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Assessment of Cardiac Function in Fetuses of Gestational Diabetic Mothers During the Second Trimester

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Abstract

Fetuses of diabetic mothers may have structural or functional cardiac abnormalities which increase morbidity and mortality. Isolated functional abnormalities have been identified in the third trimester. The aim of the present study was to assess fetal cardiac function (systolic, diastolic, and global myocardial performance) in the second trimester in mothers with gestational diabetes, and also to relate cardiac function with glycemic control. Mothers with gestational diabetes mellitus referred for fetal cardiac evaluation in the second trimester (between 19 and 24 weeks) from March 2015 to February 2016 were enrolled as case subjects in this study. Non-diabetic mothers who had a fetal echocardiogram done between 19 and 24 weeks for other indications were enrolled as controls. Functional cardiac variables showed a statistically significant difference in isovolumetric relaxation and contraction times and the myocardial performance index and mitral E/A ratios in the gestational diabetic group (p = 0.003). Mitral annular plane systolic excursion was significantly less in the diabetic group (p = 0.01). The only functional cardiac variable found abnormal in mothers with poor glycemic control was the prolonged isovolumetric relaxation time. Functional cardiac abnormalities can be detected in the second trimester in fetuses of gestational diabetic mothers and timely intervention can improve postnatal outcomes.

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References

  1. Fouda UM, El Kassen MMA, Hefny SM, Fouda RM, Hashem AT (2013) Role of fetal echocardiography in the evaluation of structure and function of fetal heart in diabetic pregnancies. J Maternal-Fetal Neonatal Med 26(6):571–575

    Article  Google Scholar 

  2. Nashaat EH, Mansour GM (2010) Uncontrolled diabetes mellitus and fetal heart. Researcher 2(5):47–55

    Google Scholar 

  3. Akhter J, Qureshi R, Rahim F, Khan MA (1996) Diabetes in pregnancy in Pakistani women: Prevalence and complications in an indigenous south Asian community. Diabetic Med 13(2):189–191

    Article  Google Scholar 

  4. To WWK (2011) Applications of doppler studies for fetal surveillance in diabetic pregnancies. In: Radenkovic M (ed) Gestational Diabetes, Chap. 15. InTech, Rijeka, p 264–276. ISBN: 978-953-307-581-5. http://www.intechopen.com/books/gestational-diabetes/applications-of-doppler-studies-for-fetal-surveillance-indiabetic-pregnancies

  5. Hunter LE, Sharland GK (2015) Maternal gestational diabetes and fetal congenital heart disease: an observational study. J Preg Child Health 2:132. doi:10.4172/2376-127X.1000132

    Google Scholar 

  6. 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(3):312.e1-7. doi:10.1016/j.ajog.2008.07.016

    Article  PubMed  Google Scholar 

  7. Jawad F, Irshaduddin PK (1996) Prevalence of gestational diabetes and pregnancy outcome in Pakistan. East Med Health J 2(2):268–273

    Google Scholar 

  8. Weiner Z, Zloczower M, Lerner A, Zimmer E, Itskovitz-Eldor J (1999) Cardiac compliance in fetuses of diabetic women. Obstet Gynecol 93(6):948–951

    CAS  PubMed  Google Scholar 

  9. Ichizuka K, Matsuoka R, Hasegawa J, Shirato N, Jimbo M, Otsuki K, Sekizawa A, Farina A, Okai T (2005) The Tei index for evaluation of fetal myocardial performance in sick fetuses. Early Hum Dev 81:273–279

    Article  PubMed  Google Scholar 

  10. 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(6):1775–1781

    Article  CAS  PubMed  Google Scholar 

  11. Miyake T (2001) Doppler echocardiographic studies of diastolic cardiac function in the human fetal heart. Kurume Med J 48(1):59–64

    Article  CAS  PubMed  Google Scholar 

  12. Balli S, Pac FA, Ece İ, Oflaz MB, Kibar AE, Kandemir Ö (2014) Assessment of cardiac functions in fetuses of gestational diabetic mothers. Pediatr Cardiol 35(1):30–37. doi:10.1007/s00246-013-0734-0 (Epub 2013 Jun 19)

    Article  PubMed  Google Scholar 

  13. Parasuraman R, Osmond C, Howe DT (2013) Gestation-specific reference intervals for fetal cardiac Doppler indices from 12 to 40 weeks of gestation. Open J Obstet Gynecol 3:97–104

    Article  Google Scholar 

  14. Hernandez-Andrade E, Benavides-Serralde JA, Cruz-Martinez R, Welsh A, Mancilla-Ramirez J (2012) Evaluation of conventional Doppler fetal cardiac function parameters: E/A ratios, outflow tracts, and myocardial performance index. Fetal Diagn Ther 32:22–29. doi:10.1159/000330792

    Article  PubMed  Google Scholar 

  15. Reis ZSN, Osanan GC (2011). Congenital cardiopathies screening associated with diabetes mellitus using maternal fructosamine plasma concentration. In: Radenkovic M (ed) Gestational diabetes. InTech, Rijeka. doi:10.5772/21867. http://www.intechopen.com/books/gestational-diabetes/congenital-cardiopathies-screening-associated-with-diabetes-mellitus-using-maternal-fructosamine-plasmaconcentration

  16. Hornberger LK (2006) Maternal diabetes and the fetal heart. Heart 92:1019–1021

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hatém MA, Zielinsky P, Hatém DM, Nicoloso LH, Manica JL, Piccoli AL, Zanettini J, Oliveira V, Scarpa F, Petracco R (2008) Assessment of diastolic ventricular function in fetuses of diabetic mothers using tissue Doppler. Cardiol Young 18(3):297–302. doi:10.1017/S1047951108002138 (Epub 2008 Apr 14)

    Article  PubMed  Google Scholar 

  18. Wong ML, Wong WHS, Cheung YF (2007) Fetal myocardial performance in pregnancies complicated by gestational impaired glucose tolerance. Ultrasound Obs Gyn 29(4):395–400

    Article  CAS  Google Scholar 

  19. Blanchard AC, Fouran JC (1993) Determinants of Doppler flow velocity profile through mitral valve of the human fetus. Br Heart J 70:437–460

    Google Scholar 

  20. Mieghem TV, Hodges R, Jaeggi E, Ryan G (2014) Functional echocardiography in the fetus with non-cardiac disease. Prenat Diagn 34:23–32

    Article  PubMed  Google Scholar 

  21. Nair A, Radhakrishnan S (2016) Fetal left ventricular myocardial performance index: defining normal values for Indian population and a review of literature. Ann Pediatr Cardiol 9(2):132–136

    Article  PubMed  PubMed Central  Google Scholar 

  22. Rizzo G, Arduini D, Romanini C (1992) Accelerated cardiac growth and abnormal cardiac flow in fetuses of type I diabetic mothers. Obstet Gynecol 80(3):369–376

    CAS  PubMed  Google Scholar 

  23. Reis ZSN, Osanan GC (2011). Congenital cardiopathies screening associated with diabetes mellitus using maternal fructosamine plasma concentration. In: Radenkovic M (ed) Gestational diabetes, Chap. 14. InTech, Rijeka, p 264–276. ISBN: 978-953-307-581-5. http://www.intechopen.com/books/gestational-diabetes/applications-of-doppler-studies-for-fetal-surveillance-indiabetic-pregnancies

  24. Chu C, Gui YH, Ren YY, Shi LY (2012). The impact of maternal gestational diabetes mellitus on fetal hearts. Biomed Environ Sci 25(1):15–22

    PubMed  Google Scholar 

  25. Reller MD, Tsang RC, Meyer RA, Braun CP (1985) Relationship of prospective diabetes control in pregnenecy to neonatal cardiorespiratory function. J Pediatr 106(1):86–90

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors acknowledge the statistical assistance provided by Mr Iqbal Azam and the echocardiographic technical assistance by Ms Salima Ashiq Ali and Urooj Fatima.

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Authors and Affiliations

  1. Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan

    Mehnaz Atiq, Anum Ikram, Batool M. Hussain & Bakhtawar Saleem

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  1. Mehnaz Atiq
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  2. Anum Ikram
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  3. Batool M. Hussain
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  4. Bakhtawar Saleem
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Correspondence to Mehnaz Atiq.

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Conflict of interest

The authors declare no conflict of interest. The corresponding (first author) has done the study with the technical help of echocardiography staff and would shoulder the responsibility of the overall integrity of the work. The last 3 authors have collectively contributed to the conception, design, collection of data, and critical revision.

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Informed consent was obtained from all individual participants included in the study.

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Atiq, M., Ikram, A., Hussain, B.M. et al. Assessment of Cardiac Function in Fetuses of Gestational Diabetic Mothers During the Second Trimester. Pediatr Cardiol 38, 941–945 (2017). https://doi.org/10.1007/s00246-017-1600-2

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  • DOI: https://doi.org/10.1007/s00246-017-1600-2

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