Impaired vascular function in gestational diabetes: evidence for metabolic memory, endothelial dysfunction and altered smooth muscle cell biology.

Gestational diabetes mellitus (GDM) is a common, inflammatory complication during pregnancy. Women who have GDM are more likely to develop metabolic or cardiovascular disease in the years post-delivery, as are their children. The umbilical cord and placenta provide a unique interface between maternal and foetal circulation and are richly vascularised. However, the molecular and cellular mechanisms that drive metabolic memory and cardiovascular dysfunction in GDM are incompletely understood. This article highlights the clinical presentation of cardiovascular disease post-GDM from mother and child. We investigate histological changes in the vasculature of the umbilical cord and the placenta, and the mechanistic changes in vascular smooth muscle cell and endothelial cell behaviour that may underpin clinical cardiovascular presentations. Finally we suggest areas for future research to increase mechanistic knowledge in this area, which may lead to new personalised medicine approaches for early intervention after delivery to minimise the long-term detrimental effect of GDM on cardiovascular health.