Assessment of fetal cardiac diastolic function of gestational diabetes mellitus using dual-gate Doppler

Abstract

Gestational Diabetes Mellitus (GDM), as a common complication of pregnancy, has an increasing trend globally. GDM leads to maternal complications and fetal complications. Fetal cardiac diastolic dysfunction is strongly associated with GDM. This study aims to assess the ventricular diastolic function of fetuses exposed to GDM by looking into the diagnostic parameters using both conventional method and Dual-gate Doppler method (DD). And to investigate the potential of DD method in early detection of fetal cardiac diastolic dysfunction. 56 women diagnosed with GDM and 55 non-GDM pregnant women were enrolled in their 24 to 30 weeks of gestation. Conventional method and DD method were applied to measure mitral and tricuspid inflow velocities E-waves, A-waves on pulsed-wave Doppler, and mitral and tricuspid annular velocities e′-waves, a’-waves on Tissue Doppler imaging. E/A, e’/a’ and E/e′ ratio was calculated. The difference between GDM and control groups was statistically tested and analysed using one-sample Kolmogorov-Smirnov test, Student t test, Mann-Whitney U test and Kruskal-Wallis test and Bland–Altman plot analysis. Intraobserver intraclass correlation coefficients of E/A, e’/a’, and E/e’ value of both mitral and tricuspid valve are all greater than 0.80, while interobserver intraclass correlation coefficients are between 0.71 and 0.88. Right (6.35 vs 6.79; P = .001) ventricular function showed significantly lower E/e’ ratios in the GDM group compared with control fetuses by conventional method. Both left (6.16 vs 6.59; P = .036) and right (6.28 vs 6.75; P = .01) ventricular function showed significantly lower E/e’ ratios in the GDM group compared with control fetuses by DD method. Exposure to high level of maternal blood glucose leads to impaired diastolic function in the fetuses. Fetal right ventricular function is a potential key point to study to enable an early detection for fetal diastolic dysfunction since the alteration and damage are more likely to happen in right ventricular. Measurement of E/e’ ratio using DD method is considered as a promising method in fetal cardiac diastolic function assessment. Well or poorly control of the GDM does not have significant influence on the fetal diastolic function thus an early detection of GDM and GDM induced fetal cardiac dysfunction is necessary.

Effect of glycemic control on fetal hearts of pregestational diabetic women by tissue doppler and M‐mode imaging

“…A previous study suggested that fetuses of diabetic mothers may encounter an increased myocardial velocity in the atrioventricular annuluses. This aids in balancing the restricted ventricular compliance during early diastole 26 . This acceleration is especially noticeable in the right ventricle, and diastolic functions are more susceptible to being damaged due to elevated blood glucose levels that cause placental vascular resistance.…”

“…This aids in balancing the restricted ventricular compliance during early diastole. 26 This acceleration is especially noticeable in the right ventricle, and diastolic functions are more susceptible to being damaged due to elevated blood glucose levels that cause placental vascular resistance.…”

Glucose control during pregnancy in patients with type 1 diabetes correlates with fetal hemodynamics: a prospective longitudinal study.

“…17 These subtle subclinical changes likely precede diastolic dysfunction, as demonstrated using conventional ultrasound parameters during the third trimester. 18 A similar impairment of diastolic function was also observed in the fetuses of mothers with gestational diabetes 19 ; thus, hyperglycemia-induced cardiac remodeling and the consequent fetal adaptation may be responsible for this phenomenon. Indeed, we observed a positive correlation between the percentage of time spent in hyperglycemia, A1c, and diastolic function, mainly regarding the RV A wave.…”

Do Maternal Heart Diseases Affect Fetal Cardiac Functions?

“…One study found that tricuspid E' values and E'/A' ratio were lower in the diabetic group compared to the control group, but no significant difference was found between the pre-GDM and GDM groups. 31 Hou et al 32 did not detect a significant difference in tricuspid E' and E'/A' ratio in GDM patients. In our study, there were no significant changes in tricuspid E', A' values, and E'/A' ratio in the MHD group, implying that heart disease does not cause changes in fetal RV diastolic function.…”