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

Abstract

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 -

Impact of ineffective oesophageal motility and wrap type on dysphagia after laparoscopic fundoplication

“…Baez et al 27 found significantly higher DV‐PI in fetuses with congenital heart disease that died than in those that survived. Furthermore, increased pulmonary vein PI has been shown in fetuses of diabetic mothers when compared to fetuses of non‐diabetic women, indicating altered diastolic cardiac function28. Girsen et al 29 showed that fetuses with an abnormal DV blood velocity waveform pattern had increased levels of the heart failure marker NT‐proBNP (amino‐terminal fragment of pro‐brain natriuretic peptide) in the umbilical artery blood, indicating fetal cardiac compromise.…”

Fetal Cardiac Function: Technical Considerations and Potential Research and Clinical Applications

“…The fetuses of diabetic mothers show signs of impaired relaxation (diastolic dysfunction), as measured by increased pulsatility in precordial veins [63,64,65,66], a lower E/A ratio [67], an increased IRT [67], increased diastolic annular peak velocities and E/E’ ratio [7], and increased cord blood levels of atrial and B-type natriuretic peptide (ANP/BNP) and troponin [68]. Abnormalities are more evident in pregnancies with poorer glycemic control but still occur with strict metabolic control [60,61,62,63,64,65,66]. Cardiac hypertrophy and dysfunction persist postnatally in a proportion of these fetuses, leading to worse neonatal outcomes [69].…”

Paediatric and congenital heart disease in South America: an overview

“…However, large cardiology centres usually have well-structured programmes of fetal cardiology with advanced techniques for the diagnosis and even treatment of some CHD in utero. Interesting clinical research has been performed on several cardiac fetal topics, including screening of CHD in selected pregnant women, abnormalities of the septum primum, cardiovascular abnormalities in fetuses of diabetic mothers, diastolic dysfunction, restriction of flow across the foramen ovale, treatment of fetal arrythmias and fetal interventions for aortic stenosis and hypoplastic left heart syndrome 545100101102103104105106107108109110111112113…”