Sudden unexpected death in infancy: epidemiologically determined risk factors related to pathological classification

OBJECTIVE: Gestational diabetes is associated with increased risk of developing noninsulin-dependent diabetes (NIDDM) later in life. By the time that a diagnosis of NIDDM is established, functional disturbances in the vascular system may be observed. This study was planned to assess macro- and microvascular function in nonpregnant women without signs of diabetes two to four years after a pregnancy complicated with gestational diabetes. DESIGN: Cross-sectional study. SETTING: Vascular research laboratory in the obstetric unit of a university hospital. PARTICIPANTS: Seventeen nonpregnant, healthy women with a history of gestational diabetes and 20 nonpregnant control women of similar age without previous diabetes. METHODS: For quantification of the mechanical properties in large arterial vessels the wall movements of the abdominal aorta and left common carotid artery were recorded with an ultrasonic tracking system. Microvascular perfusion in the skin of the hand and foot was recorded by a laser Doppler technique to assess the vasodilatory response induced by transcutaneous acetylcholine. RESULTS: Women in the gestational diabetes group showed evidence of increased wall stiffness in the common carotid artery and a lower maximum incremental velocity of the pulsatile vessel diameter change in both aorta and carotid artery compared with controls. Acetylcholine induced vasodilatation in both hand and foot was lower in women with previous gestational diabetes compared with controls. CONCLUSION: Abnormal vascular function was found in asymptomatic women with a history of gestational diabetes. It is speculated that these abnormalities might be early evidence of vascular complications associated with subsequent NIDDM.