Maternal vascular dysfunction in gestational diabetes is associated with birth of small neonates

The study aimed to evaluate maternal hemodynamic and vascular changes in women with small-for-gestational age(SGA) and large-for-gestational age(LGA) fetuses in the presence and absence of gestational diabetes mellitus(GDM).

Women at 35⁺⁰ to 36⁺⁶ weeks' gestation with and without GDM were included. Maternal demographics, ultrasound for fetal growth, Doppler studies of uterine and ophthalmic arteries, carotid-femoral pulse-wave velocity(PWV), augmentation index, cardiac output, and total peripheral resistance(TPR) were recorded. Multinomial logistic regression was used.

Of 11,132 women, 1,228(11.0%) developed GDM. In GDM pregnancies, 158(12.8%) delivered SGA and 136(11.1%) delivered LGA neonates, while non-GDM pregnancies had 1,051(10.6%) SGA and 806(8.1%) LGA neonates. In GDM and non-GDM women, SGA groups had the highest uterine artery pulsatility index(PI) percentiles, PWV and ophthalmic artery peak systolic velocity ratio. PWV was higher in the GDM SGA group compared to non-GDM SGA group. Cardiac output was lower in SGA groups when compared to the AGA group. In women with GDM, TPR, ophthalmic artery PSV ratio and uterine artery PI percentile had a positive association with the development of SGA.

Women with GDM and vascular dysfunction have higher risk to deliver SGA neonates. Maternal hemodynamic and vascular maladaptation could potentially explain the development of SGA in women with GDM.