Use of Fetal Echocardiography for Characterization of Fetal Cardiac Structure in Women With Normal Pregnancies and Gestational Diabetes Mellitus

Garg, Salil; Sharma, Prafull; Sharma, Divyesh; Behera, Vineet; Durairaj, M; Dhall, Anil

doi:10.7863/ultra.33.8.1365

Cited by 37 publications

(38 citation statements)

References 20 publications

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“…In contrast, the RV sphericity index was increased owing to a shorter RV length along with thickening of the IVS and LV and RV walls. Increased thickness of ventricular walls and ventricular hypertrophy has been reported previously in fetuses of pregnancies with maternal diabetes and attributed to the altered metabolic environment and fetal hyperinsulinemia. Recent animal studies have implicated adverse cardiac remodeling, including dysregulation of the insulin‐like growth factors 1 and 2, elevated collagen synthesis, profibrosis and apoptosis as the etiology of fetal cardiac hypertrophy, ventricular chamber dilatation and myocardial dysfunction in gestational diabetes.…”

Section: Discussionmentioning

confidence: 83%

“…The effects of maternal diabetes on the fetus are summarized by the Pedersen hypothesis, which postulates that maternal hyperglycemia overstimulates fetal pancreatic beta cells resulting in fetal hyperinsulinemia, increased metabolic rate and a tendency for fetal hypoxemia. The fetal heart is one of the major organs affected by hyperinsulinemia and hypoxia, with myocardial hypertrophy reported extensively in fetuses and neonates of diabetic mothers. Infants of diabetic mothers are also at increased risk of cardiovascular morbidity and mortality in later life, presumably through mechanisms that affect myocardial fiber architecture influencing cardiac geometry, myocardial deformation and ventricular function.…”

Section: Introductionmentioning

confidence: 99%

“…Infants of diabetic mothers are also at increased risk of cardiovascular morbidity and mortality in later life, presumably through mechanisms that affect myocardial fiber architecture influencing cardiac geometry, myocardial deformation and ventricular function. Conventional‐echocardiography studies have found evidence of diastolic dysfunction and increased systolic contractility in fetuses and neonates of women with gestational diabetes mellitus (GDM). However, modern cardiac imaging modalities, such as tissue Doppler imaging (TDI) and speckle‐tracking imaging (STI), have fundamentally changed the way in which echocardiography is able to characterize global and regional myocardial function, demonstrating a higher sensitivity for detecting even mild myocardial damage and having a stronger predictive value for subsequent cardiovascular complications compared with conventional echocardiographic indices.…”

Section: Introductionmentioning

confidence: 99%

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Perinatal changes in fetal cardiac geometry and function in diabetic pregnancy at term

Patey

Carvalho

Thilaganathan

2019

Ultrasound in Obstet & Gyne

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Objective To evaluate the effect of diabetes in pregnancy on fetal and neonatal cardiac geometry and function around the time of delivery. Methods This was a prospective study of 75 pregnant women delivering at term, comprising 54 normal pregnancies and 21 with a diagnosis of pregestational or gestational diabetes mellitus. Fetal and neonatal conventional and spectral tissue Doppler and two‐dimensional speckle‐tracking echocardiography were performed a few days before and within hours after delivery. Fetal and neonatal cardiac geometry, global myocardial deformation and performance, diastolic and systolic function and left ventricular (LV) torsion were compared between normal pregnancies and those with diabetes, and perinatal changes within the diabetes group were assessed. Results Compared with normal pregnancies, diabetic pregnancies demonstrated significant differences in fetal ventricular geometry, myocardial deformation and cardiac function (right ventricular (RV) sphericity index, 0.56 vs 0.65; LV torsion, 2.1 °/cm vs 5.6 °/cm; LV isovolumetric relaxation time, 101 ms vs 115 ms; and RV isovolumetric contraction time, 107 ms vs 119 ms; P < 0.001 for all). Compared with normal pregnancies, diabetic pregnancies demonstrated significant differences in neonatal cardiac parameters (mean RV sphericity index, 0.43 vs 0.55; mean LV torsion, 1.30 °/cm vs 2.78 °/cm; median LV myocardial performance index (MPI′), 0.39 vs 0.51; median RV‐MPI′, 0.34 vs 0.40; P < 0.01 for all). Paired comparison between fetal and neonatal cardiac indices in diabetic pregnancies demonstrated that delivery resulted in a significant improvement in some, but not all, cardiac indices (mean RV sphericity index, 0.65 vs 0.55; mean LV torsion, 5.60 °/cm vs 2.78 °/cm; median RV‐MPI′, 0.51 vs 0.40; P < 0.01 for all). Conclusions Compared with normal term fetuses and neonates, those of diabetic women exhibit cardiac indices indicative of myocardial impairment, reflecting a response to a relatively hyperglycemic intrauterine environment with alteration in fetal loading conditions (LV preload deprivation and increased RV afterload) and adaptation to subsequent acute changes in hemodynamic load at delivery. Elucidating mechanisms that contribute to the alterations in perinatal cardiac function in diabetic pregnancy could help in refining management and developing better therapeutic strategies to reduce the risk of adverse pregnancy outcomes. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perinatal changes in fetal cardiac geometry and function in diabetic pregnancy at term

Patey

Carvalho

Thilaganathan

2019

Ultrasound in Obstet & Gyne

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“…87,101,[107][108][109] HCM is a relatively common finding in neonates of diabetic mothers, irrespective of the fact that good glycemic control is present. 87,101,108,[110][111][112][113] However, good glycemic control has been shown to decrease the severity of dysfunction, as supported by a correlation between poor glycemic control and lower E/A ratios or higher MPI. 37,87,88,103,109 Gonzalez et al 109 demonstrated HCM to occur in 22% of pregnancies with PDG, with a higher incidence rate for hemoglobin A1C >7% than for <5.9 in the third trimester.…”

Section: What Strategy Is Considered Best To Assess Congenital Hearmentioning

confidence: 99%

Exposure of the developing heart to diabetic environment and early cardiac assessment: A review

et al. 2018

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Hyperglycemia during organogenesis is associated with an increased risk of congenital cardiac defects (CHDs). The pathophysiology leading to CHDs is not completely uncovered. However, elevated oxidative stress is considered to be the primary trigger that causes CHDs in fetuses of diabetic mothers. Maternal diabetes has been found to increase the risk for all types of CHDs. Diabetes may also impact the fetal cardiac performance at all gestational ages. Early detection of CHDs has certain advantages, such as making early decision about termination of pregnancy, enabling early genetic testing, and early reassurance if scan is normal. Combined transabdominal and transvaginal approach at 13-14 weeks of gestation is a reasonable strategy to assess fetal heart in diabetic women. Diagnostic accuracy of early fetal echocardiography has reached to above a reasonable cutoff when it is done in the late first trimester or early second trimester in the hands of expert sonographers. However, the literature is less certain to provide a firm conclusion about functional heart assessment in fetuses of diabetic mothers.

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“…Hypertrophic cardiomyopathy affects the right ventricle and the posterior left ventricular wall, but the septal hypertrophy is more evident because of the large number of insulin receptors in the septum of the heart. 9,19,20 In our study, we observed that only 2 of the 34 fetuses with HCM exhibited alterations in the left ventricular wall, but none of them exhibited alterations in the septum.…”

Section: Discussionmentioning

confidence: 52%

Prevalence of Hypertrophic Cardiomyopathy in Fetuses of Mothers with Gestational Diabetes before Initiating Treatment

Palmieri

Simões²,

Silva

et al. 2017

Rev Bras Ginecol Obstet

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Objective To evaluate the prevalence of hypertrophic cardiomyopathy (HCM) in fetuses of pregnant women with gestational diabetes mellitus (GDM) in the beginning of the treatment. Methods A cross-sectional study was performed between July 1, 2013, and December 20, 2013, in a public maternity clinic in southern Brazil. The subjects were 63 fetuses of mothers with gestational diabetes, with a single pregnancy and no other associated pathologies. We diagnosed HCM through a fetal echocardiography before treatment and evaluated the maternal and fetal characteristics. Results The average age of the pregnant women was 32.32 (AE6.2) years, and the average gestational age at the time of the evaluation was 30.59 (AE2.27) weeks. The interventricular septum thickness showed a standard deviation of more than two in 50.8% of the fetuses (95% confidence interval [95%CI]: 38.1-63.5%). The left ventricular wall thickness showed a standard deviation of more than 2 in 13 (20.6%) fetuses (95%CI: 11.1-30.2%). The HCM was confirmed in 54% of the fetuses (95%CI: 41.3-65.1%). The fetal abdominal circumference was normal in 46 (73%) fetuses, and 50% of these fetuses had HCM. Conclusion The prevalence of hypertrophic cardiomyopathy in fetuses of pregnant women with GDM before treatment was of 54% (95%CI: 41.3-65.1%).

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Use of Fetal Echocardiography for Characterization of Fetal Cardiac Structure in Women With Normal Pregnancies and Gestational Diabetes Mellitus

Cited by 37 publications

References 20 publications

Perinatal changes in fetal cardiac geometry and function in diabetic pregnancy at term

Perinatal changes in fetal cardiac geometry and function in diabetic pregnancy at term

Exposure of the developing heart to diabetic environment and early cardiac assessment: A review

Prevalence of Hypertrophic Cardiomyopathy in Fetuses of Mothers with Gestational Diabetes before Initiating Treatment

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