Impaired Uterine Contractility Associated With Diabetes

Women with diabetes can bring a host of medical complications to their pregnancy. Recently, research has shown that cesarean section rates are higher in women with diabetes, and some estimates note that more than half of those C-sections are emergency operations and not elective procedures. With an increased risk of such adverse effects as wound infection, thrombosis and postpartum hemorrhage for women with diabetes who have C-sections, a better understanding of the link between diabetes and high rate of C-sections is needed.

To address this question, researchers sought to explore the contractility of myometrium and whether it is impaired in women whose pregnancies are complicated by diabetes. The researchers looked at pregnant patients with diabetes (gestational diabetes N= 22; type 1 diabetes N=18) and women without diabetes (N=68). At the time of elective delivery via C-section, lower segment biopsies were taken for analysis.

Overall, the researchers noted significantly reduced contractility in women with diabetes as compared to patients without diabetes. Contractions in the women with diabetes were more likely to be smaller and shorter in duration as compared with their counterparts without diabetes.

Upon further investigation, the researchers found that calcium channel expression and signaling were reduced in the women with diabetes. Specifically, the study authors noted reduced relative abundance of L-type calcium channel immunoreactivity in diabetic myometrial samples as compared with age-matched samples from patients without diabetes. Their analysis revealed that spontaneous contractions and their accompanying calcium transients were significantly lower in patients with diabetes compared with that in patients without diabetes.

Reduced contractility was found in the women with diabetes even in the presence of oxytocin. While oxytocin increased contractions in both groups of women, the contractility remained significantly reduced in the women with diabetes when compared with the effects of oxytocin in patients without diabetes.

“Our data point to both histological and cellular changes occurring in diabetic patients that compound to reduce contractility, and Ca2+ signaling,” they wrote. “Our data suggest that in labour, myometrial activity will be poorer in diabetic patients and will lead to an increase risk of CS [C-section] even when controlling for other factors such as obesity and hypertension.”

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References:

Reference:
Al-Qahtani S, Heath A, Quenby S, et al. Diabetes is associated with impairment of uterine contractility and high Caesarean section rate. Diabetologia. 2012;55(2):489-98 [Epub].