Endothelial function is preserved in pregnant women with well‐controlled type 1 diabetes

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 109; no. 6; pp. 699 - 707
• Main Authors: Ang, Christine, Hillier, Chris, Johnston, Fiona, Cameron, Alan, Greer, Ian, Lumsden, Mary Ann
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.06.2002; Blackwell
• Subjects: Adult; Analysis of Variance; Arteries - physiology; Biological and medical sciences; Cyclooxygenase Inhibitors - pharmacology; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - physiopathology; Diseases of mother, fetus and pregnancy; Endothelium, Vascular - physiology; Enzyme Inhibitors - pharmacology; Female; Gynecology. Andrology. Obstetrics; Humans; Indomethacin - pharmacology; Medical sciences; Muscle Relaxation - drug effects; Muscle, Smooth, Vascular - physiology; NG-Nitroarginine Methyl Ester - pharmacology; Nitric Oxide - pharmacology; Oxadiazoles - pharmacology; Pregnancy; Pregnancy in Diabetics - drug therapy; Pregnancy in Diabetics - physiopathology; Pregnancy. Fetus. Placenta; Vasoconstriction - drug effects; Vasodilator Agents - pharmacology; Human; Subcutaneous; Controlled diabetes; Smooth muscle; Artery; Abdomen; Endothelium; Pregnancy; Resistance; Relaxation; Biopsy; Nitric oxide; Surgery; Prostanoid; Insulin dependent diabetes; Female; Cesarean section; Hyperpolarization
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2002.01353.x

Objective Pregnant women with diabetes mellitus have a higher incidence of adverse pregnancy outcomes. Vascular, and in particular, endothelial function may be significantly modified in diabetes resulting in impaired endothelium‐dependent relaxation. This study aims to investigate endothelium‐dependent relaxation in pregnant women with pre‐existing type 1 diabetes mellitus. Methods Small arteries (mean luminal diameter ∼295 μm) were isolated from biopsies of subcutaneous fat from pregnant women with pre‐existing type 1 diabetes mellitus, non‐diabetic pregnant women, and non‐diabetic non‐pregnant women. Endothelial and smooth muscle function were determined using wire myography, and the contributions of nitric oxide, vasodilator prostanoid and endothelial hyperpolarisation were studied using specific inhibitors. Results Arteries obtained from the diabetic pregnant women did not demonstrate any difference in either endothelial or smooth muscle function when compared with non‐diabetic pregnant women. The contribution of nitric oxide to endothelium‐dependent relaxation was ∼20% in the pregnant women regardless of whether they were diabetic, and ∼11% in the non‐pregnant women. Endothelial hyperpolarisation appeared to contribute largely to vasorelaxation in human subcutaneous arteries, and was at least twice that of nitric oxide in pregnant women and fivefold greater in non‐pregnant women. Conclusions This study provides evidence that pregnant women with well‐controlled pre‐existing type 1 diabetes mellitus have both normal endothelial and smooth muscle function. Endothelium‐dependent hyperpolarisation appears to play a large role in vascular relaxation in human subcutaneous resistance arteries. This study suggests that the problems associated with diabetic pregnancies are unlikely to be due to vascular dysfunction.