Stillbirth in women with diabetes: a retrospective analysis of fetal autopsy reports

Lynch, Tara A.; Westen, Elizabeth; Li, Dongmei; Katzman, Philip J.; Malshe, Amol; Drennan, Kathryn

doi:10.1080/14767058.2020.1779213

Cited by 6 publications

(5 citation statements)

References 25 publications

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“…[23] In a recent study investigating stillbirths in diabetic pregnancies, it has been reported that women with diabetes have a 14 times higher risk of fetal cardiomyopathy identified at fetal autopsy compared with women without diabetes. [24] This fact re-emphasises the importance of cardiac function determination in fetuses of gestational diabetic pregnancies as a proxy for adverse outcome. One of the main mechanisms inducing fetal compromise in gestational diabetes could therefore be the development of myocardial dysfunction.…”

Section: Discussionmentioning

confidence: 97%

A proposed fetal risk scoring system for gestational diabetes to assist in optimising timing of delivery

Bhorat

Reddy

2022

S Afr J Obstet Gynae

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Background. The pathophysiology of gestational diabetes, which is related to abnormal gluocose tolerance and hyperinsulinaemia, renders standard fetal monitoring models ineffective, insufficient and inappropriate, as these models revolve around detecting and prognosticating on placenta-mediated disease rather than increased metabolic rates due to hyperinsulinaemia, functional hypoxia and ischaemic trophoblastic thresholds. To improve perinatal morbidity and mortality in gestational diabetes, there is therefore a need to introduce new prognostic parameters and scoring systems. Objectives. A proposed risk scoring system has been developed, based on our previous studies, to risk-categorise patients with gestational diabetes in terms of fetal outcome in view of the fact that the pathophysiology of gestational diabetes is not recognised by standard monitoring models, which revolve around placental insufficiency rather than metabolic anomalies.Methods. Patients with diabetes from four case-control studies were combined to form a total sample of 159 cases for validation of the risk scoring system. Univariate logistic regression analysis was used to assess the effect of individual risk factors with proposed cut-offs on adverse pregnancy outcome. The diagnostic accuracy of the total summative score was assessed by computing the area under the receiver operating characteristic (ROC) curve. Results. Four potential parameters were identified to risk-categorise fetuses in a pregnancy complicated by gestational diabetes, i.e. the myocardial performance index (MPI), the E/A ratio (early diastolic filling/late diastolic filling, a marker of diastolic dysfunction), increasing fetal weight (macrosomia), and an increased amniotic fluid index. The total score, obtained by summation of the composite scores for these parameters, ranged from 0 to 11. The total score performed as an excellent predictor of adverse outcome, evidenced by an ROC area under the curve of 0.94. A cut-point of 6 on the score confers a sensitivity of 84.2% and specificity of 90.2% for predicting adverse outcome. Conclusion. To our knowledge, this is the first gestational diabetes scoring system proposed to predict an adverse outcome.

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Section: Discussionmentioning

confidence: 97%

A proposed fetal risk scoring system for gestational diabetes to assist in optimising timing of delivery

Bhorat

Reddy

2022

S Afr J Obstet Gynae

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“…The prevalence of fetal hypertrophic myocardiopathy, conotruncal anomalies, ventricular septal defects, and other cardiac malformations is increased in mothers with DM and is associated with higher rates of perinatal morbidity and mortality. 2) 14) 15) The hypertrophy of IVS is the most common structural cardiac anomaly in fetuses from mothers with DM, and with a deleterious risk on the fetal heart function. In this scenario, several studies have been published including ultrasound/echocardiographic fetal cardiac functional parameters by M-mode, Doppler, 2D and 3D ultrasound in the fetuses of mothers with DM.…”

Section: Discussionmentioning

confidence: 99%

“…Fetal cardiomyopathy is reported to be an important etiology of intrauterine fetal demise due to the findings on fetal autopsy examinations in DM, compared with controls. 2) A great variety of studies have demonstrated the prevalence of myocardial hypertrophy in fetuses of mothers with DM in comparison to non-DM pregnancies presenting a risk of heart failure in utero . 3) 4) 5) …”

Section: Introductionmentioning

confidence: 99%

Fetal Interventricular Septum Volume Evaluated by Three-Dimensional Ultrasound Using Spatiotemporal Image Correlation and Virtual Organ Computer-Aided Analysis in Fetuses From Pre-Gestational Diabetes Mellitus Pregnant Women

Bravo-Valenzuela

Peixoto

Mattar

et al. 2022

J Cardiovasc Imaging

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BACKGROUND To assess the interventricular septum (IVS) volume of fetuses from pre-gestational diabetes mellitus (DM) pregnant women by 3-dimensional ultrasound using spatiotemporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods. METHODS This was a prospective cross-sectional study of 45 fetuses from pre-gestational DM and 45 fetuses from healthy pregnant women (controls). Only singleton pregnancies between 20 and 34 + 6 weeks of gestation were included. The fetal IVS volumes were obtained off-line using STIC and VOCAL methods. To analyze differences among variables, the Student’s t-test and Mann-Whitney U test were used. The correlation among continuous variables was determine using Spearman’s correlation test (r). RESULTS The median of fetal IVS volume was significantly higher in pre-gestational DM than in healthy pregnant women (0.3 cm 3 vs. 0.2 cm 3 , p = 0.032). A strong positive correlation was observed between fetal IVS volume and gestational age at the time of ultrasound examination (r = 0.75, R 2 = 0.48, p < 0.0001) and between fetal IVS volume and estimated fetal weight (r = 0.63, R 2 = 0.37, p < 0.0001). No significant correlation was noted between fetal IVS volume and glycated hemoglobin levels (r = −0.16, R 2 = 0.01, p = 0.540) in the pre-gestational DM pregnant women. CONCLUSIONS Significant differences were observed in fetal IVS volumes between pre-gestational and healthy mothers, with higher values in the fetuses of pre-gestational DM pregnant women.

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“…The impact of impaired cardiac function on the risk of stillbirth in pregnancies complicated by hyperglycemia has been highlighted by Lynch and colleagues, who demonstrated that fetal cardiomyopathy was present in 46.7 % of stillbirths from women with diabetes, an incidence 14 times greater compared with stillbirth from non-diabetic women [43].…”

Section: Reviewmentioning

confidence: 99%

Third Trimester Myocardial Performance Index in Fetuses from Women with Hyperglycemia in Pregnancy: A Systematic Review and Meta-Analysis

et al. 2021

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Introduction The myocardial performance index (MPI) has been proposed to evaluate cardiac dysfunction in newborns from diabetic mothers. Although MPI is routinely assessed in newborns, its role in the evaluation of fetuses from women with hyperglycemia in pregnancy (HIP) is still under evaluation. We aimed to evaluate the differences in third trimester fetal MPI in pregnant women with hyperglycemia compared to healthy controls. Materials and Methods Seven electronic databases were searched for all studies assessing women with HIP who underwent evaluation of fetal left MPI during pregnancy compared to a control group. The summary measures were reported as mean differences (MD) in the mean fetal left MPI between women with HIP and healthy controls, with a 95 % confidence interval (CI). A post hoc subgroup analysis based on the type of HIP – pregestational diabetes, GDM, or gestational impaired glucose tolerance (GIGT) – was performed as an additional analysis. Results 14 studies assessing 1326 fetuses (580 from women with HIP and 746 from controls) were included. Women with HIP had a significantly higher mean left fetal MPI compared to controls (MD 0.08; 95 %CI: 0.05 to 0.11; p < 0.00 001). Subgroup analysis according to the type of HIP concurred with the overall analysis for women with DM (MD 0.07; 95 %CI: 0.01 to 0.13; p = 0.02) and for women with GDM (MD 0.012; 95 %CI: 0.07 to 0.17; p < 0.00 001) but not for women with GIGT (MD –0.01, 95 % CI –0.28 to 0.27; p = 0.96). Conclusion Fetal left MPI is increased in pregnancies with HIP appearing as a potential marker of cardiac dysfunction.

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Stillbirth in women with diabetes: a retrospective analysis of fetal autopsy reports

Cited by 6 publications

References 25 publications

A proposed fetal risk scoring system for gestational diabetes to assist in optimising timing of delivery

A proposed fetal risk scoring system for gestational diabetes to assist in optimising timing of delivery

Fetal Interventricular Septum Volume Evaluated by Three-Dimensional Ultrasound Using Spatiotemporal Image Correlation and Virtual Organ Computer-Aided Analysis in Fetuses From Pre-Gestational Diabetes Mellitus Pregnant Women

Third Trimester Myocardial Performance Index in Fetuses from Women with Hyperglycemia in Pregnancy: A Systematic Review and Meta-Analysis

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