Ambulatory arterial stiffness index in type 1 diabetes mellitus: any different during pregnancy? Finn F. Lauszus a,b, *, Jens Fuglsang b , Anni Rosgaard a , Thea Lousen b , Joachim G. Klebe b a Department of Obstetrics/Gynaecology, Herning Hospital, Denmark b Department of Obstetrics/Gynaecology, Skejby Hospital, Denmark 1. Introduction The ambulatory arterial stiffness index (AASI) and pulse pressure (PP), both computed from repeated 24-h ambulatory blood pressure (BP) recordings, have been proposed as a novel indirect measure of arterial stiffness [1–5]. The AASI was shown to correlate with pulse wave velocity and it can be used to detect arterial dysfunction at a younger age than is achievable by pulse pressure [1]. The AASI predicts cardiovascular death and stroke more precisely than classical risk factors [2,3] and is associated with target organ damage in individuals with arterial hyperten- sion, i.e. left ventricular hypertrophy, carotid artery abnormalities and reduced renal function [4,5]. In diabetic pregnancy reno-vascular co-morbidity may be present and is strongly associated with hypertension, preeclamp- sia, and pregnancy outcome. We have previously studied the variation patterns of BP measurements [6] and suggested that in pregnant women with type 1 diabetes (T1DM) the characteristics of BP depend on the timing of measurements and on repeated measurements. Diabetes itself seems not to play a major role in the performance of BP measurement. We, therefore, found interest in evaluating the use of AASI and PP during pregnancy in T1DM women and a control group of non-diabetic women. Early evaluation in pregnancy carries the potential to influence outcome on the diabetic status and co-morbidity. The aims of this study were (i) to analyze AASI and PP during pregnancy in T1DM and healthy controls and (ii) to explore the relation between BP variation and AASI. Similarly, we compared (iii) AASI and PP in pregnancy with the values after pregnancy in T1DM women. We hypothesized that the dynamic changes in diurnal BP would provide a measure of the stiffness of the arterial wall and a method to evaluate the vasculopathy during pregnancy in women with diabetes. 2. Materials and methods In total, 101 women were included: 42 non-diabetic women and 59 women with T1DM (Table 1). The diabetic women were recruited before pregnancy when possible, while the non-diabetic women were asked at the first ultrasound scan during pregnancy. The diabetic women attended the maternity ward for visits every European Journal of Obstetrics & Gynecology and Reproductive Biology xxx (2013) xxx–xxx A R T I C L E I N F O Article history: Received 18 December 2012 Received in revised form 26 March 2013 Accepted 29 April 2013 Keywords: Pregnancy Diabetes AASI Pulse pressure A B S T R A C T Objective: To analyze the ambulatory arterial stiffness index (AASI) and pulse pressure (PP) during pregnancy and 3 months after delivery in type 1 diabetes mellitus (T1DM) and compare it to healthy pregnant controls. Study design: Prospective, descriptive study of 59 women with T1DM and 42 non-diabetic women. Blood pressure was measured using a portable oscillometry monitor and AASI was calculated as 1 minus the regression slope of diastolic on systolic blood pressure obtained from 24-h monitoring. Main outcome measures were comparisons of the AASI and PP between T1DM women and controls examined during pregnancy, and of the AASI and PP during and after pregnancy in T1DM women. Results: PP and AASI were higher at all times during pregnancy in T1DM compared to postpartum (p < 0.01). AASI and PP were significantly associated with albumin excretion rate when adjusting for retinopathy, preeclampsia, duration of diabetes, HbA1c, age, and BMI. The AASI was positively correlated with night–day ratio in the 1st and 3rd trimesters during pregnancy. No difference was found in AASI compared with non-diabetic controls during pregnancy. Conclusions: AASI and PP increased during diabetic pregnancy and were associated with the women’s albuminuria grade. ß 2013 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Department of Obstetrics/Gynaecology, Herning Hospital, Gl. Landevej 61, DK-7400 Herning, Denmark. Tel.: +45 7843614; fax: +45 78434636. E-mail address: finlau@rm.dk (F.F. Lauszus). G Model EURO-8067; No. of Pages 5 Please cite this article in press as: Lauszus FF, et al. Ambulatory arterial stiffness index in type 1 diabetes mellitus: any different during pregnancy? Eur J Obstet Gynecol (2013), http://dx.doi.org/10.1016/j.ejogrb.2013.04.010 Contents lists available at SciVerse ScienceDirect European Journal of Obstetrics & Gynecology and Reproductive Biology jou r nal h o mep ag e: w ww .elsevier .co m /loc ate/ejo g rb 0301-2115/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ejogrb.2013.04.010