Download PDF
Ultraschall Med 2004; 25(1): 34-39
DOI: 10.1055/s-2003-45246
Original Article

© Georg Thieme Verlag Stuttgart · New York

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

Veränderte zerebrale Blutflussregulation bei Schwangeren mit GestationsdiabetesB.  Rosengarten1 , S.  Gruessner2 , C.  Aldinger1 , W.  Künzel2 , M.  Kaps1
  • 1Department of Neurology, Faculty of Medicine, Justus-Liebig University of Giessen, Giessen, Germany
  • 2Department of Obstetrics, Faculty of Medicine, Justus-Liebig University of Giessen, Giessen, Germany
Further Information

Publication History

eingereicht: July 18, 2003

angenommen: October 10, 2003

Publication Date:
12 February 2004 (online)

Also available at
    Permissions and Reprints

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.

Schlüsselwörter

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

Key words

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

References

  • 1 Catalano P M, Tyzbir E D, Roman N M, Amini S B, Sims E A. Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women.  Am J Obstet Gynecol. 1991;  165 1667-1672
    CrossrefPubMedSearch in Google Scholar
  • 2 Kühl C. Insulin secretion and insulin resistance in pregnancy and GDM. Implications for diagnosis and management.   Diabetes. 1991;  40 18-24
    CrossrefPubMedSearch in Google Scholar
  • 3 Gabbe S G. Gestational diabetes mellitus.  N Engl J Med. 1986;  315 1025-1026
    CrossrefPubMedSearch in Google Scholar
  • 4 Metzger B E. Summary and recommendations of the Third International Workshop Conference on Gestational Diabetes Mellitus.  Diabetes. 1991;  40 197-201
    CrossrefPubMedSearch in Google Scholar
  • 5 Peters R K, Kjos S L, Xiang A, Buchanan T A. Long term diabetogenic effect of single pregnancy in women with previous gestational diabetes mellitus.  Lancet. 1996;  347 227-230
    CrossrefPubMedSearch in Google Scholar
  • 6 O'Sullivan J B. The Boston gestational diabetes studies: review and prospectives. In: Sutherland HW, Stowers JM, Pearson DWM, eds Carbohydrate metabolism in pregnancy and the newborn.  Springer, Berlin 1989: 287-294
    Search in Google Scholar
  • 7 Feener E P, King G L. Vascular dysfunction in diabetes mellitus.  Lancet. 1997;  350 9-13
    CrossrefPubMedSearch in Google Scholar
  • 8 Lukovits T G, Mazzone T, Gorelick P B. Diabetes mellitus and cerebrovascular disease.  Neuroepidemiology. 1999;  18 1-14
    PubMedSearch in Google Scholar
  • 9 Stehouwer C DA, Shaper N C. The pathogenesis of vascular complications of diabetes mellitus: one voice or many?.  Eur J Clin Invest. 1996;  26 535-543
    CrossrefPubMedSearch in Google Scholar
  • 10 Knock G A, McCarthy A L, Lowy C, Poston L. Association of gestational diabetes with abnormal maternal vascular endothelial function.  Br J Obstet Gynaecol. 1997;  104 229-234
    PubMedSearch in Google Scholar
  • 11 Stehouwer C D, Fischer H R, van Kuijk A W, Polak B C, Donker A J. Endothelial dysfunction precedes development of microalbuminuria in IDDM.  Diabetes. 1995;  44 561-564
    PubMedSearch in Google Scholar
  • 12 Zenere B M, Arcado G, Saggiani F, Rossi L, Muggeo M, Lechi A. Noninvasive detection of functional alterations of the arterial wall in IDDM patients with and without microalbuminuria.  Diabetes Care. 1995;  18 975-982
    PubMedSearch in Google Scholar
  • 13 Meeking D R, Cummings M H, Thorne S, Donald A, Clarkson P, Crook J R, Watts G F, Shaw K M. Endothelial dysfunction in type 1 diabetic subjects with and without microalbuminuria.  Diabet Med. 1999;  16 841-847
    CrossrefPubMedSearch in Google Scholar
  • 14 Anastasiou E, Lekakis J P, Alevizaki M, Papamichael C M, Megas J, Souvatzoglou A, Stamatelopoulos S F. Impaired endothelium-dependent vasodilatation in women with previous gestational diabetes.  Diabetes Care. 1998;  21 2111-2115
    PubMedSearch in Google Scholar
  • 15 Dorup I, Skajaa K, Sorensen K E. Normal pregnancy is associated with enhanced endothelium-dependent flow-mediated vasodilation.  Am J Physiol. 1999;  276 H821-H825
    PubMedSearch in Google Scholar
  • 16 von Reutern G M, Kaps M, von Büdingen H J. Ultraschalldiagnostik der hirnversorgenden Arterien.  Thieme, Stuttgart 2000: 264-272
    Search in Google Scholar
  • 17 Rosengarten B, Huwendiek O, Kaps M. Neurovascular coupling and cerebral autoregulation can be described in terms of a control system.  Ultrasound Med Biol. 2001;  27 189-193
    CrossrefPubMedSearch in Google Scholar
  • 18 Rosengarten B, Huwendiek O, Kaps M. Neurovascular coupling in terms of a control system: Validation of a second order linear system model.  Ultrasound Med Biol. 2001;  27 631-635
    CrossrefPubMedSearch in Google Scholar
  • 19 Iadecola C. Regulation of the cerebral microcirculation during neural activity: is nitric oxide the missing link?.  TINS. 1993;  16 206-214
    PubMedSearch in Google Scholar
  • 20 Aaslid R. Cerebral hemodynamics. In: Newell DW, Aaslid R eds Transcranial Doppler.  Raven, New York 1992: 49-55
    Search in Google Scholar
  • 21 Kuschinsky W. Regulation of cerebral blood flow: an overview. In: Mraovitch S, Sercombe R, eds Neurophysiological basis of cerebral blood flow control: An introduction.  John Libbey, Hong Kong 1996: 245-262
    Search in Google Scholar
  • 22 Aaslid R. Visually evoked dynamic blood flow response of the human cerebral circulation.  Stroke. 1987;  18 771-775
    CrossrefPubMedSearch in Google Scholar
  • 23 Sturzenegger M, Newell D W, Aaslid R. Visual evoked blood flow response assessed by simultaneous two-channel transcranial Doppler using flow velocity averaging.  Stroke. 1996;  27 2256-2261
    CrossrefPubMedSearch in Google Scholar
  • 24 Conrad B, Klingelhofer J. Dynamics of regional cerebral blood flow for various visual stimuli.  Exp.Brain Res. 1989;  77 437-441
    CrossrefPubMedSearch in Google Scholar
  • 25 Rosengarten B, Dost A, Kaufmann A, Gortner L, Kaps M. Impaired cerebrovascular reactivity in type 1 diabetic children.  Diabetes Care. 2002;  25 408-410
    PubMedSearch in Google Scholar
  • 26 Fülesdi B, Limburg M, Bereczki D, Michels R PJ, Neuwirth G, Legemate D, Valikovics A, Csiba L. Impairment of cerebrovascular reactivity in long term type 1 diabetes.  Diabetes. 1997;  46 1840-1845
    PubMedSearch in Google Scholar
  • 27 Gosling R G, King D H. Arterial assessment by Doppler-shift ultrasound.  Proc R Soc Med. 1974;  67 447-449
    PubMedSearch in Google Scholar
  • 28 Lind T. A prospective multicentre study to determine the influence of pregnancy upon the 75 g oral glucose tolerance test: the Diabetic Pregnancy Study Group of the European Association for the Study of Diabetes. In: Sutherland HW, Stowers JH, Pearson DWM, eds Carbohydrate metabolism in pregnancy and the newborn IV. . Springer, London 1989: 209-226
    Search in Google Scholar
  • 29 Fujioka K A, Donville C M. Anatomy and freehand examination techniques. In: Newell DW, Aaslid R, eds Transcranial Doppler.  Raven, New York 1992: 9-31
    Search in Google Scholar
  • 30 Melsa J L, Shultz D G, Rohrs C E. Linear control systems.  Englewood Cliffs, NJ: Prentice-Hall 1990
    Search in Google Scholar
  • 31 Phippard A F, Horvath J S, Glynn E M, Garner M G, Fletcher P J, Duggin G G, Tiller D J. Circulatory adaptation to pregnancy: serial studies on haemodynamics, blood volume, renin and aldosterone in the baboon.  J Hypertens. 1986;  4 773-779
    PubMedSearch in Google Scholar
  • 32 Robson S C, Hunter S, Boys R J, Dunlop W. Serial study of factors influencing changes in cardiac output during human pregnancy.  Am J Physiol. 1989;  4 H1060-H1065
    PubMedSearch in Google Scholar
  • 33 Dorup I, Skajaa K, Sorensen K. Normal pregnancy is associated with enhanced endothelium-dependent flow-mediated vasodilation.  Am J Physiol. 1999;  276 H821-H825
    PubMedSearch in Google Scholar
  • 34 Vallance P, Collier J, Moncada S. Effects of endothelium-derived nitric oxide on peripheral arteriolar tone in man.  Lancet. 1989;  2 997-1000
    PubMedSearch in Google Scholar
  • 35 Anumba D O, Robson S C, Boys R J, Ford G A. Nitric oxide activity in the peripheral vasculature during normotensive and preeclamptic pregnancy.  Am J Physiol. 1999;  277 H848-H854
    PubMedSearch in Google Scholar
  • 36 Rosengarten B, Aldinger C, Kaufmann A, Kaps M. Neurovascular coupling remains unaffected by glyceryl trinitrate.  Cerebrovasc Dis. 2002;  14 58-60
    PubMedSearch in Google Scholar
  • 37 Williams K, Wilson S. Maternal middle cerebral artery blood flow velocity variation with gestational age.  Obstet Gynecol. 1994;  84 445-448
    PubMedSearch in Google Scholar
  • 38 Ikeda T, Mori N. Assessment of cerebral haemodynamics in pregnant women by internal carotid artery pulsed Doppler velocimetry.  Am J Obstet Gynecol. 1990;  163 494-498
    PubMedSearch in Google Scholar

Prof. Dr. M. Kaps

Department of Neurology · Faculty of Medicine · Justus-Liebig University of Giessen

Am Steg 14 · 35385 Giessen · Germany

Email: Manfred.Kaps@Neuro.med.uni-Giessen.de