Evaluation of the effect of preeclampsia and gestational diabetes mellitus on endothelial function by flow-mediated dilatation

Introduction: Gestational diabetes mellitus and preeclampsia are one of the most common medical complications of pregnancy. The incidence is increasing due to the increasing gestational age and obesity. Both gestational diabetes and preeclampsia are risk factors for cardiovascular diseases and atherosclerosis. Flow-mediated dilatation (FMD) is a good ultrasonographic marker of early atherosclerotic changes used to measure endothelial function. In this study; We evaluated FMD, an indicator of endothelial function, and investigated whether there is an increased risk of cardiovascular disease in patients with a history of preeclampsia or gestational diabetes mellitus. Materials and Methods: The study was carried out with 104 patients who gave birth in the Obstetrics and Gynecology Clinic of Abant Izzet Baysal University Training and Research Hospital between January 2016 and January 2017. Thirty-four patients with a history of preeclampsia, 37 patients with a history of GDM, and 33 patients with uncomplicated deliveries were included in the study. All patients in the study had only one live birth and their age range was between 20 and 30 years. Demographic data, cardiovascular risk markers, obstetric data, laboratory tests and FMD change (%) measurements of all patients were compared. Mean and standard deviation values of the obtained data were calculated. After the distribution of numerical variables was evaluated by Kolmogorov-Smirnov method, one-way analysis of variance (ANOVA) was used for homogeneously distributed parameters and Post Hoc Tukey test was used for comparisons between subgroups. Kruskal Wallis test was used for comparison of non homogeneous parameters between groups and Bonferroni corrected Mann Whitney U test was used for post-hoc analysis. The degree of relationship between continuous variables wascalculated by Pearson or Spearman's correlation analysis, where appropriate. Statistical significance level was accepted as p <0.05. Results: Mean age, average height, family history, occupation, gravida, parity,There was no statistically significant difference in terms of abortion number, postnatal period and mode of delivery (p <0.05). The gestational age was 25.41 ± 2.53 (years) in pregnant women with GDM history and 25.35 ± 2.67 (years) in pregnant women with a history of preeclampsia, while the mean age was 26 ± 3.01 (years) in the control group.There was no statistically significant difference in systolic blood pressure, diastolic blood pressure and triglyceride levels in preeclampsia group compared to control group, but there was no statistically significant difference in terms of glucose, LDL, HDL and total cholesterol. A statistically significant difference was found in glucose, Hba1c and triglyceride values when the control group and the patients with GDM history were compared. When FMD change (%) was compared in all three groups, the mean group of patients with a history of preeclampsia; The mean group of patients with a history of GDM was 9.8 ± 3.1; 10.32 ± 2.50, the mean of the control group; 13.19 ± 3.03. A statistically significant difference was found between the control group and GDM and preeclampsia groups in terms of FMD change (%) (<0.001). There was a significant negative correlation between FMD change (%) values and systolic blood pressure, diastolic blood pressure, glucose, LDL, total cholesterol and proteinuria. Conclusion: The use of these measurements in patients with a history of GDM and preeclampsia can be used as a predictive marker for cardiovascular disease, and early detection of risk can be time-consuming in terms of prevention. Demonstrating that GDM and preeclams cause increased cardiovascular risk in women's lives will raise awareness of taking measures to reduce risk in this group of patients.