Decreased fetal cardiac performance in the first trimester correlates with hyperglycemia in pregestational maternal diabetes

Abstract

ABSTRACT

Tissue Doppler Is More Sensitive and Reproducible than Spectral Pulsed-Wave Doppler for Fetal Right Ventricle Myocardial Performance Index Determination in Normal and Diabetic Pregnancies

“…Our study began with an a priori assumption that our study population of fetuses of mothers with DM would show subtle differences, as previously suggested, and was powered to detect the expected difference in MPI. 18,25,26,29 We further provide additional characterization of our study groups by demonstrating the expected differences in peak velocities and ratios of E/E 0 between groups that have been previously shown by others and that suggest that diastolic function abnormalities can exist in this population even in the absence of myocardial hypertorphy. 20 Of note, our study also confirmed a trend toward increases in E 0 and A 0 , though it was not adequately powered to detect statistically significant difference in these values for peak myocardial velocities (which have been shown in prior studies to be increased in fetuses of mothers with DM).…”

“…Prior studies have demonstrated subtle abnormalities in RV diastolic function in the fetuses of mothers with pregestational DM using spectral Doppler and DTI. 18,20 In these fetuses, diastolic myocardial velocities at the level of the mitral and tricuspid valve annuli were significantly higher, and E 0 /A 0 ratios were higher than in normal fetuses, while the ratio of early diastolic peak inflow velocity to peak annular velocity (E 0 /E) was lower in the fetuses of mothers with DM. These changes in diastolic function are independent of the presence of myocardial hypertrophy.…”

“…14 Since then, other groups have examined the utility of assessing global MPI using spectral Doppler in fetal disease states such as twin-twin transfusion syndrome [15][16][17] and pregestational DM in later gestation. 18 Spectral Doppler imaging in the right ventricle for the purpose of measuring MPI is more difficult than in the left ventricle, given the difficulty of simultaneously recording both inflow and outflow in a single Doppler sample. If the inflow and outflow Doppler signals are obtained separately, heart rate fluctuations may introduce errors and will increase variability in measurement.…”

The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

“…Fetuses of pre-gestational and poorly controlled diabetic mothers demonstrate increased right and left ventricular MPI compared to non-diabetic controls as early as the first trimester [16,99,100] and also in late gestation [11,101,102]. Abnormal fetal left Mod-MPI in gestational diabetes compared with normal fetuses has also been reported [13,100].…”

Ultrasound assessment of fetal cardiac function

“…Functional echocardiography has been demonstrated to help in the selection of high‐risk populations and to be associated with outcome in several fetal conditions including intrauterine growth restriction, 4 , 9 twin‐to‐twin transfusion syndrome, 10 , 11 hydrops, 7 fetal arrhythmias, maternal diabetes 12 , 13 and congenital diaphragmatic hernia 5 14 In addition, given the substantial evidence indicating the occurrence of programming of adult cardiovascular disease in fetal life, 15 – 18 cardiac function assessment might help to predict perinatal and long‐term cardiovascular outcomes.…”