Insulin resistance and arterial stiffness: impact of gestational diabetes on pulse wave velocity

Aissatou Seck, Fatou Diallo Agne, Abibatou Sall Fall, Fatou Binetou Sar, Valentin Ouedraogo, Arame Mbengue, Magid Hallab, Abdoulaye Ba, Abdoulaye Samb


Background: Gestational diabetes is an intolerance of glucose with the first appearance during the pregnancy. This hyperglycaemia status, because of the pre-existing insulin-resistance, constitute a favourable land of arterial stiffness. The aim of this study is to determine the impact of non obese gestational diabetes on arterial stiffness by measuring the pulse wave velocity (PWV).

Methods: We recruited 60 pregnant women aged from 20 to 35 years old. They were between twentieth four and thirtieth five weeks of gestational age. Subjects were divided into two groups: the first group (G1), considered as control group, included 25 normoglycemic pregnant subjects without any history of illness or risk factors of gestational diabetes; the second group (G2) included 35 women with Gestational Diabetes Mellitus (GDM). All pregnant women had not history of smoking, were not taking decoction or medicine, which could disturb pregnancy evolution. Anthropo-physiological and biochemical parameters studied, were: age, body mass index (BMI), blood pressure (BP), triglyceride, cholesterol and HOMA-IR index. The PWV between finger and toe (PWVft) was measured by pOpmètre®.

Results: The two groups are matched by age (G1:28±4ans; G2:29±3ans) and BMI (G1:25.6±1.27; G2:26.9±1.3). Blood pressure (BP) values are in normal interval (systolic BP: [110-132mmHg]; diastolic BP: [63-87mmHg]; mean BP: [79-103mmHg]). Total cholesterol (G1:0.95±0.08;G2:2.4±0.7; p˂0.0001), HDL cholesterol (G1:0.44±0.02; G2:0.76±0.2; p˂0.0001, LDL cholesterol (G1:0.40±0.05; G2:1.3±0.5; p˂0.0001), triglyceride (G1:0.57±0.45; G2:1.6±0.4;p˂0.0001), HOMA.IR (G1:1.31±1.05; G2:7.4±1.07; p˂0.01), PWVft (G1:5.99±1.23; G2:10.3±1.9; p˂0.0001) are significantly higher in diabetic group. PWVft is positively correlate to HOMA-IR index, total cholesterol, LDL cholesterol and triglycerides (r=0.3348, p=0.032; r=0.5275, p˂0.0001; r=0.4855,p˂0.0001; r=0.5581, p˂0.0001respectively).

Conclusions: Gestational diabetes might induce an increase of pulse wave velocity expressing increment of arterial stiffness. This last constitute an early underlying cardiovascular risk. 


Arterial stiffness, Gestational diabetes, Insulin resistance, Pulse wave velocity

Full Text:



Buchanan TA, Xiang A, Kjos SL, Watanabe R, What is gestational diabetes? Diabetes Care. 2007;30(2):S105-11.

American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2004;27(Suppl.1):S88-90.

Hill JC, Krishnaveni GV, Annamma I, Leary SD, Fall CH. Glucose tolerance in pregnancy in South India: relationships to neonatal anthropometry. Acta Obstet Gynecol Scand. 2005;84(2):159-65.

England LJ, Dietz PM, Njoroge T, Callaghan WM, Bruce C, Buus RM, et al. Preventing type 2 diabetes: public health implications for women with a history of gestational diabetes mellitus. Am J Obst Gynecol. 2009 Apr 1;200(4):365-e1.

Yang H, Wei Y, Gao X, Xu X, Fan L, He J, et al. Risk factors for gestational diabetes mellitus in Chinese women-a prospective study of 16 286 pregnant women in China. Diabetic Medicine. 2009 Nov 1;26(11):1099-104.

Lain KY, Catalano PM. Metabolic changes in pregnancy. Clin Obstet Gynecol. 2007;50(4):938-48.

Zeng Z, Liu F, Li S. Metabolic Adaptations in Pregnancy: A Review. Ann Nutr Metab. 2017;70:59-65.

Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovascular J Africa: Cardiovasc J Afr. 2016;27:89-94.

Descamps P, Marret H, Binelli C, Chaplot S, Gillard P: Body changes during pregnancy. Neuro chirurgie. 2000;46(2):68-75.

Carr DB. Gestational diabetes mellitus increases the risk of cardiovascular disease in women with a family history of type 2 diabetes. Diabetes Care. 2006;29(9):2078-83.

Retnakaran R, Qi Y, Sermer M, Connelly PW, Hanley AJ, Zinman B. The postpartum cardiovascular risk factor profile of women with isolated hyperglycemia at 1-hour on the oral glucose tolerance test in pregnancy. Nutr Metab Cardiovas Dis. 2011;21(9):706-12.

Mrizak I, Arfa A, Fekih M, Debbabi H, Bouslema A, Boumaiza I et al. Inflammation and impaired endothelium-dependant vasodilatation in non obese women with gestational diabetes mellitus: preliminary results. Lipids Health Dis. 2013;12:93.

Belhadj-Mostefa A, Touati F, Roula D, Valensi P. P26 La rigidité artérielle contribue à la détérioration de la fonction rénale chez les diabétiques de type 2. Diab Meta. 2014;40(1):A36.

Hallab M, Collette M, Terrier-Barbeau C, Legrand M, Ducluzeau PH, Berrut G, et al. Arterial stiffness measured by pOpmeter® in patients at cardiovascular risk, link to carotid atheroma plaques. Ann Cardio Angio. 2013;62:189-92.

World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation on Obesity. Report of WHO consultation: 1998.

Reference Values for Arterial Stiffness' Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: 'establishing normal and reference values'. Eur Heart J. 2010;31(19):2338-50.

Okita K, Iwahashi H, Kozawa J, Okauchi Y, Funahashi T, Imagawa A, et al. Homeostasis model assessment of insulin resistance for evaluating insulin sensitivity in patients with type 2 diabetes on insulin therapy. Endocrine J. 2013;60(3):283-290.

Farkas K, Kolossvary E, Jarai Z, Nemcsik J, Farsang C. Non-invasive assessment of micro vascular endothelial function by laser Doppler flowmetry in patients with essential hypertension. Atherosclerosis. 2004;173:97-102.

Debbabi H, Bonnin P, Ducluzeau P H, Lefthériotis G, Levy BI. Noninvasive assessment of endothelial function in the skin microcirculation. Am J Hypertens. 2010;23(5):541-6.

Savvidou MD, Kametas NA, Donald AE, Nicolaides KH. Non-invasive assessment of endothelial function in normal pregnancy. Ultrasound Obstet Gynecol. 2000;15:502-7.

Saarelainen H, Laitinen T, Raitakari OT, Juonala M, Heiskanen N, Lyyra-Laitinen T, et al. Pregnancy-related hyperlipidemia and endothelial function in healthy women. Circulation J. 2006;70(6):768-72.

Qi Fu, Benjamin DL: Autonomic circulatory control during pregnancy in humans. Semin Reprod Med. 2009;27(4):330-7.

Manish Gutch, Sukriti Kumar, Syed Mohd Razi, Kumar Keshav Gupta, and Abhinav Gupta, Assessment of insulin sensitivity/resistance. Indian J Endocrinol Metab. 2015;19(1):160-4.

Stein S, Stepan H, Kratzsch J, Verlohren M, Verlohren HJ, Drynda K, et al. Serum fibroblast growth factor 21 levels in gestational diabetes mellitus in relation to insulin resistance and dyslipidemia. Metabolism. 2010 Jan 1;59(1):33-7.

Herrera E, Ortega-Senovilla H. Disturbances in lipid metabolism in diabetic pregnancy-Are these the cause of the problem? Best Pract Res Clin Endocrinol Metab. 2010;24(4):515-25.

Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001 May;37(5):1236-41.

Hansen TW, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, et al. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation. 2006 Feb 7;113(5):664-70.

Savvidou MD, Anderson JM, Kaihura C, Nicolaides KH. Maternal arterial stiffness in pregnancies complicated by gestational and type 2 diabetes mellitus. Am J Obst Gynecol. 2010;203:274.e1-7.

Inci S, Nar G, Balkan F, Aksan G, Degirmenci H, Hamur H. Effect of human gestational diabetes mellitus on arterial stiffness. Acta Endocrinol (1841-0987). 2014 Jul 1;10(3).

Prenner SB, Chirinos JA. Arterial stiffness in diabetes mellitus. Atherosclerosis. 2015;238:370-9.

Lekva T, Bollerslev J, Norwitz ER, Aukrust P, Henriksen T, Ueland T. Aortic stiffness and cardiovascular risk in women with previous gestational diabetes mellitus. PloS one. 2015 Aug 26;10(8):e0136892.

Kamel M, Compaoré A, Potier L, Belhatem N, Feron M, Matallah N, et al. Outpatient measurement of arterial stiffness in patients with type 2 diabetes and obesity. J Diabetes. 2017;9:237-42.

Osman MW, Nath M, Khalil A, Webb DR, Robinson TG, Mousa HA. The effects of metformin on maternal haemodynamics in gestational diabetes mellitus: A pilot study. Diab Res Clin Prac. 2018 May 1;139:170-8.

Westerbacka J, Leinonen E, Salonen JT, Salonen R, Hiukka A, Yki-Järvinen H, et al. Increased augmentation of central blood pressure is associated with increases in carotid intima-media thickness in type 2 diabetic patients. Diabetologia. 2005 Aug 1;48(8):1654-62.

Meyer C, McGrath BP, Teede HJ. Overweight women with polycystic ovary syndrome have evidence of subclinical cardiovascular disease. J Clin Endocrinol Metab. 2005;90:5711-6.

Rahman S, Ismail AA, Ismail SB, Naing NN, Rahman AR. Early manifestation of macrovasculopathy in newly diagnosed never treated type II diabetic patients with no traditional CVD risk factors. Diabetes Res Clin Pract. 2008;80:253-8.

Rahman S, Rahman T, Ismail AA, Rashid AR. Diabetes associated macrovasculopathy: pathophysiology and pathogenesis. Diab Ob Meta. 2007;9(6):767-80.

Bulzico DA, Zajdenverg L, Cabizuca CA, de Oliveira JEP, Salles GF. Assessment of arterial stiffness in women with gestational diabetes. Diabetic Medicine Diabetes UK. Diab Med. 2012;29:227-31.

Salmi A, Zaki MN, Zakaria, Nor Aliza G, Rasool HG. Arterial stiffness, inflammatory and pro-atherogenic markers in gestational diabetes mellitus. VASA. 2012;41:96-104.