Effect of pregestational diabetes mellitus on fetal cardiac function and structure

• Published in: American journal of obstetrics and gynecology 2008-09, Vol.199 (3), p.312.e1-312.e7
• Main Authors: Russell, Noirin E., MRCPI, Foley, Michael, FRCOG, Kinsley, Brendan T., FRCPI, Firth, Richard G., FRCPI, Coffey, Mary, SRN, McAuliffe, Fionnuala M., MD
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; cardiac function; cardiomyopathy; diabetes mellitus; Diabetes Mellitus, Type 1 - physiopathology; Diabetes. Impaired glucose tolerance; Echocardiography, Doppler; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; fetal cardiology; Fetal Heart - diagnostic imaging; Fetal Heart - pathology; Fetal Heart - physiology; Gestational Age; Gynecology. Andrology. Obstetrics; Heart Ventricles - embryology; Heart Ventricles - pathology; Humans; Medical sciences; Myocardial Contraction; Obstetrics and Gynecology; Pregnancy; Pregnancy in Diabetics - physiopathology; Pregnancy Trimester, First - physiology; Pregnancy Trimester, Second - physiology; Pregnancy Trimester, Third - physiology; Prospective Studies; Ultrasonography, Prenatal; Ventricular Function
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2008.07.016

Objective Fetuses of diabetic pregnancy experience cardiomyopathy, the intracardiac cause of which is understood poorly. The aim of this study was to assess the interrelation between cardiac functional and structural changes in fetuses of mothers with pregestational diabetes mellitus. Study Design Twenty-six mothers with pregestational diabetes mellitus were recruited prospectively to have a fetal echocardiogram at 13, 20, and 36 weeks of gestation to assess cardiac function and structure. For comparison, 30 healthy control subjects were recruited at each gestational age. Results In the first trimester, there was evidence of poorer fetal cardiac diastolic function among the diabetic cohort (lower left early/atrial ratio, longer isovolumetric relaxation time and higher left myocardial performance index; P < .05). In the third trimester, the fetal interventricular septum and the right ventricular free wall were thicker in the diabetic cohort ( P < .05). Conclusion In fetuses of pregestational diabetic pregnancy, sonographic evidence of altered cardiac function is evident before ultrasound evidence of cardiac structural changes. This suggests that altered cardiac function may precede cardiac structural changes in fetuses of pregestational diabetic pregnancy.