Effect of gestational diabetes and insulin resistance on offspring’s myocardial relaxation kinetics at three years of age

Abstract

PurposeScientific evidence on the long-term impact of gestational diabetes mellitus (GDM) on offspring’s myocardial relaxation is scarce. Studies have linked GDM with transient ventricular hypertrophy in newborns resulting in diastolic dysfunction, but long-term assessment is lacking. The main objective of this study was to evaluate myocardial relaxation in 3-year-old children in relation to the degree of insulin resistance of their mother during pregnancy.MethodsWe prospectively assessed myocardial relaxation by echocardiography imaging on 106 children at 3 years of age. Subjects were divided into 3 groups [GDM, insulin resistance (IR) and normoglycemic (CTRL)], based on their mother’s 75g-OGTT and HOMA-IR results at second trimester screening. We collected information on children adiposity and body size, maternal characteristics and maternal and cord blood measurement of C-peptide and insulin.ResultsThe study population comprised 29 children from GDM mothers, 36 children from IR mothers and 41 CTRL children. Compared to the CTRL group, we found that a higher proportion of children in the IR group and the GDM group met the criteria for impaired myocardial relaxation, but this did not reach statistical significance (odds ratio adjusted for heart rate and body surface area of 1.4 [0.2–9.5] and 3.5 [0.6–20.6], respectively).ConclusionWe did not detect an increased risk of impaired myocardial relaxation at three years of age in children exposed in-utero to IR and GDM, compared to children from normoglycemic mothers.

No effect of gestational diabetes or pre-gestational obesity on 6-year offspring left ventricular function—RADIEL study follow-up

“…E/A ratio Z -score was close to the population mean. Similar results were previously reported with the same normalization method in a population of children at three years of age [ 23 ]. Taking into consideration that Z -score references were not validated in an external population, the observed discrepancies could reflect the selection bias in the original study [ 18 ].…”

“…We observed no effect of gestational hyperglycaemia or GDM on child LV diastolic or systolic function at 6 years of age. Our results extend current knowledge, as the longest prospective follow-up reported so far is limited to a relatively small cohort of 3-year-old children (29 following GDM) with no data available on LV systolic function [ 23 ].…”

Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review

“…The cardiac hypertrophy is usually transient, often resolving in two weeks to six months of age; however, the long-term outcome of the fetal and perinatal changes is not completely elucidated. Blais et al evaluated myocardial relaxation in 3-year-old children in relation to the degree of insulin resistance of their mother during pregnancy [ 202 ]. They evaluated 29 children from GDM mothers, 36 children from insulin-resistant mothers (women whose fasting and post-OGTT glucose levels were comprised within the limits of normal), and 41 controls and found that left ventricular mass was normal and comparable between the groups.…”

“…Compared to the controls, impaired myocardial relaxation was more likely in the GDM and insulin-resistant groups (however, the differences did not reach statistical significance). There were higher median cord blood C-peptide and insulin levels in subjects with impaired myocardial relaxation, but this did not reach statistical significance either [ 202 ]. Rijpert et al found that cardiac dimensions and systolic and diastolic function were normal at 7–8 years of age among 30 offspring of diabetic mothers compared to 30 controls, including three offspring of diabetic mothers who had neonatal cardiac hypertrophy [ 203 ].…”

“…Depla [196] Paauw et al [197] El-Ganzoury et al [198] Topcuoglu et al [199] Peixoto et al [200] Patey et al [201] Blais et al [202] Rijpert et al [203] Offspring of both pregestational and gestational diabetic pregnancies had increased intraventricular septal thickness compared to controls, associated with poor maternal glycemic control. Fetuses of diabetic women exhibited significant alterations in cardiac geometry, myocardial deformation, and ventricular function that persisted following birth.…”