Jahre), 31 Schwangeren (31 ± 6 Jahre; 31 ± 4 Gestationswoche) und 30 Gestationsdiabetikerinnen (32 ± 5 Jahre; 34 ± 4) wurden gemäß eines Regelkreisansatzes statistisch ausgewertet. Ergebnisse: Vergleiche der Flussgeschwindigkeiten unter Ruhebedingungen und der Regelkreisparameter, wie Verstärkung, Dämpfung, Anstiegszeit und Eigenfrequenz, zeigten signifikante Unterschiede für den Parameter Dämpfung sowohl für die peak-systolischen (0,55 ± 0,18 vs. 0,44 ± 0,1 und 0,45 ± 0,11, p < 0,01) wie enddiastolischen (0,61 ± 0,23 vs. 0,49 ± 0,2 und 0,5 ± 0,14, p < 0,05) Daten (Mittelwert ± SD der Daten von Gestationsdiabetikerinnen vs. Nicht-Schwangeren und Schwangeren, Signifikanzniveau). Nicht-Schwangere und Schwangere zeigten bzgl. der neurovaskulären Kopplung keine Unterschiede. Schlussfolgerungen: Der Gestationsdiabetes führt zu einer endothelialen Dysfunktion, die nicht-invasiv, schmerzfrei und einfach mit einem transkraniellen Doppler-Test gemessen werden kann.

Abstract

Aim: Gestational diabetes mellitus is a prediabetic state leading to endothelial dysfunction and altered organ perfusion. Under normal conditions cerebral blood flow is closely coupled to cortical activity, to which it rapidly adjusts. On the basis of this so-called neurovascular coupling we evaluated the influence of a gestational diabetic state on endothelium-dependent vasoregulative properties of this mechanism. Method: A functional transcranial Doppler test performed during visual stimulation was used to measure vascular reactivity. Peak systolic and end-diastolic flow velocity response from 20 non-pregnant (age 27 ± 6 y), 31 healthy pregnant women (31 ± 6 y; 31 ± 4 gestational week) and 30 women with gestational diabetes (32 ± 5 y; 34 ± 4) were separately evaluated according to a control system approach. All women did not show any vascular risk factors prior to pregnancy. Results: Comparison of resting blood flow velocity and the control system parameters of gain, attenuation, rate time and natural frequency, showed a consistent and significant difference in the parameter “attenuation” for the peak systolic data (0.55 ± 0.18 vs. 0.44 ± 0.1 and 0.45 ± 0.11, p < 0.01) as well as end-diastolic (0.61 ± 0.23 vs. 0.49 ± 0.2 and 0.5 ± 0.14, p < 0.05) figures (mean ± SD of value from women with gestational diabetes vs. non-pregnant and healthy pregnant women, significance level). No differences were found between non-pregnant and normal pregnant women for the neurovascular coupling mechanism. Conclusions: Gestational diabetes mellitus results in endothelial dysfunction which can be measured in a non-invasive, painless and easy manner by a transcranial Doppler test.

Transkranieller Doppler - Diabetes mellitus - Regelkreisanalyse - Hirndurchblutung - neurovaskuläre Kopplung

Transcranial Doppler - diabetes mellitus - control system analysis - cerebral blood flow - neurovascular coupling

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