Asymmetrical Septal Hypertrophy in Newborn Infants of Diabetic Mothers

Abstract

The objective of this paper is to determine the frequency and outcome of asymmetrical septal hypertrophy (ASH) in large-for-gestational-age infants (LGA) born to diabetic (DM) and nondiabetic mothers (NDM), and to establish the relationship between ASH and maternal diabetes control. A comparative study was design to assess ASH in infants born to DM and NDM. The study was conducted in the Departments of Neonatology and Pediatric Cardiology of the "Hospital de Gineco-Pediatria 48", Instituto Mexicano del Seguro Social from January to December 1997. Eighty-five full-term infants of DM (group A) and 85 LGA infants of NDM (group B) were included. As a control group (group C), we studied 85 healthy, full-term infants. In all cases a Doppler echocardiogram was obtained in the first 48 h after birth, and for the ASH infants, at 2 and 4 months. Chest X ray, electrocardiogram, and laboratory tests were performed as complementary studies. ASH was present in 38.8% of LGA infants of DM and in 7.1% of NDM. The difference was significant (p < 0.01). Interventricular septum (IVS) and IVS/ posterior wall of left ventricle ratio were significantly different between groups A and B with C. There was no correlation between Hb A1 level and the presence of ASH in group A. ASH is a common finding in infants of DM. We could not find a relationship between the degree of metabolic control during pregnancy and the incidence and severity of ASH.

Maternal diabetes causes coordinated down-regulation of genes involved with lipid metabolism in the murine fetal heart

“…Maternal diabetes can cause fetal hypertrophic cardiomyopathy in humans [10][11][12][13] and increases the size of the fetal heart in rats with streptozotocin-induced hypoinsulinemic diabetes [27][28][29]. However, the heartto-body weight ratio was not increased in offspring from Ins2 Akita mothers with hyperglycemia compared with controls (Fig.…”

“…Infants of diabetic mothers have an increased risk of hypertrophic cardiomyopathy at birth. Hence, up to 40% of newborn infants of women with type 1 diabetes mellitus have cardiac enlargement with asymmetric septal hypertrophy [10][11][12][13]. Remarkably, the cardiac hypertrophy rapidly reverses postnatally, suggesting that the diabetic intrauterine environment is essential for the cardiac abnormality.…”

Increased Plasma Pro-B-Type Natriuretic Peptide in Infants of Women with Type 1 Diabetes

“…Up to 40% of newborn infants of women with type 1 diabetes have echocardiographic signs of cardiomyopathy with cardiac enlargement and asymmetric septal hypertrophy. Most often, these changes are asymptomatic and disappear within the first 6 months of life, but they can also lead to severe morbidity and mortality (2)(3)(4). It is thus conceivable that cardiac dysfunction could be a cause of stillbirths in pregnancies complicated by diabetes.…”

“…B-Type natriuretic peptide (BNP) 4 is a 32-amino acid peptide produced in excess by cardiac myocytes during cardiac stress (11 ). BNP is released as a 108-amino acid propeptide (proBNP), which is then cleaved into the active BNP (32 amino acids) and an N-terminal fragment (11 ).…”

Troponin T and NT ProBNP Levels in Gestational, Type 1 and Type 2 Diabetic Mothers and Macrosomic Infants

“…Demirören et al [6] compared echocardiographic findings of infants of diabetic mothers (macrosomic and nonmacrosomic) and macrosomic infants of nondiabetic mothers and found greater IVS thickness in IDMs when compared to the control group; however, they found no statistically significant difference in the macrosomic group. Vela-Huerta et al [23] evaluated asymmetrical septal hypertrophy in two groups including 85 macrosomic IDMs and 85 macrosomic INDMs and found significantly greater IVS thickness values in macrosomic IDMs than in macrosomic INDMs. In our study, although IVS thickness was greater in pregestational and gestational IDMs when compared to the control group, there was no significant difference (p [ 0.05).…”