Abstract
We investigated cardiac function in 67 fetuses of gestational diabetic mothers (FGDMs) and 122 fetuses of healthy mothers between 24 and 36 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. Fetal echocardiograms were performed at 24, 28, 32, and 36 weeks of gestation. Glycated hemoglobin (HbA1c) levels were obtained from all pregnant women at 24 weeks of gestation. The mean age of diabetic pregnant women was significantly greater than that of controls. Serum HbA1c values of both groups were within normal limits, but they were significantly greater in the diabetic group (p = 0.003). The increase in peak aortic and pulmonary artery velocities were greater in FGDM (p < 0.001). No pathological interventricular septal (IVS) hypertrophy was observed. There was a significant increase in IVS thickness in FGDM compared with controls, which was more prominent at the end of the third trimester (p < 0.001). During the course of pregnancy, mitral E-wave (p < 0.001), A-wave (p = 0.007), tricuspid E-wave (p < 0.001) and A-wave (p = 0.002) velocities were greater in FGDM. The increases in mitral E/A and tricuspid E/A ratios were lower in FGDM with advancing gestation. The E a-wave (p = 0.02), A a-wave (p = 0.04), and S a-wave (p < 0.001) velocities of the right-ventricular (RV) free wall and the E a (p = 0.02) and A a (p = 0.01) velocities of the left-ventricle (LV) posterior wall were greater in FGDM during the course of pregnancy. The E a/A a ratio of the RV posterior wall was greater in FGDM with advancing gestation (p < 0.03). LV and RV E/E a ratios were similar in both groups. The LV myocardial performance index measured by pulsed-wave Doppler was greater in FGDM (p < 0.001). We detected diastolic dysfunction in FGDM. The data suggest that gestational diabetes mellitus may impair ventricular diastolic functions without causing pathological fetal myocardial hypertrophy. We detected subclinical diastolic dysfunction using both pulsed-wave and tissue Doppler imaging in FGDM.
Similar content being viewed by others
References
American Diabetes Association (2002) Preconception care of women with diabetes. Diabetes Care 28:82–84
Api O, Emeksiz MB, Api M, Ugurel V, Unal O (2009) Modified myocardial performance index for evaluation of fetal cardiac function in pre-eclampsia. Ultrasound Obstet Gynecol 33:51–57
Corrigan N, Brazil DP, McAuliffe F (2009) Fetal cardiac effects of maternal hyperglycemia during pregnancy. Birth Defects Res A 85:523–530
Dawid G, Węgrzynowski J, Kwiatek M, Biczysko-Mokosa A, Petriczko E, Horodnicka-Józwa A (2010) A fetal dilated and hypertrophic cardiomyopathy associated with maternal gestational diabetes a case report. Pediatr Endocrinol Diabetes Metab 16:123–125
Desoye G, Shafrir E (1996) The human placenta in diabetic pregnancy. Diabetes Rev 4:70–89
Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I et al (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458
Gandhi JA, Zhang XY, Maidman JE (1995) Fetal cardiac hypertrophy and cardiac function in diabetic pregnancies. Am J Obstet Gynecol 173:1132–1136
Garcia-Flores J, Jañez M, Gonzalez MC, Martinez N, Espada M, Gonzalez A (2011) Fetal myocardial morphological and functional changes associated with well-controlled gestational diabetes. Eur J Obstet Gynecol Reprod Biol 154:24–26
Hatém MA, Zielinsky P, Hatém DM, Nicoloso LH, Manica JL, Piccoli AL et al (2008) Assessment of diastolic ventricular function in fetuses of diabetic mothers using tissue Doppler. Cardiol Young 18:297–302
Hernandez-Andrade E, López-Tenorio J, Figueroa-Diesel H, Sanin-Blair J, Carreras E, Cabero L et al (2005) A modified myocardial performance (Tei) index based on the use of valve clicks improves reproducibility of fetal left cardiac function assessment. Ultrasound Obstet Gynecol 26:227–232
Langer O, Conway DL (2000) Level of glycemia and perinatal outcome in pregestational diabetes. J Matern Fetal Med 9:35–41
Macklon NS, Hop WCJ, Wladimiroff JW (1998) Fetal cardiac function and septal thickness in diabetic pregnancy: a controlled observational and reproducibility study. Br J Obstet Gynaecol 105:661–666
Nii M, Roman KS, Kingdom J, Redington AN, Jaeggi ET (2006) Assessment of the evolution of normal fetal diastolic function during mid and late gestation by spectral Doppler tissue echocardiography. J Am Soc Echocardiogr 19:1431–1437
Ren Y, Zhou Q, Yan Y, Chu C, Gui Y, Li X (2011) Characterization of fetal cardiac structure and function detected by echocardiography in women with normal pregnancy and gestational diabetes mellitus. Prenat Diagn 31:459–465
Rizzo G, Arduini D, Romanini C (1992) Accelerated cardiac growth and abnormal cardiac flow in fetuses of type I diabetic mothers. Obstet Gynecol 80:369–376
Rizzo G, Arduini D, Capponi A, Romanini C (1995) Cardiac and venous blood flow in fetuses of insulin-dependent diabetic mothers: evidence of abnormal hemodynamics in early gestation. Am J Obstet Gynecol 173:1775–1781
Russell NE, Foley M, Kinsley BT, Firth RG, Coffey M, McAuliffe FM (2008) Effect of pregestational diabetes mellitus on fetal cardiac function and structure. Am J Obstet Gynecol 199:312
Schafer G, Veter K (1999) Diabetes and pregnancy. Ther Umsch 56:572–576
Tsutsumi T, Ishii M, Eto G, Hota M, Kato H (1999) Serial evaluation for myocardial performance in fetuses and neonates using a new Doppler index. Pediatr Int 41:722–727
Weiner Z, Zloczower M, Lerner A, Zimmer E, Itskovitz-Eldor J (1999) Cardiac compliance in fetuses of diabetic women. Obstet Gynecol 93:948–951
Wong ML, Wong WH, Cheung YF (2007) Fetal myocardial performance in pregnancies complicated by gestational impaired glucose tolerance. Ultrasound Obstet Gynecol 29:395–400
Zielinsky P, Nicoloso LH, Firpo C, Marcantonio S, Scheid M, Gus EI et al (2004) Alternative parameters for echocardiographic assessment of fetal diastolic function. Braz J Med Biol Res 37:31–36
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Balli, S., Pac, F.A., Ece, İ. et al. Assessment of Cardiac Functions in Fetuses of Gestational Diabetic Mothers. Pediatr Cardiol 35, 30–37 (2014). https://doi.org/10.1007/s00246-013-0734-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-013-0734-0