Skip to main content
SpringerLink
Log in

Assessment of the Fetal Myocardial Performance Index in Well-Controlled Gestational Diabetics and to Determine Whether It Is Predictive of Adverse Perinatal Outcome

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

This study was aimed at determining if the myocardial performance index (MPI) is altered in well-controlled gestational diabetics and if so whether it is predictive of adverse perinatal outcome. In a prospective cross-sectional study, 54 consecutive women with well-controlled gestational diabetes controlled on insulin or metformin in the third trimester were recruited and matched with 54 women with normal pregnancies (control group). Using Doppler echocardiography, the MPI was calculated. Sonographic biophysical and placental resistance Doppler markers in both groups were also determined. An abnormal outcome was defined as any of the following: stillbirth; neonatal death; neonatal intensive care admissions; tachypnea with pulmonary edema; neonatal cord pH < 7.15; 5-min Apgar score < 7, polycythemia; and nucleated red blood cells > 10/100 white blood cell counts, hypoglycemia. The MPI was significantly higher in the diabetic group compared to controls (p < 0.0001). Rate of adverse outcome was 22% in the diabetic group. The diabetic group with adverse outcomes had significantly elevated MPI values compared to the diabetic group with normal outcomes. There were 26 diabetics controlled on metformin and 28 controlled on insulin. The adverse outcome rate was slightly higher in the IDDM group compared to the non-insulin-dependent group but was not statistically significant. The main adverse outcomes were low Apgars (18%), hypoglycemia (22%), polycythemia (13%) and low pH in 7%. All control births had normal outcomes. MPI served as an independent predictor of adverse outcome. The MPI z-score had a good diagnostic accuracy as evidenced by the area under the ROC curve of 0.83. An MPI z-score exceeding 4.55 conferred a 90% sensitivity and 74% specificity, with 77% of outcomes correctly classified with a likelihood ratio of 3.5. The MPI is impaired in fetuses in well-controlled gestational diabetes, with fetuses with an adverse outcome having significantly higher MPI values compared to the fetuses with normal outcome in the diabetic group. MPI has the potential to improve fetal surveillance in gestational diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Salvesen DR, Brunedell JM, Proudler A et al (1993) Fetal pancreatic beta-cell function in pregnancies complicated by maternal diabetes mellitus. Am J Obstet Gynecol 168:1363–1369

    Article  CAS  PubMed  Google Scholar 

  2. Wong SF, Chan FY, Cincotta RB et al (2003) Use of umbilical artery Doppler velocimetry in the monitoring of pregnancy in women with pre-existing diabetes. Aust N Z J Obstet Gynaecol 43:302–306

    Article  PubMed  Google Scholar 

  3. Wong SF, Petersen SG, Idris N et al (2010) Ductus venosus velocimetry in monitoring pregnancy in women with pregestional diabetes mellitus. Ultrasound Obstet Gynecol 36:350–354

    Article  CAS  PubMed  Google Scholar 

  4. Tei C, Ling C, Hodge DO (1995) New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function: a study in normal and dilated cardiomyopathy. J Cardiol 26:357–366

    CAS  PubMed  Google Scholar 

  5. Tei C (1995) New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol 26:135–136

    CAS  PubMed  Google Scholar 

  6. Tei C, Dujardin KS, Hodge DO (1996) Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 9:838–847

    Article  CAS  PubMed  Google Scholar 

  7. Bhorat IE, Bagratee JS, Reddy T. Gestational age-adjusted trends and reference intervals for the modified myocardial performance index (Mod-MPI) with its interpretation in the context of established cardiac physiological principles. Prenat Diag. https://doi.org/10.1002/pd.4414

    Article  Google Scholar 

  8. Rizzo G, Aarduini D, Romanini C (1991) Cardiac function in fetuses of type 1 diabetic mothers. Am J of Obstet Gynecol 164:837–843

    Article  CAS  Google Scholar 

  9. Rizzo G, Pietropolli A, Capponi A et al (1994) Analysis of factors influencing ventricular filling patterns in fetuses of type 1 diabetic mothers. J Perinat Med 22:149–157

    Article  CAS  PubMed  Google Scholar 

  10. Veille JC, Hanson R, Sivakoff M, Hoen H, Ben-Ami M (1993) Fetal cardiac size in normal, intrauterine growth retarded, and diabetic pregnancies. Am J Perinatol 10:275–279

    Article  CAS  PubMed  Google Scholar 

  11. Mehta S, Nuamah I, Kalhan S (1991) Altered diastolic function in asymptomatic infants of mothers of gestational diabetes. Diabetes 40(Suppl 2):56–60

    Article  PubMed  Google Scholar 

  12. Bhorat IE, Bagratee JS, Pillay M, Reddy T. Use of the myocardial performance index as a prognostic indicator of adverse fetal outcome in poorly controlled gestational diabetic pregnancies. Prenat Diag https://doi.org/10.1002/pd.4471

    Article  Google Scholar 

  13. Bhorat I, Pillay M, Reddy T (2017) Determination of the fetal myocardial performance index in women with gestational impaired glucose tolerance and to assess whether this parameter is a possible prognostic indicator of adverse fetal outcome. J Matern Fetal Neonatal Med 5:2. https://doi.org/10.1080/14767058.2017.1334047

    Article  Google Scholar 

  14. Alberti K, Zimmett P (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15:539–553

    Article  CAS  PubMed  Google Scholar 

  15. Hernandez-Andrade E, Figuero-Diesel H, Kottman C et al (2007) Gestational-age adjusted reference values for the modified myocardial performance index for evaluation of left fetal cardiac function. Ultrasound Obstet Gynecol 29:321–325

    Article  CAS  PubMed  Google Scholar 

  16. Cruz-Martinez R, Figueras F, Bennasar M et al (2012) Normal reference ranges from 11–14 week gestation of fetal left modified myocardial performance index by concentional doppler with the use of stringent criteria for delimitation of time periods. Fetal Diagn and Ther 32:79–86

    Article  CAS  Google Scholar 

  17. Meriki N, Izurieta A, Welsh AW (2012) Fetal left modified myocardial performance index: technical refinements in obtaining pulse Doppler waveforms. Ultrasound Obstet Gynecol. 39:421–429

    Article  CAS  PubMed  Google Scholar 

  18. Jopling J, Henry E, Wiedmeier SE, Christensen RD (2009) Reference ranges for hematocrit and blood hemoglobin concentration during the neonatal period: data from a multihospital health care system. Pediatrics 123(2):e333–e337

    PubMed  Google Scholar 

  19. Kates EH, Kates JS (2007) Anemia and polycythemia in the newborn. Pediatr Rev. 28(1):33–34

    Article  PubMed  Google Scholar 

  20. Bradley RJ, Brudenell JM, Nicolaides KH (1991) Fetal acidosis and hyperlacticemia diagnosed by cordocentesis in pregnancies complicated by maternal diabetes mellitus. Diabet Med 8:464–468

    Article  CAS  PubMed  Google Scholar 

  21. Salvesen DR, Brudenell JM, Nicolaides KH (1992) Fetal polycythaemia and thrombocytopaenia in pregnancies complicated by diabetes mellitus. Am J of Obstet Gynecol 166:1287–1292

    Article  CAS  Google Scholar 

  22. Salvesen DR, Brudenell JM, Nicolaides KH (1993) Fetal plasma erythropoietin in pregnancies complicated by maternal diabetes mellitus. Am J Obstet Gynecol 168:88–94

    Article  CAS  PubMed  Google Scholar 

  23. Jaeggi ET, Fouron JC, Proulx F (2001) Fetal cardiac performance in uncomplicated and well controlled maternal type 1 diabetes. Ultrasound Obstet Gynecol 17:311–315

    Article  CAS  PubMed  Google Scholar 

  24. Weber HS, Copel JA, Reece EA, Green J, Kleinman CS (1991) Cardiac growth in foetuses of diabetic mothers with good metabolic control. J Pediatr 118:103–107

    Article  CAS  PubMed  Google Scholar 

  25. Gandhi JA, Zhang XY, Maidman JE (1995) Fetal cardiac hypertrophy and cardiac function in diabetic pregnancies. Am J Obstet Gynecol 173:1132–1136

    Article  CAS  PubMed  Google Scholar 

  26. Weiner Z, Zloczower M, Lerner A et al (1999) Cardiac compliance in fetuses of diabetic women. Obstet Gynecol 93:948–951

    CAS  PubMed  Google Scholar 

  27. Nicolaides KH, Rizzo G, Hecher K (2000) Placental and fetal Doppler. The Parthenon Publishing Group, London, pp 128–129

    Book  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Subdepartment of Fetal Medicine, University of Kwa-Zulu Natal, Durban, South Africa

    Ismail Bhorat & Morgan Pillay

  2. Biostatistics Unit, South African Medical Research Council of South Africa, Durban, South Africa

    Tarylee Reddy

  3. Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, 719 Umbilo Rd, Durban, South Africa

    Ismail Bhorat

Authors
  1. Ismail Bhorat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Morgan Pillay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tarylee Reddy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ismail Bhorat.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and research committee (Ethical approval was obtained from the Biomedical Research Ethics Committee at the University of Kwa-Zulu Natal – BE 228) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bhorat, I., Pillay, M. & Reddy, T. Assessment of the Fetal Myocardial Performance Index in Well-Controlled Gestational Diabetics and to Determine Whether It Is Predictive of Adverse Perinatal Outcome. Pediatr Cardiol 40, 1460–1467 (2019). https://doi.org/10.1007/s00246-019-02158-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-019-02158-4

Keywords

Search

Navigation