Depressed left and right ventricular cardiac output in fetuses of diabetic mothers

Abstract

IntroductionWe compared right and left ventricular cardiac output (RVCO and LVCO) in fetuses of diabetic mothers (FDM) with a large normal cohort.MethodsWe prospectively enrolled 264 normal fetuses and 30 FDM. Fetal CO parameters such as semilunar valve velocity time integrals (AVVTI, PVVTI), ventricular outflow diameters (LVOTD, RVOTD) and stroke volumes (AVSV, PVSV) were measured, and LVCO and RVCO were calculated. These were normalized using non-linear regression to estimated fetal weight (EFW) to provide means and standard deviations. Among FDMs, mean Z scores and 95% confidence limits (CL) were calculated and compared to zero.ResultsLVCO, RVCO and parameters they were calculated from, increased predictably and non-linearly with increasing EFW. In FDM, LVCO was depressed (mean Z −1.679, 95% CL −2.404, −0.955, P < 0.001), and AVVTI, LVOTD and AVSV were significantly lower than normal. Similarly, RVCO (mean Z = −1.119, CL −1.839, −0.400, P = 0.003), RVOTD (mean −2.085, CL −3.077, −1.093, P < 0.001) and PVSV (mean −1.184, CL −1.921, −0.446, P = 0.003) were lower than normal, however, PVVTI was not different (mean Z 0.078, CL −0.552, +0.707, P = 0.803).ConclusionNormal biventricular stroke volumes and outputs follow a non-linear regression with EFW. FDM have significantly lower right and left heart stroke volumes and outputs for weight than do normal fetuses.

Decreased fetal cardiac output in pregnant women with severe SARS‐Cov‐2 infection

“…13 On the contrary, Winter et al observed a decrease fetal CO in diabetic mother's fetuses when they include fetal EFW to the calculation and they suggest EFW-corrected CO's are valuable for accurate assessment of fetal cardiac function than CO (ml/min) alone. 9 In our study, CCO (ml/min) measurement without including fetal weight was found similar between all mild, moderate, severe, and control groups. On the other hand, fetal weight-normalized CCO (ml/min/kg) and CCO z score were found to be significantly lower in the severe disease group compared to the control and mild disease groups.…”

“…In fact, fetal cardiac output has been evaluated in several studies in obstetric conditions associated with cardiac dysfunction, such as hydrops fetalis, FGR, twin to twin transfusion syndrome (TTTS), and diabetes mellitus (DM). [9][10][11][12][13] It has been observed…”

“…output have been demonstrated in hydrops fetalis, fetal growth retardation (FGR), anemia, and various pathological conditions. [9][10][11][12][13] In this present study, we aimed to evaluate changes of fetal cardiac output in pregnant women who recovered from SARS-Cov-2 infection.…”

Could SARS-CoV-2 Infection Change Fetal Cardiac Output?

“…Pilania et al found that CO is higher in fetuses of diabetic mothers, but they did not adjust the CO for EFW [13]. On the contrary, Winter et al observed a decrease fetal CO in diabetic mother's fetuses when they include fetal EFW to the calculation and they suggest EFW-corrected CO's are valuable for accurate assessment of fetal cardiac function than CO (mL/min) alone [9]. In our study, CCO (mL/min) measurement without including fetal weight was found similar between all mild, moderate, severe, and control groups.…”

“…Fetal cardiac output has been evaluated in several studies in obstetric conditions associated with cardiac dysfunction, such as hydrops fetalis, FGR, twin to twin transfusion syndrome (TTTS), and diabetes mellitus (DM) [9][10][11][12][13]. It has been observed that direct calculation of cardiac output could give valuable information for heart failure and is potentially useful in the assessment of fetal well-being [24].…”