Impact of Gestational and Pre-Gestational Diabetes Mellitus on the Foetal Heart (original) (raw)
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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...
Cardiac function in gestational diabetes mellitus: A longitudinal study from fetal life to infancy
2020
Objective: To determine whether cardiac functional and structural changes in fetuses of mothers with gestational diabetes mellitus (GDM) persist in the offspring beyond the neonatal period. Design: Longitudinal study Setting: Fetal Medicine Unit in a UK teaching hospital Population: 73 women with GDM and 73 women with uncomplicated pregnancy were recruited and fetal cardiac scans were performed at 35-36 weeks' gestation. Repeat echocardiogram was performed in their offspring during infancy. Main outcome measures: Fetal and infant cardiac functional and structural changes Results: Fetuses of mothers with GDM, compared to controls, had more globular right ventricles (sphericity index 0.7, IQR 0.6/0.7 vs 0.6, IQR 0.5/ 0.6, p<0.001) and reduced right global longitudinal systolic strain (-16.4, IQR-18.9/-15.3 vs-18.5, IQR-20.6/-16.8, p=0.001) and left global longitudinal systolic strain (-20.1, IQR-22.5/-16.9 vs-21.3, IQR-23.5/-19.5), p=0.021). In the GDM group, compared to controls, in infancy there was higher left ventricular E/e' (
Einstein, 2008
einstein. 2008; 6(1): [42][43][44][45][46][47][48][49][50] Diabetes and pregnancy: analysis of pregnant women submitted to fetal echocardiography during a ten-year period Diabetes e gestação: análise das gestantes submetidas à ecocardiografia fetal em um período de dez anos aBStract Objectives: To analyze diabetic pregnant women who underwent fetal echocardiography , from April 1993 to December 2003, and to identify the fetal echocardiographic abnormalities and postnatal outcome. Methods: A retrospective cross-sectional study of 178 diabetic pregnant women who underwent fetal echocardiography. Clinical and laboratory maternal, fetal echocardiographic, delivery and newborn variables were studied. Means were calculated for quantitative variables and percentages for qualitative variables. Analysis of variance, Student's t test and the Dunnet's test were used. The adopted level of significance was p < 0.05. results: There were 20,493 deliveries in the period considered, of which 380 were of diabetic mothers and 178 of them were studied. Mean age was 33.7 years (± 5.0). The mean body mass index (BMI) at the first prenatal appointment was 28.0 kg/m 2 . The majority (84.8%) underwent fetal echocardiography at ≥ 28 weeks of gestation. Nine cases of interventricular septum hypertrophy were found (5.1%), three cases (1.7%) of cardiac malformation were identified, one of which was a false-positive and, among the normal cases, one false-negative was identified. Six stillbirths occurred, three from women with gestational diabetes (2.4%) and three from type 2 diabetics (6.3%, p = 0.305). The rates of major congenital malformations among gestational and type 2 diabetes were 5.6 and 10.4%, respectively (p = 0,322). conclusions:
Iranian Journal of Pediatrics
Objectives: To evaluate fetal cardiac changes in gestational diabetic mothers, compared to healthy ones by means of different indices and to determine which index can first represent the alterations. Methods: The study was conducted as an observational cross-sectional study, including 25 pregnant women with gestational diabetes as the cases and 50 healthy pregnant women as the controls. The preload index, left and right side myocardial performance index (MPI), Interventricular septal hypertrophy, the left and right side cardiac output were assessed in all the patients. Results: The gestational ages were 31.65 ± 8.02 and 31.64 ± 5.37 weeks in case and control group respectively, without any significant difference. Both of the left and right ventricular MPI did not differ statistically between the case and controls. The cases had a greater Interventricular septal hypertrophy but the cardiac output was similar. The preload index was higher in the fetuses of the gestational diabetic mothers. Conclusions: In our study, the MPI did not show any difference between the fetuses of the gestational diabetic mothers and nondiabetic ones; but, fetuses of gestational diabetic mothers had a greater value of PLI, representing early diastolic function changes in right heart even before the overt heart failure occurred. This could be a sign of vasculopathy in gestational diabetic mothers.
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.
Background and objectives: Despite advances in prenatal care, there is a high rate of morbidity and mortality in infants of diabetic mothers. Interventricular septal hypertrophy is a well-known congenital heart abnormality in neonates of mothers with gestational diabetes. In this study, we investigate the effect of gestational diabetes mellitus on interventricular septum thickness. Methods: In this cross-sectional cohort study, 42 neonates from mothers with gestational diabetes mellitus and 42 neonates from non-diabetic mothers were selected from gynecology ward of Sayyad Shirazi Hospital in Gorgan (Iran) between April 2016 and April 2017. Ventricular septum thickness in neonates was measured by M-mode echocardiography. Comparison of septum thickness and frequency of septal hypertrophy between the two groups was performed using t-test, Mann-Whitney test and chi-square test. All statistical analyses were preformed in SPSS 16 at significance level of 0.05. Results: The mean septum thickness was 4.51±1.58 mm in newborns of non-diabetic mothers and 5.84±1.44 mm in newborns of diabetic mothers (P<0.001). Septal hypertrophy (thickness of ≥6 mm) was significantly more common in newborns of diabetic mothers (P=0.029). In addition, we found no significant difference in septum thickness between newborns of diabetic mothers receiving diet or insulin therapy. Conclusion: Overall, our findings suggest that there is a significant correlation between gestational diabetes and ventricular septal hypertrophy. In addition, glycemic control with diet or insulin therapy has no significant impact on septum thickness.
Ultrasound in Obstetrics & Gynecology, 2017
Objectives: Some pregnant women with congenital heart disease have cardiac insufficiency and pulmonary artery hypertension. The complication during perinatal period is higher than normal people. The newborns often occur premature birth, low birth weight, asphyxia and so on. In this study, we sought to analyse the condition of pregnant women with congenital heart disease during perinatal period and newborns. Methods: A total of 456 pregnant women with congenital heart disease at Beijing An Zhen Hospital/Beijing Heart and Lung Institute from 2006 to 2016 were retrospectively reviewed. The clinical and echocardiographic data were analysed. The echocardiographic findings were compared with pregnancy outcome. Results: The most common congenital heart disease of the 456 patients is atrial septal defect (n=258, 56.6%), ventricular septal defect (n=63, 13.8%) and patent ductus arteriosus (n=42, 9.2%). The numbers of patients with NYHA I, II, III, and IV were 69, 285, 102 and 12, respectively. The numbers of patients with low birth weight infant is higher in type III/IV than type I/II (p<0.001). The numbers of patients with various degree of pulmonary hypertension, i.e. severe, moderate and mild were 57, 27 and 120, respectively. The numbers of low birth weight infant is higher in severe/moderate than mild pulmonary hypertension. 3 women were died after labour (0.65%). The numbers of natural labour, Caesarean section and pregnancy termination were 1(3.1%), 372(81.6%)and 24(5.2%), respectively. The weight of newborn is 2953±529g. Apgar score were 10 (n=390, 86.1%), 9 (n=27, 5.9%), 8 (n=6, 1.3%), 7 (n=6, 1.3%) and 4 (n=3, 0.6%). Conclusions: Echocardiography can be used to assess the heart structure and function for pregnant women with congenital heart disease and to evaluate NYHA classification, ejection fraction, and pulmonary hypertension in this group of patients. EP17.02 Third trimester non-invasive evaluation of maternal cardiac function in gestational diabetes