Gestational Diabetes Mellitus (GDM) is a metabolic disease,
first detected during gestation and can lead to greater changes when compared to
normoglycemic pregnancy. The literature demonstrates relations to pregnancy-specific
urinary incontinence (PS-UI) with pelvic floor myopathy (PFMi) has been associated with
GDM. Thus, the aim of this study was identify biochemical and functional variables present in
women positive for the triad, GDM, PFMi and PS-UI (G-Triad) as compared to control women
(G-nonTriad).

This cross-sectional study was
conducted and was approved by the Ethical Committee of Botucatu (CAAE 82225617.0.0000.5411). Written informed consent was obtained from all participants after
careful explanation of all research procedures. Pregnant women between 24 and 38 weeks
gestation and ages 19-40 years old were included. Subjects completed a questionnaire of
personal, clinical and obstetric information and about urinary incontinence, were examined to
diagnosis GDM using the 75g oral glycemic tolerance test (75g-OGTT ≥92 mg/dL or 1 hour
≥180 mg/dL or 2 hours ≥153 mg/dL) and for analysis of circulating concentrations of
relaxin-2, insulin, glucose, calcium, calcitonin, parathormone, vitamin D, cortisol, magnesium,
sodium, potassium, zinc, iron and phosphorus. Bidigital palpation of the pelvic floor using
PERFECT scheme and electromyography (modified Glazer protocol) were performed.
Assessment of PFM strength (Modified Oxford Scale) was measured to characterize
myopathy.

The IBM SPSS Statistics 20.0 software was used for statistical analysis,
applying the t-test for independent samples. Differences with p < 0.05 were considered
significant. Among all participants included (n = 126) initially allocated, 69 women were in the
G-non-Triad and 57 women were in the G-Triad. The G-Triad group had a higher
pre-gestational and gestational BMI (p=0.001), glycemic levels (p=0.001), calcium
concentration (p=0.000) and sustained contractions for 10 seconds in electromyography
(p=0.039). The G-non-Triad group had higher muscular strength and relaxin-2 concentration
(p=0.001).

To our knowledge, there are no previous studies that
have evaluated and analyzed differences between a triad composed of GDM, PS-UIand
MiPF (G-Triad) and a control group (G-non-Triad) of normoglycemic pregnant women,
without PS-UI, whose PFM strength was equal to or greater than three during a bidigital
palpation assessment. However, the results of the study corroborate previous findings that
associate increased pre-gestational and gestational BMI with GDM and PS-UI, with pregnant
women with higher BMI being at greater risk for these conditions. The G-Triad group,
composed of pregnant women with GDM, PFMi and PS-UI, presented higher glycemic levels
and lower force in PFM contractions, which may predispose to pelvic floor dysfunctions, such
as PS-UI. Regarding biomarkers, pregnant women in the G-Triad group had lower levels of
relaxin-2, associated with pelvic floor function, which may explain the higher prevalence of
UI. On the other hand, there was an increase in calcium levels in the G-Triad group,
suggesting inadequate calcium regulation, which may negatively impact muscle function.
These findings reinforce the importance of monitoring pregnant women with GDM to prevent
complications associated with pelvic floor dysfunction.

Women
positive for the G-Triad women are significantly different from G-nonTriad women in biochemical and functional variables.

Sartorão Filho CI, Pinheiro FA, Prudencio CB, Nunes SK, Takano L, Enriquez EMA, et al. Impact of gestational diabetes on pelvic floor: A prospective cohort study with three-dimensional ultrasound during two-time points in pregnancy. Neurourol Urodyn. 2020 Nov;39(8):2329–37.
Prudencio CB, Rudge MVC, Pinheiro FA, Sartorão Filho CI, Nunes SK, Pedroni CR, et al. Negative impact of gestational diabetes mellitus on progress of pelvic floor muscle electromyography activity: Cohort study. PLoS One [Internet]. 2019 Nov 1 [cited 2021 Jan 15];14(11). Available from: https://repositorio.unesp.br/handle/11449/199622
Prudencio CB, Nunes SK, Pinheiro FA, Filho CIS, Antônio FI, de Aquino Nava GT, et al. Relaxin-2 during pregnancy according to glycemia, continence status, and pelvic floor muscle function. Int Urogynecol J. 2022;33(11):3203–11.