Evaluation of fetal myocardial performance index in gestational diabetes mellitus

Abstract

This study aimed to compare fetal myocardial performance index (MPI) between fetuses of pregnant women with gestational diabetes mellitus (GDM) and healthy controls and to evaluate the relationship between MPI and maternal glucose levels. This was a prospective study of 90 pregnant women, including 50 pregnancies with GDM (27 pregnancies with insulin‐regulated GDM and 23 pregnancies with diet‐regulated GDM) and 40 healthy controls. Isovolumetric contraction time (ICT) + isovolumetric relaxation time (IRT)/ejection time (ET) were used to calculate the MPI (MPI = [ICT + IRT]/ET). Fetal MPI, PR interval, E/A ratio, maternal plasma glucose levels on the day of MPI measurement, and neonatal outcomes were compared. The fetal left‐MPI was significantly higher in the GDM group than healthy controls (0.43 ± 0.04 vs. 0.40 ± 0.06, p = 0.007). The best cut‐off level for MPI was >0.41 to predict adverse perinatal outcomes (sensitivity: 70%, specificity: 68%, area under the curve: 0.715, 95% confidence interval: 0.5143–0.8205, p < 0.001). The fetal MPI values showed no correlation with maternal plasma fasting, postprandial glucose, and hemoglobin A1c (HbA1c) levels. Reduced E/A ratio, higher neonatal intensive care unit admissions, and the need for cesarean delivery were detected in the GDM group. Fetal MPI is impaired in women with GDM, and the need for insulin therapy is associated with higher MPI values and adverse neonatal outcomes. Fetal MPI can help detect fetuses with potential adverse outcome risks, owing to impaired fetal cardiac function.

Mecanismos moleculares en afección miocárdica fetal inducida por diabetes mellitus gestacional: Artículo de Revisión

“…En línea con lo anterior estudios han señalado que la DMG se asocia con hipertrofía del miocardio, particularmente en la porción septal interventricular (IVS) y disfunción ventricular, lo que explica parcialmente porque DMG se asocia más a anomalías de función cardíaca (Depla et al, 2021). Dichos hallazgos se relacionan con disminución del índice de rendimiento miocárdico fetal (MPI, como indice de función integral cardíaca), así como función diastólica disminuida a las 24 semanas de gestación en embarazos que cursan con DMG (Depla et al, 2021;Ozturk et al, 2023). En ese sentido y considerando que el objetivo de la presente revisión es establecer los mecanismos moleculares de la afección cardíaca en relación a la DMG, nos centramos en explicar los mecanismos moleculares relacionados a la hipertrofia cardíaca.…”

A new Doppler index, cerebro‐placental‐uterine ratio, and fetal cardiac parameters in early onset preeclampsia

“…10 Pathologic conditions such as FGR, diabetes mellitus, preeclampsia, twin-to-twin transfusion syndrome (TTTS), and fetal anemia have been shown to alter MPI rates. 11,12 Numerous studies suggest that this condition may offer insights into the clinical management of the disease and its impact on cardiac function. [10][11][12] The splanchnic mesoderm gives rise to epicardial adipose tissue (EAT), which is located between the myocardium and the visceral pericardium.…”

“…11,12 Numerous studies suggest that this condition may offer insights into the clinical management of the disease and its impact on cardiac function. [10][11][12] The splanchnic mesoderm gives rise to epicardial adipose tissue (EAT), which is located between the myocardium and the visceral pericardium. The effects of the EAT include endocrine, immunologic, inflammatory, and energy storage effects.…”