Estudo da história natural da hipertrofia miocárdica e sua associação com hiperinsulinismo em filhos de mães diabéticas

Zielinsky, Paulo; Costa, M; Oliveira, Leandro Turra; Bonow, Fernanda P.; Silva, Nilza Iracema Telles da; Hagemann, Lauro L.

doi:10.1590/s0066-782x1997001200005

Cited by 15 publications

(16 citation statements)

References 21 publications

(40 reference statements)

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“…prenatal diagnosis of cardiovascular diseases and, in some cases, made intra-uterine treatment possible. 1,2 Doppler echocardiography is a suitable tool for noninvasive evaluation of fetal cardiac diastolic function. [3][4][5] The advent of pulsed wave Doppler has now enabled the assessment of flow through the fetal heart.…”

Section: F Etal Echocardiography Has Improved Thementioning

confidence: 99%

Assessment of diastolic ventricular function in fetuses of diabetic mothers using tissue Doppler

Hatém¹,

Zielinsky²,

Hatem³

et al. 2008

Cardiol Young

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Section: F Etal Echocardiography Has Improved Thementioning

confidence: 99%

Assessment of diastolic ventricular function in fetuses of diabetic mothers using tissue Doppler

Hatém¹,

Zielinsky²,

Hatem³

et al. 2008

Cardiol Young

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“…Fetal myocardial hypertrophy is the most frequent abnormality found in newborns from diabetic mothers, and it may be found in up to 35% of these newborns 13 . The interventricular septum is particularly rich in insulin receptors 14 , which would justify increased hypertrophy in this segment, secondary to myocardial cell hyperplasia and hypertrophy due to the increased synthesis of fat and proteins.…”

mentioning

confidence: 99%

Pulmonary vein pulsatility in fetuses of diabetic mothers: prenatal Doppler echocardiographic study

Zielinsky¹,

Piccoli²,

Teixeira³

et al. 2003

Arq. Bras. Cardiol.

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The incidence of insulin-dependent diabetes mellitus is about 0.8%, and gestational diabetes is 3-5%. Both are evidence of the metabolic disturbances of carbohydrates during pregnancy 1 . The incidence of congenital malformation is 3 to 4 times greater in children from diabetic mothers than in the general population 2 . Among those malformations, 50% are congenital cardiac diseases 3 . Maternal diabetes is a risk factor for congenital heart disease and an indication for fetal echocardiography [4][5][6][7][8][9][10][11][12] .Maternal hyperglycemia and the excess of glucose transferred to the fetus encourage fetal pancreatic islets to increase the production of insulin, leading to hyperinsulinism, which is responsible for fetal complications. Fetal myocardial hypertrophy is the most frequent abnormality found in newborns from diabetic mothers, and it may be found in up to 35% of these newborns 13 . The interventricular septum is particularly rich in insulin receptors 14 , which would justify increased hypertrophy in this segment, secondary to myocardial cell hyperplasia and hypertrophy due to the increased synthesis of fat and proteins.Fetal Doppler echocardiography has increased our knowledge about the cardiocirculatory changes in the prenatal period. Recent studies have shown significant changes in the cardiovascular flow of fetuses from diabetic mothers, especially in pregnancies with inadequate glycemic control 15 .With the introduction of echocardiography, several clinical studies have demonstrated normal patterns of pulmonary venous flow in children and adults through transesophageal and transthoracic echocardiography 16,17 . The use of the pulmonary vein pulsatility index as a parameter for diastolic function evaluation during fetal life has not yet been reported. Thus, we have tested the hypothesis that the pulmonary vein pulsatility index in fetuses from diabetic mothers is greater than that in fetuses from nondiabetic mothers, based on the idea that a less complacent left ventricle would increase presystolic flow impedance in the pulmonary vein, corresponding to the atrial contraction phases. Consequently, it would increase the pulsatility index in this vessel. Objective -To verify the hypothesis that the pulmonary vein pulsatility index is higher in fetuses of diabetic mothers than it is in normal fetuses of nondiabetic mothers. Methods -

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“…This results in rapid foetal growth and offspring born large for gestational age, known as macrosomia. Foetal hyperinsulinemia has also been associated with the development of hypertrophic cardiomyopathy [25, 26]. Insulin has been shown to stimulate fibroblast proliferation [27], which again may lead to increased collagen deposition.…”

Section: Discussionmentioning

confidence: 99%

Cardiomyopathy in Offspring of Pregestational Diabetic Mouse Pregnancy

Dowling

Corrigan

Horgan

et al. 2014

Journal of Diabetes Research

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Purpose. To investigate cardiomyopathy in offspring in a mouse model of pregestational type 1 diabetic pregnancy. Methods. Pregestational diabetes was induced with STZ administration in female C57BL6/J mice that were subsequently mated with healthy C57BL6/J males. Offspring were sacrificed at embryonic day 18.5 and 6-week adolescent and 12-week adult stages. The size and number of cardiomyocyte nuclei and also the extent of collagen deposition within the hearts of diabetic and control offspring were assessed following cardiac tissue staining with either haematoxylin and eosin or Picrosirius red and subsequently quantified using automated digital image analysis. Results. Offspring from diabetic mice at embryonic day 18.5 had a significantly higher number of cardiomyocyte nuclei present compared to controls. These nuclei were also significantly smaller than controls. Collagen deposition was shown to be significantly increased in the hearts of diabetic offspring at the same age. No significant differences were found between the groups at 6 and 12 weeks. Conclusions. Our results from offspring of type 1 diabetic mice show increased myocardial collagen deposition in late gestation and have increased myocardial nuclear counts (hyperplasia) as opposed to increased myocardial nuclear size (hypertrophy) in late gestation. These changes normalize postpartum after removal from the maternal intrauterine environment.

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Estudo da história natural da hipertrofia miocárdica e sua associação com hiperinsulinismo em filhos de mães diabéticas

Abstract: There was spontaneous regression of ventricular septum thickness in children of diabetic mothers during the first 6 months of life. The association between hyperinsulinism and hypertrophic cardiomyopathy was present up to the first month of life.

Cited by 15 publications

References 21 publications

Assessment of diastolic ventricular function in fetuses of diabetic mothers using tissue Doppler

Assessment of diastolic ventricular function in fetuses of diabetic mothers using tissue Doppler

Pulmonary vein pulsatility in fetuses of diabetic mothers: prenatal Doppler echocardiographic study

Cardiomyopathy in Offspring of Pregestational Diabetic Mouse Pregnancy

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