Impact of maternal diabetes and obesity on fetal cardiac functions

Abstract

Background: In several developing industrial countries, the incidence of obesity among populations is spreading quickly and dramatically; also, the frequency of maternal obesity is in continuous elevation, which represents a considerable public health problem. Maternal hyperglycemia is a common gestational risk factor for the fetus. Several studies proposed that maternal DM and obesity lead to intrauterine impacts which induce changes in the fetal myocardium, and the pre-pregnancy obesity and diabetes are accompanied with development of cardiovascular alterations in the offspring and subsequent pathological changes in their early life. The aim of this study is to assess the cardiac function in fetuses of obese pregnant women (FOW) and fetuses of diabetic women (FDW) in comparison with fetuses of normal pregnant women (FNW) using tissue Doppler imaging. Results: There was impairment in systolic and diastolic cardiac function in both fetuses of obese and diabetic women with decreased global longitudinal strain tissue Doppler velocities at 30 weeks of gestation compared to fetuses of normal women. Conclusion: Imaging of the fetus of pregnant women by Echo Doppler at about 30 weeks of gestations showed a reduced cardiac function of fetuses of obese and diabetic women matched with fetuses of normal BMI women. Our finding proposed that early subclinical alterations in the fetal cardiac output can arise from maternal obesity alone. This explains the predilection of children of obese mothers at advanced ages to cardiovascular disorder.

Maternal Obesity: A Focus on Maternal Interventions to Improve Health of Offspring

“…Reactive oxidative species also causes excess lipid peroxidation and cardiac fibrosis which is another reason behind dysfunctional cardiovascular programming ( 35 , 39 , 40 ). Bayoumy et al ( 41 ) measured cardiac function in fetuses of obese, diabetic, and normal pregnant women by employing tissue Doppler imaging at 30 weeks gestation. Fetuses of obese and diabetic pregnant women had lower systolic and diastolic function compared to women with normal BMI, indicating weakened cardiovascular function in developing fetuses owing to maternal obesity.…”

“…These observations of cardiovascular effects on offspring are difficult to attribute in entirety to abnormal glucose metabolism in obese mothers. Thus, further investigation is warranted to better understand the overall impact of maternal obesity on fetal health status ( 41 ).…”

Cardiac changes in infants of diabetic mothers

“…Tissue Doppler imaging (TDI) can elaborate on the presence of early foetal cardiac dysfunction, even in the absence of structural abnormalities. The ability to detect early cardiac dysfunction is valuable in monitoring and timing the delivery of complicated preterm pregnancy[ 50 ]. Two-dimensional speckle-tracking echocardiography (STE) could offer an additional benefit over conventional echocardiography to detect subclinical unfavourable changes in myocardial function in this population.…”

Evaluation of the selected parameters of the fetal diastolic functions in normally grown or macrosomic fetuses of gestational diabetic mothers with poor glycaemic control

“…However, using standard echocardiography to assess fetal cardiac performance (Mitral and tricuspid annular plane systolic excursions, mitral and tricuspid early velocity, late velocitiy, and early and late diastolic filling ratio), they demonstrated that all fetuses seem to be healthy. 33 Additionally, Kulkarni et al also reported that two-dimensional speckle-tracking echocardiography measures of myocardial function in fetuses of diabetic and obese women were generally more consistent than traditional Doppler echocardiography parameters. 34 In this study, conventional echocardiographic techniques were used to assess fetal diastolic functions.…”