Assessment of Cardiac Function in Fetuses of Gestational Diabetic Mothers During the Second Trimester

Abstract

Fetuses of diabetic mothers may have structural or functional cardiac abnormalities which increase morbidity and mortality. Isolated functional abnormalities have been identified in the third trimester. The aim of the present study was to assess fetal cardiac function (systolic, diastolic, and global myocardial performance) in the second trimester in mothers with gestational diabetes, and also to relate cardiac function with glycemic control. Mothers with gestational diabetes mellitus referred for fetal cardiac evaluation in the second trimester (between 19 and 24 weeks) from March 2015 to February 2016 were enrolled as case subjects in this study. Non-diabetic mothers who had a fetal echocardiogram done between 19 and 24 weeks for other indications were enrolled as controls. Functional cardiac variables showed a statistically significant difference in isovolumetric relaxation and contraction times and the myocardial performance index and mitral E/A ratios in the gestational diabetic group (p = 0.003). Mitral annular plane systolic excursion was significantly less in the diabetic group (p = 0.01). The only functional cardiac variable found abnormal in mothers with poor glycemic control was the prolonged isovolumetric relaxation time. Functional cardiac abnormalities can be detected in the second trimester in fetuses of gestational diabetic mothers and timely intervention can improve postnatal outcomes.

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

“…Other studies suggested that the MPA index has a more stable pattern with advancing gestation . Fetuses of diabetic mothers usually have a higher value for the MPI at all trimesters compared to controls . Although these results support impairment in both systolic and diastolic components of cardiac cycle in fetuses of diabetic mothers, some studies could not reveal any changes in the MPI index or E/A ratio in fetuses of diabetic mothers …”

“…This may be attributed to the already lower E/A ratio that exists in fetuses of diabetic mothers at early gestation, as supported by studies evaluating the E/A ratio in the first trimester . Many other studies have also found a lower E/A ratio in fetuses of diabetic mothers compared with those of nondiabetic mothers in the second and third trimesters . At the same time, the E/A ratio can be measured lower in fetuses of diabetic mother compared to healthy controls even if blood glucose level is well regulated .…”

“…37,87,88 Many other studies have also found a lower E/A ratio in fetuses of diabetic mothers compared with those of nondiabetic mothers in the second and third trimesters. 37,87,90,[101][102][103] At the same time, the E/A ratio can be measured lower in fetuses of diabetic mother compared to healthy controls even if blood glucose level is well regulated. 37,90,101 In addition, the E/A ratio seems to be affected in both atrioventricular valves, but predominantly in the mitral valve.…”

“…37,87,90,[101][102][103] At the same time, the E/A ratio can be measured lower in fetuses of diabetic mother compared to healthy controls even if blood glucose level is well regulated. 37,90,101 In addition, the E/A ratio seems to be affected in both atrioventricular valves, but predominantly in the mitral valve. 87,88,90,101,104 Other studies suggested that the MPA index has a more stable pattern with advancing gestation.…”

“…Diabetes may adversely impact the fetal cardiac performance at all gestational ages. HCM is the most commonly encountered structural change associated with possible alterations in fetal cardiac functions, as it may transiently obstruct left ventricular outflow . However, functional cardiac alterations observed in these fetuses may occur independently from the presence of HCM.…”