BACKGROUND GDM and preeclampsia are common complications of pregnancy, for which overweight/obesity is a common risk factor. Both conditions are associated with a two-to-four-fold increase in future incident heart failure, which may be linked to early maladaptive myocardial changes. OBJECTIVES To determine maternal myocardial structural, functional, and energetic responses to pregnancies complicated by gestational diabetes mellitus (GDM) or preeclampsia compared to healthy pregnancies (HP) at third-trimester of pregnancy and twelve-months postpartum. STUDY DESIGN Thirty-eight women with HP, 30 GDM, 20 preeclampsia, 10 non-pregnant controls with overweight (Overweight-NC) and 10 with normal-weight were recruited. Cardiovascular magnetic resonance spectroscopy and imaging were used to define myocardial energetics (phosphocreatine: ATP ratio [PCr/ATP]), left ventricular (LV) volumes, mass, and ejection fraction and global longitudinal shortening (GLS). Pregnancy groups underwent repeat scans twelve-months postpartum, nulliparous-controls were assessed once. RESULTS During third-trimester, compared to HP, women with either GDM or preeclampsia displayed higher BMI, higher LV-mass (HP:90[85,94]g, GDM:103[96,112], Preeclampsia:118[111,125]g; P=0.001), and lower PCr/ATP (HP:2.2[2.1,2.4], GDM:1.9[1.7,2], Preeclampsia:1.9[1.8,2.1];P=0.0004) and GLS (HP:20[18,21]%, GDM:18[17,19]%, Preeclampsia:16[14,17]%;P=0.01). Post-pregnancy, no group saw significant changes in LV-mass, PCr/ATP or GLS. There were no significant differences in LV-mass, PCr/ATP or GLS between the GDM and preeclampsia groups during or post-pregnancy. Moreover, the Overweight-NC showed no significant differences in LV-mass ( 53[43,63])g, PCr/ATP (2.0[1.8,2.2]) or GLS (-19[17,21]%) compared to GDM or preeclampsia groups during or post-pregnancy. CONCLUSIONS Women with GDM or preeclampsia exhibit similar myocardial phenotypes during pregnancy with persistent subclinical alterations in LV mass, energetics and GLS twelve-months postpartum. These myocardial alterations are similar to those detected in Overweight-NC, potentially suggesting the myocardial changes may predominantly be driven by overweight/obesity.

中文翻译：

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妊娠糖尿病、子痫前期和健康妊娠妇女怀孕期间和怀孕后的心脏结构、功能和能量评估。


背景 GDM 和子痫前期是妊娠的常见并发症，超重/肥胖是常见的危险因素。这两种情况都与未来心力衰竭事件增加 2 到 4 倍有关，这可能与早期适应不良的心肌变化有关。目的 确定与妊娠晚期和产后 12 个月的健康妊娠 （HP） 相比，母体心肌对妊娠糖尿病 （GDM） 或子痫前期妊娠的结构、功能和能量反应。研究设计 招募了 38 名患有 HP、30 例 GDM、20 例子痫前期、10 例超重 （Overweight-NC） 的非妊娠对照和 10 例正常体重的妇女。心血管磁共振波谱和成像用于定义心肌能量学 （磷酸肌酸：ATP 比值 [PCr/ATP]） 、左心室 （LV） 体积、质量和射血分数以及整体纵向缩短 （GLS）。妊娠组在产后 12 个月进行重复扫描，未产妇对照评估一次。结果 在妊娠晚期，与 HP 相比，患有 GDM 或子痫前期的女性表现出更高的 BMI、更高的 LV 质量 （HP：90[85,94]g，GDM：103[96,112]，子痫前期：118[111,125]g;P=0.001），和较低的 PCr/ATP （HP：2.2[2.1,2.4]，GDM：1.9[1.7,2]，子痫前期：1.9[1.8,2.1];P=0.0004）和 GLS （HP：20[18,21]%，GDM：18[17,19]%，子痫前期：16[14,17]%;P=0.01）。妊娠后，没有组看到 LV 质量、 PCr/ATP 或 GLS 的显着变化。GDM 组和子痫前期组在妊娠期间或妊娠后 LV 质量、 PCr/ATP 或 GLS 无显著差异。此外，超重-NC 在 LV 质量 （ 53[43,63]）g、PCr/ATP （2.0[1.8,2.2]）或 GLS （-19[17,21]%） 与 GDM 或子痫前期组相比。结论 GDM 或子痫前期女性在妊娠期间表现出相似的心肌表型，产后 12 个月 LV 质量、能量和 GLS 持续出现亚临床改变。这些心肌改变与在超重-NC 中检测到的相似，可能表明心肌变化可能主要是由超重/肥胖驱动的。