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)

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.

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
  • 2 Kühl C. Insulin secretion and insulin resistance in pregnancy and GDM. Implications for diagnosis and management.   Diabetes. 1991;  40 18-24
  • 3 Gabbe S G. Gestational diabetes mellitus.  N Engl J Med. 1986;  315 1025-1026
  • 4 Metzger B E. Summary and recommendations of the Third International Workshop Conference on Gestational Diabetes Mellitus.  Diabetes. 1991;  40 197-201
  • 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
  • 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
  • 7 Feener E P, King G L. Vascular dysfunction in diabetes mellitus.  Lancet. 1997;  350 9-13
  • 8 Lukovits T G, Mazzone T, Gorelick P B. Diabetes mellitus and cerebrovascular disease.  Neuroepidemiology. 1999;  18 1-14
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 16 von Reutern G M, Kaps M, von Büdingen H J. Ultraschalldiagnostik der hirnversorgenden Arterien.  Thieme, Stuttgart 2000: 264-272
  • 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
  • 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
  • 19 Iadecola C. Regulation of the cerebral microcirculation during neural activity: is nitric oxide the missing link?.  TINS. 1993;  16 206-214
  • 20 Aaslid R. Cerebral hemodynamics. In: Newell DW, Aaslid R eds Transcranial Doppler.  Raven, New York 1992: 49-55
  • 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
  • 22 Aaslid R. Visually evoked dynamic blood flow response of the human cerebral circulation.  Stroke. 1987;  18 771-775
  • 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
  • 24 Conrad B, Klingelhofer J. Dynamics of regional cerebral blood flow for various visual stimuli.  Exp.Brain Res. 1989;  77 437-441
  • 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
  • 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
  • 27 Gosling R G, King D H. Arterial assessment by Doppler-shift ultrasound.  Proc R Soc Med. 1974;  67 447-449
  • 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
  • 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
  • 30 Melsa J L, Shultz D G, Rohrs C E. Linear control systems.  Englewood Cliffs, NJ: Prentice-Hall 1990
  • 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
  • 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
  • 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
  • 34 Vallance P, Collier J, Moncada S. Effects of endothelium-derived nitric oxide on peripheral arteriolar tone in man.  Lancet. 1989;  2 997-1000
  • 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
  • 36 Rosengarten B, Aldinger C, Kaufmann A, Kaps M. Neurovascular coupling remains unaffected by glyceryl trinitrate.  Cerebrovasc Dis. 2002;  14 58-60
  • 37 Williams K, Wilson S. Maternal middle cerebral artery blood flow velocity variation with gestational age.  Obstet Gynecol. 1994;  84 445-448
  • 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

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