Determination of the fetal myocardial performance index in women with gestational impaired glucose tolerance and to assess whether this parameter is a possible prognostic indicator of adverse fetal outcome

Bhorat, Ismail; Pillay, Manormoney; Reddy, Tarylee

doi:10.1080/14767058.2017.1334047

Cited by 22 publications

(44 citation statements)

References 22 publications

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“…The same group of authors further proved the utility of mod-MPI as an excellent predictor of above-mentioned adverse perinatal outcomes, even among women with mild glucose intolerance on diet. 8 However, in our study, cardiac changes could not predict intrapartum CTG changes or low APGAR. In our study, there were no perinatal mortality, and only 2 perinatal asphyxia/acidosis.…”

Section: Discussioncontrasting

confidence: 81%

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Fetal echocardiography at term in diabetic pregnancies helps predict the adverse neonatal outcome - Results of a prospective observational study from South India

Tejaswi

Samantha

Vasudeva

et al. 2020

Indian Heart Journal

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There is sparse Indian data on whether fetal echocardiography among pregnant diabetics would be useful to predict adverse perinatal/neonatal outcome. Objectives To study fetal cardiac changes in diabetic mothers and non-diabetic controls from 24 weeks gestation until the neonatal period; correlate them with maternal glycemic control; study their implications on adverse perinatal/neonatal outcome. Methodology Prospective observational cohort study. Pregnant diabetics (17 overt, 66 gestational) recruited beyond 24 weeks, divided as well (39) and poorly (44) controlled, based on American Diabetes Association 2016 criteria. Controls were 102 healthy non-diabetic pregnancies. Fetal echocardiography performed at weeks 24–32, 32–36, >37, and between 4 and 7 days on neonates. The thickness of Interventricular septum (IVS), Right Ventricle (RV), and Left ventricle (LV) assessed with M mode. E/A ratio across Tricuspid/Mitral valves and Tei index determined. TDI(Tissue Doppler imaging) used to assess tissue annular velocities across IVS, RV, and LV. Maternal glycemic control and various perinatal/neonatal adverse outcomes were recorded. Results Significant myocardial hypertrophy seen among fetuses of diabetic mothers versus controls, most severe at term among the poorly controlled diabetics. Structural changes persisted in the neonate. At term, fetal myocardial dysfunction was evident among diabetic pregnancies only as poor annular systolic velocity across IVS, RV using TDI. However, Tissue Doppler changes could not predict adverse perinatal/neonatal outcome. Myocardial dysfunction could not be demonstrated in the neonates. Myocardial hypertrophy at term was a surrogate marker for suboptimal glycemic control, and it could predict important neonatal morbidities like hypoglycaemia, hyperbilirubinemia, prolonged NICU stays, and persistent foetal cardiac shunts. Conclusion Our study shows a significant association between fetal myocardial hypertrophy and maternal glycemic control among GDM pregnancies. There also seems to be an association between fetal myocardial hypertrophy and some of the adverse perinatal events including hypoglycemia. However these newborns were not found to have clinically relevant cardiac comorbidities even though there was significant septal hypertrophy in utero.

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Section: Discussioncontrasting

confidence: 81%

“…This is in contrast to earlier studies suggesting a higher MPI thus poorer global myocardial function among foetuses of diabetic women. Such myocardial dysfunction has been demonstrated among fetuses whether diabetes is mild, 8 or severe. 9 …”

Section: Discussionmentioning

confidence: 99%

Fetal echocardiography at term in diabetic pregnancies helps predict the adverse neonatal outcome - Results of a prospective observational study from South India

Tejaswi

Samantha

Vasudeva

et al. 2020

Indian Heart Journal

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“…MPI levels are expected to change in the presence of pathological conditions that influence fetal cardiac functions. These include fetal growth restriction (FGR), twin‐twin transfusion syndrome, maternal diabetes mellitus, preeclampsia, fetal hydrops, and fetal anemia . When fetal cardiac functions influence the MPI, it may be important to decide the time of the birth.…”

Section: Introductionmentioning

confidence: 99%

Utility of the modified myocardial performance index in growth‐restricted fetuses

et al. 2019

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Objectives The modified myocardial performance index (Mod‐MPI) can be used to assess myocardial function. Fetal growth restriction can affect fetal myocardial function, thereby altering the Mod‐MPI. The results of previous studies on the utility of the Mod‐MPI in growth‐restricted fetuses are conflicting. The aim of this study was to calculate the left modified‐MPI in growth‐restricted fetuses and to compare the results with those of healthy fetuses. Methods This was a prospective cross‐sectional case–control study. In total, 40 women with growth‐restricted fetuses and 40 women with fetuses of normal weight (controls) at 29–39 gestational weeks were enrolled in the study. An experienced obstetrician calculated the Mod‐MPI for each fetus. Women with systemic diseases or fetuses with chromosomal/structural abnormalities were excluded from the study. The results of Mod‐MPI measurements of the two groups were compared. Results The mean single deepest vertical pocket (SDVP) of amniotic fluid, estimated fetal weight (EFW), and isovolumetric relaxation time (IRT) was significantly lower in the fetal growth restriction (FGR) group as compared with these parameters in the control group (P < .05). The uterine artery (UtA) pulsatility index (PI) was significantly higher in the FGR group as compared with that in the control group (P < .05). There were six cases of absent end‐diastolic flow (AED) in the FGR group. There were no statistically significant between‐group differences in the Mod‐MPI, isovolumetric contraction time (ICT), and ejection time (ET) (P > .05). There was also no statistically significant correlation between the Mod‐MPI in the fetuses with AED and the control group for Mod‐MPI (P > .05). Conclusion The utility of the Mod‐MPI in FGR remains unclear. Future studies with larger populations are needed to determine the utility of the Mod‐MPI as a predictor of cardiac compromise in FGR.

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“…All control births had a normal outcome. We also showed that even in milder forms of gestational diabetes there is a percentage of patients whose fetuses are sensitive to the impaired glucose tolerance and these pregnancies can behave adversely despite the clinical label of mild disease resulting in a higher than an expected rate of adverse outcome in the gestational impaired glucose tolerance (GIGT) group of 25% [8] as well as in the wellcontrolled gestational diabetic group with an adverse outcome rate of 22% [9]. Macrosomia and polyhydramnios were also noted to be associated with a signi cantly higher risk for adverse outcome in these studies [6,7,8,9].…”

Section: Resultsmentioning

confidence: 85%

“…In a series of prospective studies [6,7,8,9] we identi ed four parameters that could potentially be used in a scoring system to risk categorise gestational diabetics in terms of fetal outcome and serve as a guide to clinicians managing gestational diabetics to optimize timing of delivery. Our score is based on the myocardial performance index (MPI), E/A ratio (marker of diastolic dysfunction), increasing fetal weight (macrosomia) and increased amniotic uid index (AFI).…”

Section: Discussionmentioning

confidence: 99%

A Proposed Fetal Risk Scoring System for Gestational Diabetes to assist in optimizing Timing of Delivery

Bhorat¹,

Reddy²

2021

Preprint

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Background: Gestational diabetes is characterized by three main factors: macrosomia, increased metabolic rate and large vascular cross sections. A critical and crucial finding in diabetic pregnancies is that significant acidaemia and hyperlacticemia can occur in fetuses in the absence of hypoxaemia. The increased metabolic rate results in significant increases in oxidative metabolism but this capacity is reduced in fetuses due to low pyruvate dehydrogenase activity increasing the risk for acidosis. This pathophysiology is not recognized by standard monitoring models which revolves around placental insufficiency which is in fact not the problem in a gestational diabetic pregnancy. A proposed risk scoring system has been developed based on our previous studies to risk categorise gestational diabetics in terms of fetal outcome.Methods: The diabetic cases from four case-control studies were combined to form a total sample of 159 cases for validation of the risk scoring system. Univariate logistic regression was used to assess the effect of individual risk factors with proposed cutoffs on adverse pregnancy outcome. The diagnostic accuracy of the total summative score, was assessed by computing the area under the ROC curve.Results: Four potential parameters were identified to risk- categorise fetuses in a gestational diabetic pregnancy ie the myocardial performance index (MPI), E/A ratio (marker of diastolic dysfunction), increasing fetal weight (macrosomia) and increased amniotic fluid index (AFI). The total score, obtained by summation of the composite scores for parameters ranged from 0 to 11. The total score performed as an excellent predictor of adverse outcome, evidenced by the ROC area under the curve of 0.94. A cutpoint of 6 on the score confers a sensitivity of 84.2% and specificity of 90.2% for detection of adverse outcome. Conclusion: To our knowledge this is the first Gestational Diabetic Scoring system proposed to predict an adverse outcome.

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Determination of the fetal myocardial performance index in women with gestational impaired glucose tolerance and to assess whether this parameter is a possible prognostic indicator of adverse fetal outcome

Abstract: The MPI is impaired in fetuses in GIGT women, with fetuses with an adverse outcome having significantly higher MPI measurements compared to the fetuses with normal outcome in the GIGT group. MPI has the potential to improve fetal surveillance in gestational diabetes.

Cited by 22 publications

References 22 publications

Fetal echocardiography at term in diabetic pregnancies helps predict the adverse neonatal outcome - Results of a prospective observational study from South India

Fetal echocardiography at term in diabetic pregnancies helps predict the adverse neonatal outcome - Results of a prospective observational study from South India

Utility of the modified myocardial performance index in growth‐restricted fetuses

A Proposed Fetal Risk Scoring System for Gestational Diabetes to assist in optimizing Timing of Delivery

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