Early development of a restrictive pattern of ventricular filling in pregnant diabetics can lead to complications during delivery. Whereas pregnancy in healthy women results in a reversible physiological left ventricular hypertrophy, a disturbed relaxation pattern and a temporary decrease of left ventricular systolic function, pregnant women who are diabetic have delayed relaxation at the beginning of pregnancy and develop a restrictive filling pattern, say specialists in Düsseldorf, Germany. They studied the course of haemodynamic parameters under the increased volume load during pregnancy and delivery in women with insulin-dependent diabetes.
The specialists examined 51 women with insulin-dependent diabetes and 51 healthy pregnant women. Fifty one healthy women who were not pregnant were used as controls.
Left ventricular mass and fractional shortening were calculated and mitral inflow and pulmonary venous flow profiles were analysed to evaluate left ventricular diastolic function.
It was found that during pregnancy, left ventricular mass increased, fractional shortening decreased and diastolic dysfunction occurred. While the healthy pregnant women developed signs of disturbed relaxation during pregnancy, pregnant diabetic women showed signs of a disturbed relaxation at the beginning of gestation.
Of the 51 pregnant diabetic women, 29 developed a restrictive ventricular filling pattern at the 24th week of gestation. The remaining 22 diabetic women had a comparable restrictive filling pattern only during vaginal delivery.
There were dangerous complications in 10 of the 29 pregnant diabetic women but no complications in the other 22 diabetic pregnant women or the healthy pregnant women. Diabetologia 2003;46:267-275
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