Anness, A.R., Foster, M. orcid.org/0000-0001-8233-9873, Osman, M.W. et al. (5 more authors) (2024) Do maternal haemodynamics have a causal influence on treatment for gestational diabetes? Journal of Obstetrics and Gynaecology, 44 (1). 2307883. ISSN 0144-3615
Abstract
Background
Arterial stiffening is believed to contribute to the worsening of insulin resistance, and factors which are associated with needing pharmacological treatment of gestational diabetes (GDM), such as maternal obesity or advanced age, are associated with impaired cardiovascular adaptation to pregnancy. In this prospective observational study, we aimed to investigate causal relationships between maternal haemodynamics and treatment requirement amongst women with GDM.
Methods
We assessed maternal hemodynamics in women with GDM, comparing those who remained on dietary treatment with those who required pharmacological management. Maternal haemodynamics were assessed using the Arteriograph® (TensioMed Ltd, Budapest, Hungary) and the NICOM® non-invasive bio-reactance method (Cheetah Medical, Portland, Oregon, USA). A graphical causal inference technique was used for statistical analysis.
Results
120 women with GDM were included in the analysis. Maternal booking BMI was identified as having a causative influence on treatment requirement, with each unit increase in BMI increasing the odds of need metformin and/or insulin therapy by 12% [OR 1.12 (1.02 - 1.22)]. Maternal heart rate (87.6 ± 11.7 vs. 92.9 ± 11.90 bpm, p=0.014) and PWV (7.8 ± 1.04 vs. 8.4 ± 1.61 m/s, p=0.029) were both significantly higher amongst the women requiring pharmacological management, though these relationships did not remain significant in causal logistic regression.
Conclusions
Maternal BMI at booking has a causal, rather than simply associational, relationship on the need for pharmacological treatment of GDM. No significant causal relationships were found between maternal hemodynamics and the need for pharmacological treatment.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
Keywords: | Gestational diabetes; maternal hemodynamics; cardiac output; pulse wave velocity; augmentation index; causal inference |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Engineering (Sheffield) > Department of Computer Science (Sheffield) |
Funding Information: | Funder Grant number ENGINEERING AND PHYSICAL SCIENCE RESEARCH COUNCIL EP/T030526/1 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 06 Feb 2024 14:22 |
Last Modified: | 01 Mar 2024 16:57 |
Status: | Published |
Publisher: | Taylor and Francis Group |
Refereed: | Yes |
Identification Number: | 10.1080/01443615.2024.2307883 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:208650 |