Characterization of the cardiomyopathy in infants of diabetic mothers.

Abstract

SUMMARY A transient form of hypertrophic cardiomyopathy has been previously described in infants of diabetic mothers (IDMs). The purpose of this study was to determine the incidence, natural history and pathologic features of this cardiomyopathy in symptomatic and asymptomatic IDMs.We studied 47 IDMs for evidence of cardiomyopathy. Among 24 symptomatic IDMs, five had marked septal hypertrophy with echocardiographic features suggesting left ventricular outflow obstruction and five had hypertrophy of the right ventricular free wall. With the exception of mild septal hypertrophy, these abnormalities resolved during the first 6 months of life, and echocardiograms in the first-degree family members were normal. Of 23 asymptomatic IDMs, three had septal hypertrophy and two had right ventricular free wall hypertrophy; none of the asymptomatic IDMs had evidence of outflow obstruction.One symptomatic IDM died, and autopsy revealed a hypertrophic septum that distorted both ventricular cavities. Microscopic examination revealed hypertrophic fibers and occasional areas of cellular disarray in the septum.Despite the clinical and pathologic similarities of the cardiomyopathy in IDMs to the hypertrophic cardiomyopathies in older children and adults, its transient and nonfamilial nature suggest that it is a separate disease. We speculate that it is a manifestation of the generalized organomegaly in IDMs.

Myocardial Excitation-contraction Coupling in the Fetus of Alloxan-diabetic Rabbit

“…In FDM, serum glucose and insulin levels were significantly greater than control values (Table 1). This finding is consistent with previous observations in human and animal FDM (3,8). In the present study, body weight in FDM was not significantly greater than control ( Table 1).…”

“…In newborns of diabetic mothers, cardiac abnormalities such as hypertrophic cardiomyopathy, left ventricular outflow obstruction, and congestive heart failure may occur (8). Hyperinsulinemia, hyperglycemia, and other alterations in carbohydrate, lipid, and protein metabolism occur in the fetus of the diabetic mother (3,12,22,23).…”

Fluxo no ducto venoso e hipertrofia miocárdica em fetos de mães diabéticas

“…The severity of the situation is related to the control of diabetes 29 . Microscopic alterations of the hypertrophic myocardium of the infants of diabetic mothers include, in addition to hyperplasia and hypertrophy, a disorganization of the normal pattern of the myofibrils, similar to that found in the cardiomyopathy of the adult 30 .…”

Macrosomia despite good glycaemic control in Type I diabetic pregnancy; results of a nationwide study in The Netherlands

“…[Diabetologia (2002) rosomia is related to an increased risk for "unexplained" death in utero and shoulder dystocia during labour, the latter being related to asphyxia, clavicle fracture and/or Erbs palsy [1,2,3]. During the neonatal period macrosomic infants are at increased risk for hypoglycaemia, infant respiratory distress syndrome (IRDS), hyperbilirubinaemia and hypertrophic cardiomyopathy [4,5,6]. A number of long-term population studies have shown that macrosomic newborns of women with diabetes have a higher risk to develop obesity and Type II (non-insulin-dependent) diabetes mellitus at a young age [7,8,9].…”