Altered diastolic function in infants of mothers with gestational diabetes: No relation to macrosomia

Abstract

In a previous study, asymptomatic infants of mothers with gestational diabetes (IGDMs) were observed to have altered left ventricular (LV) filling. In the present study, we reanalyzed the data to examine whether the observed abnormalities were related to maternal diabetes or due to the greater preponderance of macrosomic infants (32%) in the gestational diabetes group. No echocardiographic (systolic or diastolic) differences were observed when the data were compared in 16 large-for-gestational-age (LGA) and 24 appropriate-for-gestational-age (AGA) infants among IGDM. Comparison of 16 LGA IGDM and 17 LGA infants of control mothers revealed lower LV size during diastole and systole in the IGDM. The present analysis suggests that the cardiac alterations in the IGDMs are not due to the preponderance of macrosomia but, rather, the consequence of altered in utero metabolic environment.

Neonatal echocardiograms of macrosomic neonates

“…It is unclear whether macrosomic infants born to non-diabetic mothers also demonstrate these findings. In a previous study, Mehta et al [6] found that macrosomic infants of diabetic mothers demonstrated a smaller left ventricular volume during systole and diastole than macrosomic infants born to non-diabetic mothers. They concluded that the cardiac findings observed in macrosomic infants born to diabetic mothers were related to an abnormal intrauterine environment rather than the macrosomia per se.…”

Absence of Increase in Carotid Artery Intima-Media Thickness in Infants of Diabetic Mothers

“…Mehta et al (19) observed no differences between macrosomic and non-macrosomic IDM by echocardiography, while Demiroren et al (20) reported that LVMI was the most important echocardiographic measurement for distinguishing macrosomic infants of diabetic and non-diabetic mothers. Akcakus et al (15) found an increased LVMI in macrosomic IDM.…”

Assessment of left ventricular filling in normally grown fetuses, growth‐restricted fetuses and fetuses of diabetic mothers

“…Consequently, we have no reason to expect relaxation abnormalities in the IDDM fetus. It has been demonstrated that asymptomatic infants of mothers with diabetes mellitus also have altered ventricular filling 11 . Analysis of left ventricular filling parameters and upper abdominal circumference suggests that the cardiac alterations are not due to the preponderance of macrosomia but rather are the consequence of an altered in utero metabolic environment.…”

“…In pregnancies associated with diabetes, chronic fetal hyperinsulinemia may occur, causing increased total body weight and selective organomegaly as a result of hypertrophy of insulin-sensitive tissues 8,9 . In the presence of fetal macrosomia, cardiac weight is increased, owing to a larger mass of myocardial nuclei, increased cell number and increased myocardial fiber 10 . However, besides hypertrophy, reduced left ventricular filling has been shown in infants of mothers with gestational diabetes 11 .…”