Evaluation of prenatal changes in fetal cardiac morphology and function in maternal diabetes mellitus using a novel fetal speckle-tracking analysis: a prospective cohort study

Abstract

Background Due to metabolic changes in the second trimester and the increasing number of pregnant women with obesity and advanced maternal age, the incidence of gestational diabetes mellitus (GDM) remains high. This study aimed to evaluate the effects of GDM on fetal cardiac morphology and function, and to determine whether these changes increase with increasing estimated fetal weight (EFW). Methods Fifty-eight women with GDM (GDM group) and 58 women with a healthy pregnancy (control group) were included in this prospective observational cohort study. Each group included subgroups of 31 pregnant women with a gestational age between 24+0 weeks and 27+6 weeks as well as 27 pregnant women with a gestational age between 28+0 weeks and 40+0 weeks. For all fetuses, a cine of 2–3 s in the four-chamber view was obtained, and online speckle-tracking analysis was performed using the GE Automatic Fetal Heart Assessment Tool (fetal HQ; General Electric Healthcare Ultrasound, Zipf, Austria) to measure the global sphericity index (GSI), global longitudinal strain (GLS), fractional area change (FAC), 24-segment sphericity index (SI), and 24-segment end-diastolic diameter of the left ventricle (LV) and right ventricle (RV). Data were analyzed using the independent t-test and Wilcoxon rank-sum test, as applicable. Results The GDM group (mean HbA1c value was 5.3 ± 0.57 mmol/L) showed a lower GSI value than the control group (1.21 vs. 1.27, P = 0.000), which indicated a rounder shape of the heart. In addition, fetuses in the GDM group demonstrated significant impairment in cardiac function compared to those in the control group (LV-GLS: -18.26% vs. -22.70%, RV-GLS: -18.52% vs. -22.74%, LV-FAC: 35.30% vs. 42.36%, RV-FAC: 30.89% vs. 36.80%; P = 0.000 for all). Subgroup analyses according to gestational age (24+0–27+6 weeks and 28+0–40+0 weeks) showed that the statistical differences were retained between the GDM and control groups in each subgroup. Conclusions Fetuses of women with GDM present with signs of biventricular systolic dysfunction according to deformation analysis using fetal HQ. Additionally, the heart had a rounder shape in the GDM group than in the control group. This study showed that fetal HQ can be used to assess fetal cardiac morphology and function easily and quickly, and the effects of GDM on fetal cardiac morphology and function appeared from the second trimester. Thus, whether earlier and stricter clinical intervention was necessary remained to be further studied. Furthermore, future studies will need to supplement the effects of blood glucose levels on GLS, FAC, GSI, and 24-segment SI. Additionally, the long-term follow-up after birth should also be improved to observe the influence of changes in the indicators on the prognosis.

Evaluation of Fetal Cardiac Geometry and Contractility in Gestational Diabetes Mellitus by Two-Dimensional Speckle-Tracking Technology

“…The cardiac shape is a good indicator of cardiac function [ 25 ]. Some studies reported rounder hearts in GD fetuses [ 20 , 21 , 22 ], but novel studies using FetalHQ ® to compare GD to healthy fetuses did not find a significant difference in GSI [ 8 , 9 ], which is consistent with our findings.…”

“…Strain is another sensitive marker of cardiac function. Longitudinal strain is used more often than radial or circumferential strain to evaluate myocardial deformation [ 21 ]. There are conflicting results regarding fetal cardiac strain in maternal diabetes, which could be explained by the different study design (most studies did not differentiate pregestational diabetes of GD effects, while some studies used the older GD diagnosis criteria).…”

“…So far, speckle tracking has been used to evaluate diabetes-exposed fetuses for research purposes only. Most studies have proven fetal cardiac function is impaired, but they do not report the exact same changes [ 7 , 8 , 9 , 17 , 18 , 19 , 20 , 21 , 22 ].…”

The effect of gestational diabetes mellitus on fetal right heart growth in late‐term pregnancy: A prospective study

“…16,17 In our study, the growing trend of right ventricular end-diastolic diameter (RV) in the GDM group became higher than that in the control group, and the difference in two groups became larger in the whole observation period. The rapid increase of RV in GDM group may affect the entire cardiac structure of the fetal myocardium and increase the spherical index, [18][19][20] which may be a sign of reduced myocardial compliance.…”

A preliminary study on fetal cardiac morphology and systolic function of normal and anemic pregnant women by fetal heart quantification technology

“…It can analyze the morphological and functional changes of each segment from the base of the ventricle to the apex in a more detailed and accurate manner; FAC and GLS of the left and right ventricles can also be obtained. Previous studies have demonstrated (21)(22)(23) that these indicators can accurately assess the systolic function of the left and right ventricles. The results of this study showed that fetal GSI, FAC, and GLS were not correlated with fetal GA.…”