Do maternal haemodynamics have a causal influence on treatment for gestational diabetes?
Background Arterial 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...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2024-12-01
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| Series: | Journal of Obstetrics and Gynaecology |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/01443615.2024.2307883 |
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| author | Abigail R. Anness Michael Foster Mohammed W. Osman David Webb Thompson Robinson Asma Khalil Neil Walkinshaw Hatem A. Mousa |
| author_facet | Abigail R. Anness Michael Foster Mohammed W. Osman David Webb Thompson Robinson Asma Khalil Neil Walkinshaw Hatem A. Mousa |
| author_sort | Abigail R. Anness |
| collection | DOAJ |
| description | Background Arterial 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.Methods We 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.Results 120 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.Conclusions Maternal 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. |
| format | Article |
| id | doaj-art-d0a39e8a49eb48a5a2d316271a99f860 |
| institution | Kabale University |
| issn | 0144-3615 1364-6893 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Obstetrics and Gynaecology |
| spelling | doaj-art-d0a39e8a49eb48a5a2d316271a99f8602025-01-09T12:13:17ZengTaylor & Francis GroupJournal of Obstetrics and Gynaecology0144-36151364-68932024-12-0144110.1080/01443615.2024.2307883Do maternal haemodynamics have a causal influence on treatment for gestational diabetes?Abigail R. Anness0Michael Foster1Mohammed W. Osman2David Webb3Thompson Robinson4Asma Khalil5Neil Walkinshaw6Hatem A. Mousa7Maternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UKDepartment of Computer Science, University of Sheffield, Sheffield, UKMaternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UKDiabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UKCollege of Life Sciences, University of Leicester, Leicester, UKFetal Medicine Unit, St. George’s University Hospital (University of London), UKDepartment of Computer Science, University of Sheffield, Sheffield, UKMaternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UKBackground Arterial 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.Methods We 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.Results 120 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.Conclusions Maternal 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.https://www.tandfonline.com/doi/10.1080/01443615.2024.2307883Gestational diabetesmaternal hemodynamicscardiac outputpulse wave velocityaugmentation indexcausal inference |
| spellingShingle | Abigail R. Anness Michael Foster Mohammed W. Osman David Webb Thompson Robinson Asma Khalil Neil Walkinshaw Hatem A. Mousa Do maternal haemodynamics have a causal influence on treatment for gestational diabetes? Journal of Obstetrics and Gynaecology Gestational diabetes maternal hemodynamics cardiac output pulse wave velocity augmentation index causal inference |
| title | Do maternal haemodynamics have a causal influence on treatment for gestational diabetes? |
| title_full | Do maternal haemodynamics have a causal influence on treatment for gestational diabetes? |
| title_fullStr | Do maternal haemodynamics have a causal influence on treatment for gestational diabetes? |
| title_full_unstemmed | Do maternal haemodynamics have a causal influence on treatment for gestational diabetes? |
| title_short | Do maternal haemodynamics have a causal influence on treatment for gestational diabetes? |
| title_sort | do maternal haemodynamics have a causal influence on treatment for gestational diabetes |
| topic | Gestational diabetes maternal hemodynamics cardiac output pulse wave velocity augmentation index causal inference |
| url | https://www.tandfonline.com/doi/10.1080/01443615.2024.2307883 |
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