Do maternal haemodynamics have a causal influence on treatment for gestational diabetes?
Do maternal haemodynamics have a causal influence on treatment for gestational diabetes?
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DOI：
10.1080/01443615.2024.2307883
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发表时间：
2024-12-31
影响因子：
1.3
通讯作者：
Mousa，Hatem A.
中科院分区：
文献类型：
--
作者：
Anness，Abigail R.;Foster，Michael;Mousa，Hatem A.
背景动脉硬化被认为是胰岛素抵抗恶化的原因，而与妊娠期糖尿病(GDM)需要药物治疗相关的因素，如母亲肥胖或高龄，与妊娠心血管适应性受损有关。在这项观察性研究中，我们旨在调查GDM妇女中母亲血流动力学与治疗需求之间的因果关系。方法我们评估了GDM妇女的母亲血流动力学，比较了那些继续接受饮食治疗的妇女和那些需要药物治疗的妇女。使用Arteriograph®(匈牙利布达佩斯的TinioMed Ltd)和NICOM®非侵入性生物电抗方法(美国俄勒冈州波特兰的猎豹医疗公司)对孕妇的血流动力学进行评估。结果120例妊娠期糖尿病患者进入分析。母亲预订体重指数对治疗需求有因果影响，体重指数每增加一个单位，需要二甲双胍和/或胰岛素治疗的几率增加12%[OR1.12(1.02 − 1.22)]。在需要药物治疗的妇女中，母亲心率(87.6bpm± 11.7vs.92.9 ± 11.90bpm，p= 0.014)和Pwv(7.8bpvs.8.4 ± 1.61bpm/S，p= 0.029)的原始值均显著升高，但这些关系在因果Logistic回归分析中并不显著。未发现母体血流动力学与药物治疗需求之间存在显著的因果关系。
BackgroundArterial 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 observational study, we aimed to investigate causal relationships between maternal haemodynamics and treatment requirement amongst women with GDM.MethodsWe assessed maternal haemodynamics 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.Results120 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 needing metformin and/or insulin therapy by 12% [OR 1.12 (1.02 − 1.22)]. The raw values of 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.ConclusionsMaternal 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 haemodynamics and the need for pharmacological treatment.