Cardiovascular biomarkers in pregnancy with diabetes and associations to glucose control
Daniel P Jacobsen1, Ragnhild Røysland2,3, Heidi Strand2
1Division of Obstetrics and Gynaecology, Oslo University Hospital, Kirkeveien 166, PO Box 4956, 0424, Nydalen, Oslo, Norway. danjac@ous-hf.no.
Insights
Pregnant women with diabetes, including gestational diabetes, show elevated cardiac troponin T (cTnT) levels, indicating potential heart issues. Women with gestational diabetes require intensified cardiovascular follow-up post-delivery.
Area of Science:
- Cardiology
- Endocrinology
- Reproductive Medicine
Background:
- Cardiovascular disease (CVD) is a major cause of mortality.
- Diabetes mellitus (DM), including Type 1 (DM1), Type 2 (DM2), and gestational diabetes (GDM), significantly increases CVD risk.
- Pregnancy serves as a critical period for assessing cardiovascular health in women.
Purpose of the Study:
- To measure circulating concentrations of cardiac troponin T (cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and growth differentiation factor 15 (GDF-15) in pregnant women with different forms of diabetes.
- To evaluate pregnancy as a cardiovascular stress test in relation to diabetic status.
Main Methods:
- The study included 384 pregnant women: 64 with DM1, 16 with DM2, 35 with GDM, and 269 controls.
- Blood samples were collected primarily within one week before delivery.
- Serum concentrations of cTnT, NT-proBNP, and GDF-15 were quantified using electrochemiluminescence immunoassay.
Main Results:
- Elevated cTnT levels were observed in women with DM1, DM2, and GDM compared to controls.
- NT-proBNP and GDF-15 levels were significantly increased only in women with DM1.
- Third-trimester HbA1c positively correlated with all three CVD biomarkers, while pregestational BMI negatively correlated with GDF-15.
Conclusions:
- The findings indicate myocardial involvement in pregnant women with diabetic disorders.
- While DM1 presented the most adverse CVD biomarker profile, GDM was associated with cTnT levels similar to DM2.
- Women with GDM warrant intensified long-term cardiovascular monitoring and lifestyle guidance post-delivery, akin to those with pregestational diabetes.
Aim:
Cardiovascular disease (CVD) is a leading cause of death in both men and women. Type 1 and 2 diabetes mellitus (DM1 and DM2) are well-known risk factors for CVD. In addition, gestational diabetes mellitus (GDM) is a female sex-specific risk factor for CVD. Here, we measure circulating concentrations of cardiac troponin T (cTNT), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and growth differentiation factor 15 (GDF-15) during pregnancy-a window of time often referred to as a cardiovascular stress test for women.
Methods:
This study utilized data from 384 pregnant women: 64 with DM1, 16 with DM2, 35 with GDM and 269 euglycemic controls. Blood was predominantly sampled within a week before delivery. Cardiovascular biomarker concentrations were measured in serum using electrochemiluminescence immunoassay.
Result:
Circulating cTnT levels were higher in women with DM1, DM2 and GDM as compared to controls, whereas NT-proBNP and GDF-15 levels were only increased in women with DM1. Glucose dysregulation, assessed by third trimester HbA1c levels, positively correlated with all three CVD biomarker levels, whereas pregestational body mass index correlated negatively with GDF-15.
Conclusions:
Our results support the presence of myocardial affection in women with diabetic disorders during pregnancy. Although pregestational DM1 in this study was associated with the most adverse CVD biomarker profile, women with GDM displayed an adverse cTnT profile similar to what we found in women with pregestational DM2. This supports that women with GDM should be offered long-term intensified cardiovascular follow-up and lifestyle advice following delivery, similarly to the well-established CV follow-up of women with pregestational DM.
Related Concept Videos
01:22Diabetes Mellitus: Type 2 and Gestational
01:20Pathophysiology of Diabetes
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...
01:15Diabetes: Symptoms, Diagnosis, and Complications
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:30Coronary Artery Disease I: Introduction
01:22Diabetes Mellitus: Overview and Type I Subtype
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...