The Examination of Fetal Myocardium and Maternal and Fetal Features of Pregnancy Complicated By Gestational Diabetes Mellitus (original) (raw)
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Myocardial hypertrophy in fetuses of women with gestational diabetes
Journal of Applied Pharmaceutical Science, 2020
Fetuses of diabetic mothers are known to have structural and functional cardiac changes. There are minuscule data on fetal cardiac changes from the Indian subcontinent. Hence, this study aimed to detect myocardial hypertrophy using 2D and M-mode fetal echocardiography (ECHO) in South Indian women with gestational diabetes mellitus (GDM) in their late phase of pregnancy. We have compared ECHO findings among nondiabetic controls and well-controlled and poorly controlled GDM through a cross-sectional observational study. Myocardial and interventricular septum (IVS) thicknesses were measured at the end of systole and diastole. The study included a total of 247 pregnant women; among them, 152 were diabetics [(well-controlled (n = 74) and poorly controlled (n = 78)], and 95 were nondiabetic controls. Myocardial hypertrophy is evident only beyond 29 weeks of gestation. During 29-34 weeks, myocardial hypertrophy is less severe among those with glycemic control. The fetuses beyond 35 weeks have a consistent and significant progressive thickening of fetal myocardium in all dimensions (p-value < 0.05). The overall thickness of ventricular walls and IVS increases with the diabetic status from nondiabetic controls to poorly controlled GDM women. There is a clear need to explore the perinatal implications of structural changes, considering the huge burden of diabetes in the Indian population.
Congenital Heart Disease in Pregnancies Complicated by Maternal Diabetes Mellitus
Herz, 2010
Purpose: Investigation of the incidence and distribution of congenital structural cardiac malformations among the offspring of mothers with diabetes type 1 and of the influence of periconceptional glycemic control. Methods: Multicenter retrospective clinical study, literature review, and meta-analysis. The incidence and pattern of congenital heart disease in the own study population and in the literature on the offspring of type 1 diabetic mothers were compared with the incidence and spectrum of the various cardiovascular defects in the offspring of nondiabetic mothers as registered by EUROCAT Northern Netherlands. Medical records were, in addition, reviewed for HbA 1c during the 1st trimester. Results: The distribution of congenital heart anomalies in the own diabetic study population was in accordance with the distribution encountered in the literature. This distribution differed considerably from that in the nondiabetic population. Approximately half the cardiovascular defects were conotruncal anomalies. The authors' study demonstrated a remarkable increase in the likelihood of visceral heterotaxia and variants of single ventricle among these patients. As expected, elevated HbA 1c values during the 1st trimester were associated with offspring fetal cardiovascular defects. Conclusion: This study shows an increased likelihood of specific heart anomalies, namely transposition of the great arteries, persistent truncus arteriosus, visceral heterotaxia and single ventricle, among offspring of diabetic mothers. This suggests a profound teratogenic effect at a very early stage in cardiogenesis. The study emphasizes the frequency with which the offspring of diabetes-complicated pregnancies suffer from complex forms of congenital heart disease. Pregnancies with poor 1st-trimester glycemic control are more prone to the presence of fetal heart disease. Zusammenfassung Ziel: Untersuchung von Inzidenz und Verteilung angeborener Herzfehlbildungen bei Kindern von Müttern mit Diabetes mellitus Typ 1 sowie des Einflusses der Glucosewerte der Mutter in der Konzeptionsphase. Methodik: Retrospektive, klinische Multicenterstudie, Literaturübersicht und Metaanalyse. Die Inzidenz und Art der Herzfehlbildungen bei Kindern von Müttern mit Typ-1-Diabetes in der eigenen Patientengruppe und in der Literatur wurden mit der Inzidenz und Art verschiedener kardiovaskulärer Defekte bei Nachkommen nichtdiabetischer, via EUROCAT Northern Netherlands registrierter Mütter verglichen. Zudem wurden die HbA 1C -Werte im 1. Schwangerschaftstrimester analysiert. Ergebnisse: Die Rate angeborener Herzfehlbildungen in der eigenen diabetischen Studienpopulation war vergleichbar mit jener in der Literatur. Die Häufigkeit unterschied sich deutlich von der nichtdiabetischen Gruppe. Ungefähr die Hälfte der verschiedenen kardiovaskulären Defekte waren konotrunkale Fehlbildungen. Die Studie der Autoren zeigte eine bemerkenswerte Zunahme der Wahrscheinlichkeit für viszerale Heterotaxie und Variationen eines singulären Ventrikels in dieser Patientengruppe. Erwartungsgemäß korrelierten erhöhte HbA 1c -Werte im 1. Schwangerschaftstrimester mit erhöhter Inzidenz für verschiedene kardiovaskuläre Defekte. Schlussfolgerung: Diese Studie zeigt ein erhöhtes Risiko für spezifische Herzfehlbildungen, nämlich Transposition der großen Arterien, persistierender Truncus Schlüsselwörter: Angeborene Herzkrankheit · Perikonzeptionelle Glukosekontrolle · Strukturelle kongenitale Herzfehlbildungen
Journal of Advances in Medicine and Medical Research, 2021
Background: The prevalence of maternal hyperglycemic disorders during pregnancy is increasing due to the obesity epidemic and increasing age of the pregnant mothers. This study aimed to assess the cardiac function and structure in fetuses of gestational and pre-gestational mothers suffering diabetes compared to those of healthy mothers using fetal echocardiography. Methods: This cross-sectional study included a total number of 60 pregnant women, they were classified into three equal groups; group I included 20 pregnant women with pre-gestational diabetes mellitus (GDM), group II included 20 pregnant women with GDM, and group III included 20 healthy pregnant women as the control group. These women were subjected to complete history taking, laboratory investigations, and fetal echocardiography evaluation for cardiac function using M mode, 2 dimensional, and pulsed wave Doppler. Results: Interventricular septum (IVS) as well as left ventricular (LV) wall thickness were significantly in...
Impact of Gestational and Pre-Gestational Diabetes Mellitus on the Foetal Heart
2020
Foetal cardiac structural and functional features have been examined in pregnancies diabetic and non-diabetic and healthy pregnancies. During 15.1.17-15.7.17, cardiac structure and function assessment was scheduled of 50 healthy pregnant women, 25 pregnant women with gestational diabetes and 25 with pre-gestational diabetes. The thickness of foetal interventricular septum (IVS) was significantly more in diabetic group as compared to non- diabetics (p < 0.05) but no one was having an IVS > 2 SD from normal. The top velocity of tricuspid E and the ratio of E/A was considerably low in diabetic group (p < 0.05). Values of tricuspid valve Ea and the ratio of Ea/Aa were less in the diabetic group as compared to control group (p<0.05)but there was no considerable difference in between pre-gestational diabetes mellitus and gestational diabetes mellitus (p > 0.05). In diabetic pregnancies the most common structural abnormality is the interventricular septal hypertrophy. No ris...
Myocardial hypertrophy and dysfunction in maternal diabetes
Early human development
Diabetes in pregnancy, both pre-gestational and gestational, is a frequent cause of fetal myocardial hypertrophy, partly due to fetal hyperinsulinism. In fetal life, cardiac function may be impaired, especially during diastole, as a result of decreased left ventricular distensibility and altered left atrial dynamics secondary to myocardial hypertrophy. In neonates, the hypertrophy is a transient disorder, with spontaneous regression of the increased myocardial thickness during the first months of life. Nevertheless, cardiac hypertrophy may be associated with neonatal cardiomegaly and respiratory distress secondary to poor left ventricular compliance. The development of a number of new echocardiographic parameters discussed in this article, and primarily based on the pathophysiological consequences of myocardial hypertrophy, highlight an area of research priority: the assessment of diastolic function in fetuses of diabetic mothers with (and without) myocardial hypertrophy. A score fo...
Congenital Heart Disease and Maternal Diabetes Mellitus
International Journal of Diabetes & Clinical Diagnosis, 2016
Introduction: Diabetes mellitus is a relatively common illness that can complicate pregnancy and result in an increased incidence of congenital malformations. Offspring of diabetic mothers suffering from type IDDM have a fivefold incidence of congenital malformations compared to pregnancies in the general healthy population. Specifically, the pattern of congenital heart disease (CHD) encountered among this group, with an emphasis on abnormalities of laterality, looping and conotruncal septation, suggesting that the maternal metabolic state affects cardiogenesis at a very early stage of the developmental period, prior to 7 weeks of gestation. Although many have been written on the effect of diabetes in pregnant women, less is known for the effects of type II DM and gestational diabetes mellitus (GDM) and its role in provoking CHD. Aim of this paper is to review the literature regarding the types of CHD seen in offspring of mothers suffering from different types of diabetes mellitus, maternal types 1 and 2 and gestational and to comment on the incidences and any differences found in the types of detected CHD. Method: a systematic literature resurge of the last 15 years was reviewed focusing to produce answers on the aims of the study. Conclusions: based on the existing evidence high frequency of CHD can be found in any type of maternal diabetes mellitus. For this reason, we believe that any type of diabetes present in a pregnancy must be a strong indication undergoing specific special fetal cardiac prenatal screening, aiming to detect possible CHD.
Fetal Myocardial Deformation in Maternal Diabetes Mellitus and Obesity
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2016
Experimental evidence suggests that changes in fetal myocardium occur from intrauterine effects of maternal diabetes mellitus and obesity. The aim of this study was to assess fetal cardiac function using two-dimensional speckle-tracking echocardiography (2D-STE) to determine the effects of maternal diabetes and obesity on the fetal myocardium. Comparative cross-sectional evaluation of myocardial function using two-dimensional speckle-tracking echocardiography (2D-STE) in fetuses of mothers with diabetes mellitus (FDM), fetuses of mothers with obesity (FO) and normal fetal controls (FC) was performed at two centers. There were 178 fetuses including 82 FDM, 26 FO and 70 FC that met enrolment criteria. The mean gestation age (weeks) was similar among groups: 25.3 ± 5.1 for FDM, 25 ± 4.6 for FO and 25.1 ± 4.9 for FC. Mean maternal BMI was significantly higher in the FDM and FO groups compared to FC. Statistically significant differences were detected between FDM and FC for global longit...