Fetal echocardiography at term in diabetic pregnancies helps predict the adverse neonatal outcome - Results of a prospective observational study from South India

Abstract

There is sparse Indian data on whether fetal echocardiography among pregnant diabetics would be useful to predict adverse perinatal/neonatal outcome. Objectives To study fetal cardiac changes in diabetic mothers and non-diabetic controls from 24 weeks gestation until the neonatal period; correlate them with maternal glycemic control; study their implications on adverse perinatal/neonatal outcome. Methodology Prospective observational cohort study. Pregnant diabetics (17 overt, 66 gestational) recruited beyond 24 weeks, divided as well (39) and poorly (44) controlled, based on American Diabetes Association 2016 criteria. Controls were 102 healthy non-diabetic pregnancies. Fetal echocardiography performed at weeks 24–32, 32–36, >37, and between 4 and 7 days on neonates. The thickness of Interventricular septum (IVS), Right Ventricle (RV), and Left ventricle (LV) assessed with M mode. E/A ratio across Tricuspid/Mitral valves and Tei index determined. TDI(Tissue Doppler imaging) used to assess tissue annular velocities across IVS, RV, and LV. Maternal glycemic control and various perinatal/neonatal adverse outcomes were recorded. Results Significant myocardial hypertrophy seen among fetuses of diabetic mothers versus controls, most severe at term among the poorly controlled diabetics. Structural changes persisted in the neonate. At term, fetal myocardial dysfunction was evident among diabetic pregnancies only as poor annular systolic velocity across IVS, RV using TDI. However, Tissue Doppler changes could not predict adverse perinatal/neonatal outcome. Myocardial dysfunction could not be demonstrated in the neonates. Myocardial hypertrophy at term was a surrogate marker for suboptimal glycemic control, and it could predict important neonatal morbidities like hypoglycaemia, hyperbilirubinemia, prolonged NICU stays, and persistent foetal cardiac shunts. Conclusion Our study shows a significant association between fetal myocardial hypertrophy and maternal glycemic control among GDM pregnancies. There also seems to be an association between fetal myocardial hypertrophy and some of the adverse perinatal events including hypoglycemia. However these newborns were not found to have clinically relevant cardiac comorbidities even though there was significant septal hypertrophy in utero.

Effect of glycemic control on fetal hearts of pregestational diabetic women by tissue doppler and M‐mode imaging

“…Therefore, we evaluated cardiac measurements according to FG and PPG values as well as HbA1c. A previous study observed septal and myocardial hypertrophy in the poorly controlled diabetic group but could not reveal a statistically significant relationship between glycemic control and systolic functions 29 . Our study found a statistically moderate‐strong correlation in thickness, moderate correlation in diastolic functions, and a weak correlation with systolic functions.…”

“…A previous study observed septal and myocardial hypertrophy in the poorly controlled diabetic group but could not reveal a statistically significant relationship between glycemic control and systolic functions. 29 Our study found a statistically moderate-strong correlation in thickness, moderate correlation in diastolic functions, and a weak correlation with systolic functions. These results demonstrated the association of morphological and functional changes with glycemic control and that FG was more associated with these changes than PPG.…”

Incidence of Fetal Myocardial Hypertrophy in Mother with Diabetes Mellitus by Using Cardio-Spatiotemporal Image Correlation (STIC) M-Mode

“…However, they found that severe septal hypertrophy was linked to neonatal problems such as hypoglycemia, hyperbilirubinemia, and a NICU stay of more than 7 days. 18 Other neonatal problems were not recorded in this study.…”

“…Some studies that had a smaller number of diabetic pregnant women presented glycemic control associated with FMH described increased IVST in the poor control group ( Table 4 ). 18 However, systematic review and meta-analysis mentioned FMH in well-controlled diabetic pregnancy. 4 …”

Reference Values for Point-of-Care Echocardiographic Measurements of Preterm Infants in China

“…There are few research studies on the reference value of heart valve peak flow velocity. Twenty years ago, Skelton et al ( 27 ) found that the peak flow velocities of the mitral valve, tricuspid valve, aorta, and pulmonary artery had no correlation with GA and BW; however, a recent study found that the MV-E/A value of full-term infants at the age of 4–7 days is higher than that at birth ( 29 ). Our study found that AV, MV-E, and MV-E/A were positively correlated with GA, BW, and BSA, which may be related to the small sample size of the previous study.…”