OC28.06: Pregnancy complicated by type 1 diabetes, type 2 diabetes and gestational diabetes: maternal hemodynamic assessment and subsequent complications

To identify patients affected by type 1 diabetes (T1DM), type 2 diabetes (T2DM) and gestational diabetes (GDM) at higher risk of obstetric complications during the III trimester of pregnancy throughout the assessment of hemodynamic maternal profile. 92 patients were enrolled for the study: 72 GDM, 9 T1DM and 11 T2DM. We performed hemodynamic parameters throughout the USCOM method at the moment of diagnosis and after 2 and 4 weeks from the diagnosis. Patients were compared according to the treatment (diet or diet + insulin). We found higher total vascular resistence (TVR) in T1 and T2 pregestational diabetes compared to GDM group (1192 ± 272 vs 1055 ± 192). Patients who obtained a good glycemic control with diet showed lower TVR, while patients who needed insulin treatment showed higher TVR. Patients with GDM treated with diet or diet + insulin, showed a decrease in TVR after 4 weeks of therapy. On the other hand, any hemodynamic change was found after 2 and 4 weeks in T1 and T2 diabetes. Patients with complicated labour (pPROM and preterm labour, macrosomia, Caesarean section for fetal distress and PPH) showed higher TVR (1191 ± 220 vs 1028 ± 215) and Potential to Kinetic Ratio (PKR) compared to phisiological labour (31,8 ± 14,1 vs 22,8 ± 9,4). Pregnant women with DM show an altered cardiovascular response to pregnancy, involving both endothelial dysfunction and increased vascular rigidity, as evidenced by increased TVR, decrease in cardiac output, inotropy index and stroke volume. Moreover, patients who develop complications during labour showed a hypodynamic circulation, as evidenced by the high PKR value.