Níveis de hemoglobina glicosilada e anomalias cardíacas em fetos de mães com diabetes mellitus

Behle, Ivo; Zielinsky, Paulo; Zimmer, Leonardo; Pontremoli, Mila; Risch, Juliana N.

doi:10.1590/s0100-72031998000500002

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…Among those malformations, 50% are congenital cardiac diseases 3 . Maternal diabetes is a risk factor for congenital heart disease and an indication for fetal echocardiography [4][5][6][7][8][9][10][11][12] .Maternal hyperglycemia and the excess of glucose transferred to the fetus encourage fetal pancreatic islets to increase the production of insulin, leading to hyperinsulinism, which is responsible for fetal complications. Fetal myocardial hypertrophy is the most frequent abnormality found in newborns from diabetic mothers, and it may be found in up to 35% of these newborns 13 .…”

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Pulmonary vein pulsatility in fetuses of diabetic mothers: prenatal Doppler echocardiographic study

Zielinsky¹,

Piccoli²,

Teixeira³

et al. 2003

Arq. Bras. Cardiol.

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The incidence of insulin-dependent diabetes mellitus is about 0.8%, and gestational diabetes is 3-5%. Both are evidence of the metabolic disturbances of carbohydrates during pregnancy 1 . The incidence of congenital malformation is 3 to 4 times greater in children from diabetic mothers than in the general population 2 . Among those malformations, 50% are congenital cardiac diseases 3 . Maternal diabetes is a risk factor for congenital heart disease and an indication for fetal echocardiography [4][5][6][7][8][9][10][11][12] .Maternal hyperglycemia and the excess of glucose transferred to the fetus encourage fetal pancreatic islets to increase the production of insulin, leading to hyperinsulinism, which is responsible for fetal complications. Fetal myocardial hypertrophy is the most frequent abnormality found in newborns from diabetic mothers, and it may be found in up to 35% of these newborns 13 . The interventricular septum is particularly rich in insulin receptors 14 , which would justify increased hypertrophy in this segment, secondary to myocardial cell hyperplasia and hypertrophy due to the increased synthesis of fat and proteins.Fetal Doppler echocardiography has increased our knowledge about the cardiocirculatory changes in the prenatal period. Recent studies have shown significant changes in the cardiovascular flow of fetuses from diabetic mothers, especially in pregnancies with inadequate glycemic control 15 .With the introduction of echocardiography, several clinical studies have demonstrated normal patterns of pulmonary venous flow in children and adults through transesophageal and transthoracic echocardiography 16,17 . The use of the pulmonary vein pulsatility index as a parameter for diastolic function evaluation during fetal life has not yet been reported. Thus, we have tested the hypothesis that the pulmonary vein pulsatility index in fetuses from diabetic mothers is greater than that in fetuses from nondiabetic mothers, based on the idea that a less complacent left ventricle would increase presystolic flow impedance in the pulmonary vein, corresponding to the atrial contraction phases. Consequently, it would increase the pulsatility index in this vessel. Objective -To verify the hypothesis that the pulmonary vein pulsatility index is higher in fetuses of diabetic mothers than it is in normal fetuses of nondiabetic mothers. Methods -

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Pulmonary vein pulsatility in fetuses of diabetic mothers: prenatal Doppler echocardiographic study

Zielinsky¹,

Piccoli²,

Teixeira³

et al. 2003

Arq. Bras. Cardiol.

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“…Major congenital anomalies affect 4 to 12% of newborn infants of women with clinical diabetes, representing an incidence of malformations approximately 5 times higher than that in the general population. The fetal heart is one of the most affected organs, and 40 to 50% of the congenital defects are located in the cardiovascular system 1,2 . Becerra et al 3 have reported an absolute risk for major cardiac malformations of 8.5 per 100 live-born infants of diabetic mothers.…”

Section: Abstract Fetal Echocardiography Fetal Diastolic Function mentioning

confidence: 99%

Estudo do encurtamento global do átrio esquerdo em fetos de mães diabéticas

Zielinsky¹,

Satler²,

Luchese³

et al. 2004

Arq. Bras. Cardiol.

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ObjectiveTo test the hypothesis that left atrial shortening fraction is lower in fetuses of diabetic mothers than in fetuses of mothers with no systemic disease. Methods Forty-two fetuses of mothers with previous diabetes or gestational diabetes and 39 healthy fetuses of mothers with no Key words fetal echocardiography, fetal diastolic function, global left atrial shortening fractionAlterations in left ventricular relaxation, filling, and compliance are common in fetuses of diabetic mothers. Some studies have suggested that the unidimensional echocardiographic profile of the left atrium may be used as an indicator of abnormalities in left ventricular diastolic function, and that left atrial shortening fraction is proportional to compliance and inversely proportional to left ventricular stiffness constant. The usefulness of atrial shortening as a parameter for assessing fetal diastolic function has not yet been demonstrated.Gestational diabetes has an incidence of 3.5%, accounting for high morbidity and mortality both for the fetus and mother. Major congenital anomalies affect 4 to 12% of newborn infants of women with clinical diabetes, representing an incidence of malformations approximately 5 times higher than that in the general population. The fetal heart is one of the most affected organs, and 40 to 50% of the congenital defects are located in the cardiovascular system 1,2 . Becerra et al 3 have reported an absolute risk for major cardiac malformations of 8.5 per 100 live-born infants of diabetic mothers.The increased tendency towards the appearance of disproportional myocardial hypertrophy, especially of the interventricular septum, has already been demonstrated in children of diabetic mothers 4 . The appearance of fetal echocardiography has provided the opportunity to study the disease in the prenatal period, when it is called fetal myocardial hypertrophy 5,6 . Several case series studied have reported an approximate 30% prevalence of that anatomical change in children of diabetic mothers. Septal hypertrophy has been reported as early as 21 weeks of gestational age, but the prevalence is greater in the third trimester 7,8 . Thus, fetal echocardiography should be performed in all pregnancies complicated with diabetes mellitus, because fetal myocardial hypertrophy is frequent, easily detected on examination, and is a potential cause for nonimmune hydrops. Fetal myocardial hypertrophy is characterized by interventricular septum dimensions at the end of diastole greater than 2 standard deviations according to gestational age or greater than 5mm, as this value is greater than 2 standard deviations until the end of pregnancy 6 . Myocardial hypertrophy involving the right ventricle and left ventricular posterior wall may occur, but septal hypertrophy is usually more marked. The presence of a gradient in the left ventricular outflow tract reveals the obstructive forms of the disease. The changes in myocardial compliance and relaxation cause an altered pattern of diastolic filling, with an elevation in intraventri...

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“…Fetal myocardial hypertrophy is the most frequently found abnormality in maternal diabetes mellitus, being observed in up to 35% of those babies [7][8][9][10] ( fig. 1).…”

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