Increased periconceptual maternal glycated haemoglobin in diabetic mothers reduces fetal long axis cardiac function

Abstract

Objective: To compare ventricular long axis function in fetuses of diabetic mothers (FDM) with contemporaneously studied normal controls (N) and to assess the effect of pre-pregnancy diabetic control on these measurements. Design: Long axis function was compared in 41 FDM and 159 N fetuses in a cross sectional observational study. Setting: Fetal medicine unit. Methods and results: Echocardiography confirmed structural normality. Pulsed wave valvar Doppler velocimetry, lengthening and shortening myocardial velocities, and amplitude of ventricular long axis movement were recorded at the base of the left and right ventricular free walls and septum. Periconceptual diabetic control was assessed by haemoglobin A1c (HbA1c) in early pregnancy. Doppler and myocardial velocities were negatively related and myocardial thickness was positively related with HbA1c. In both cohorts all variables except mitral and tricuspid late filling (A wave) velocities were dependent on gestational age. FDM gestational age related values were higher for most variables and robust analysis of covariance showed significantly different maturation patterns in mitral valve E:A ratio (p = 0.036) and pulmonary velocity (p = 0.04), late lengthening myocardial velocities (left p = 0.016 and right p = 0.066), left myocardial shortening velocities (p = 0.008), and left free wall (p = 0.03) and septal (p = 0.04) amplitude of motion. FDM septal thickness was significantly increased throughout gestation (p , 0.0001). Conclusion: Periconceptual diabetic control influences fetal cardiac performance and myocardial hypertrophy but, unlike the pathophysiology of adult ventricular hypertrophy, is accompanied by functional adaptation. It is unlikely to explain the increased rate of late stillbirth observed in diabetic pregnancies.

Tissue Doppler Is More Sensitive and Reproducible than Spectral Pulsed-Wave Doppler for Fetal Right Ventricle Myocardial Performance Index Determination in Normal and Diabetic Pregnancies

“…Our study began with an a priori assumption that our study population of fetuses of mothers with DM would show subtle differences, as previously suggested, and was powered to detect the expected difference in MPI. 18,25,26,29 We further provide additional characterization of our study groups by demonstrating the expected differences in peak velocities and ratios of E/E 0 between groups that have been previously shown by others and that suggest that diastolic function abnormalities can exist in this population even in the absence of myocardial hypertorphy. 20 Of note, our study also confirmed a trend toward increases in E 0 and A 0 , though it was not adequately powered to detect statistically significant difference in these values for peak myocardial velocities (which have been shown in prior studies to be increased in fetuses of mothers with DM).…”

“…Fetuses of mothers with DM have been shown to have diastolic tissue velocity augmentation by DTI, with increased systolic and diastolic myocardial velocities and decreased longitudinal cardiac function compared with normal fetuses. 25 Therefore, it is not surprising that the DTI method of deriving MPI, a measure of global (systolic and diastolic) function, would be able to demonstrate a difference between DM fetuses and normal controls that is not seen when using the spectral Doppler method. 26 who demonstrated a similar lack of difference using the spectral Doppler method between DM fetuses and normal fetuses in the first and second trimesters.…”

Feasibility and Reproducibility of a Standard Protocol for 2D Speckle Tracking and Tissue Doppler-Based Strain and Strain Rate Analysis of the Fetal Heart

“…As the heart is a central organ in fetal adaptative mechanisms, evaluation of cardiac function has been proposed to predict outcomes and to monitor fetal well-being in several cardiac [2,3] and extracardiac pathologies such as fetal hypoxia [4,5,6], hyperglycemia [7,8], pressure or volume overload [9,10], or cardiac compression [11]. Traditionally most echocardiographic methods were based on interrogating blood flow by Doppler or myocardial motion by M-mode [1,12].…”

Ultrasound assessment of fetal cardiac function

“…Functional echocardiography has been demonstrated to help in the selection of high‐risk populations and to be associated with outcome in several fetal conditions including intrauterine growth restriction, 4 , 9 twin‐to‐twin transfusion syndrome, 10 , 11 hydrops, 7 fetal arrhythmias, maternal diabetes 12 , 13 and congenital diaphragmatic hernia 5 14 In addition, given the substantial evidence indicating the occurrence of programming of adult cardiovascular disease in fetal life, 15 – 18 cardiac function assessment might help to predict perinatal and long‐term cardiovascular outcomes.…”