Pelvic floor muscle dysfunction at 3D transperineal ultrasound in maternal exposure to gestational diabetes mellitus: A prospective cohort study during pregnancy

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Pinheiro, Fabiane A. ; Sartorao Filho, Carlos I. ; Prudencio, Caroline B. ; Nunes, Sthefanie K. ; Pascon, Tawana ; Hallur, Ragavendra L. S. ; Takano, Luis ; Enriquez, Eusebio M. A. ; Catinelli, Bruna B. ; Carr, Aline M. ; Junginger, Baerbel ; Rudge, Marilza V. C. ; Barbosa, Angelica M. P. ; Diamater Study Grp

• Document type: Journal article
• Source: NEUROUROLOGY AND URODYNAMICS; v. 41, n. 5, p. 12-pg., 2022-04-14.

Abstract

Aim This study aimed to assess, for the first time, the dynamic morphometry of pelvic floor muscles (PFM) using three-dimensional transperineal ultrasound (3D-TPUS) and its progression at two-time points of gestation between women with and without gestational diabetes mellitus (GDM), and whether the PFM dysfunction is connected to GDM. Methods The study comprised 83 consecutive pregnant women with (n = 38) and without (n = 45) GDM screened at 24-30 and 38-40 weeks of gestation. 3D-TPUS and a mobility test were used to quantify PFM dynamic morphometry during maximum contraction and the Valsalva maneuver. Results When compared to the control group, GDM women had no significant variations in all levator hiatal dimensions at 24-30 weeks of gestation. Meanwhile, women with GDM experienced an increase in levator hiatal area (LHa) (p < 0.000) during PFM contraction and enlargement in LHa (p < 0.001) during Valsalva maneuver (p = 0.010) at 38-40 weeks of gestation. As a result, the mobility index among GDM women had a lower value (p = 0.000). The dynamic morphometry development of PFM in GDM women at two stages during pregnancy revealed a substantial decrease (p = 0.000) in all LHa dimensions of contraction, distension, and mobility. Conclusions Using 3D-TPUS, we found that GDM women had a specific pattern of PFM functional changes in the third trimester of pregnancy. These initial findings revealed alterations in PFM functionality, such as decreased contractility, distensibility, or mobility. This dysfunctional PFM could contribute to the long-term development of pelvic floor dysfunction years after a GDM pregnancy. (AU)

• FAPESP's process: 21/10665-6 - Effectiveness of the pelvic floor muscle training in aquatic ambient on pelvic floor muscle function and pregnancy specific urinary incontinence in pregnant women with Gestational Diabetes Mellitus: a feasibility study to randomized controlled trial
• Grantee: Caroline Baldini Prudencio
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 16/01743-5 - The new gestational triad: hyperglycemia, urinary incontinence (UI) and biomolecular profile as a long-term predictor for UI: a prospective cohort study: translational research with biodevice with stem cells for muscle regeneration in diabetic rats
• Grantee: Marilza Vieira Cunha Rudge
• Support Opportunities: Research Projects - Thematic Grants