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Vocal Shimmer: A Potential Clinical Biomarker for Gestational Diabetes
Sevinc Hepkarsi1, Tevfik Berk Bildaci2, Zehra Yavas2
1Department of Otorhinolaryngology, Izmir Democracy University Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Turkey.
Summary
Gestational diabetes mellitus (GDM) significantly impacts vocal amplitude stability and spectral clarity, indicated by higher shimmer and lower harmonics-to-noise ratio (HNR) and cepstral peak prominence-smoothed (CPPS). These vocal changes, though not always perceived subjectively, highlight the systemic effects of GDM on the laryngeal system.
Area of Science:
- Obstetrics and Gynecology
- Otolaryngology
- Speech and Language Pathology
Background:
- Gestational diabetes mellitus (GDM) is a common pregnancy complication with potential systemic effects.
- Vocal characteristics can be influenced by metabolic and hormonal changes during pregnancy.
Purpose of the Study:
- To investigate the effects of GDM on vocal characteristics using acoustic, aerodynamic, and subjective assessments.
- To identify potential objective markers for vocal changes associated with GDM.
Main Methods:
- A prospective cross-sectional study evaluated 101 pregnant women (31 GDM, 70 controls) between 24-28 weeks gestation.
- Objective vocal analysis included fundamental frequency (f0), jitter, shimmer, harmonics-to-noise ratio (HNR), and cepstral peak prominence-smoothed (CPPS) using Praat software.
- Aerodynamic measures (maximum phonation time, s/z ratio) and subjective vocal well-being (Voice Handicap Index-10, VHI-10) were also assessed.
Main Results:
- GDM group showed significantly higher shimmer and lower HNR and CPPS compared to controls (P < 0.001).
- No significant differences in f0 or aerodynamic measures were observed.
- The GDM group reported significantly higher VHI-10 scores (P = 0.003), but no correlation was found between subjective and objective vocal parameters.
Conclusions:
- GDM significantly impairs vocal amplitude stability and spectral clarity, while preserving fundamental frequency and aerodynamic support.
- Shimmer and CPPS are identified as moderate, non-invasive clinical indicators for monitoring vocal manifestations of GDM.
- The 'subjective-objective mismatch' suggests multifactorial vocal handicap in GDM, potentially due to increased vocal effort.
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