Intrapartum fetal ECG and diabetes

Yli, Branka M.; Källén, Karin; Stray‐Pedersen, Babill; Amer‐Wåhlin, Isis

doi:10.1080/14767050801924431

Cited by 26 publications

(23 citation statements)

References 36 publications

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“…On fetal ECG, ST depression was significantly more prevalent in fetuses of diabetic mothers, as demonstrated by Yli et al 26 In children with a mean hemoglobin A Ͼ10%, a reduction in heart rate variability was predictive for onset of symptomatic neuropathy. 27 Shiono et al 28 studied children and adolescents aged 7 to 20 years with poor glycemic control (hemoglobin A 1c Ն10%) with signal-averaged ECG; the authors found a prolonged filtered QRS duration and a significantly low root mean square voltage, demonstrating subclinical cardiac impairment.…”

Section: Fetal and Childhood Ecg Signs In Diabetes Mellitusmentioning

confidence: 53%

The ECG in Diabetes Mellitus

Stern

2009

Circulation

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Section: Fetal and Childhood Ecg Signs In Diabetes Mellitusmentioning

confidence: 53%

The ECG in Diabetes Mellitus

Stern

2009

Circulation

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“…However, in gestational diabetes there may be fetal diastolic dysfunction independent of hypertrophy (2). In diabetic pregnancies, fetal lactic acidosis and hypoxia have both been reported near term, and bradycardic episodes, ST segment depression, and fetal acidemia have been observed during labor in fetuses of both gestational and pregestational diabetic mothers (31,37,38), as well as heart failure with abnormal ECG during labor (19). An increased incidence of fetal bradycardic responses to fetal stress occurs in women demonstrating high anxiety during pregnancy (20).…”

Section: Perspectives and Significancementioning

confidence: 99%

Elevated maternal cortisol leads to relative maternal hyperglycemia and increased stillbirth in ovine pregnancy

Keller‐Wood

Feng

Wood

et al. 2014

American Journal of Physiology-Regulatory, Integrative and Comp

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Keller-Wood M, Feng X, Wood CE, Richards E, Anthony RV, Dahl GE, Tao S. Elevated maternal cortisol leads to relative maternal hyperglycemia and increased stillbirth in ovine pregnancy. Am J Physiol Regul Integr Comp Physiol 307: R405-R413, 2014. First published June 11, 2014 doi:10.1152/ajpregu.00530.2013.-In normal pregnancy, cortisol increases; however, further pathological increases in cortisol are associated with maternal and fetal morbidities. These experiments were designed to test the hypothesis that increased maternal cortisol would increase maternal glucose concentrations, suppress fetal growth, and impair neonatal glucose homeostasis. Ewes were infused with cortisol (1 mg·kg Ϫ1 ·day Ϫ1 ) from day 115 of gestation to term; maternal glucose, insulin, ovine placental lactogen, estrone, progesterone, nonesterified free fatty acids (NEFA), ␤-hydroxybutyrate (BHB), and electrolytes were measured. Infusion of cortisol increased maternal glucose concentration and slowed the glucose disappearance after injection of glucose; maternal infusion of cortisol also increased the incidence of fetal death at or near parturition. The design of the study was altered to terminate the study prior to delivery, and post hoc analysis of the data was performed to test the hypothesis that maternal metabolic factors predict the fetal outcome. In cortisol-infused ewes that had stillborn lambs, plasma insulin was increased relative to control ewes or cortisol-infused ewes with live lambs. Maternal cortisol infusion did not alter maternal food intake or plasma NEFA, BHB, estrone, progesterone or placental lactogen concentrations, and it did not alter fetal body weight, ponderal index, or fetal organ weights. Our study suggests that the adverse effect of elevated maternal cortisol on pregnancy outcome may be related to the effects of cortisol on maternal glucose homeostasis, and that chronic maternal stress or adrenal hypersecretion of cortisol may create fetal pathophysiology paralleling some aspects of maternal gestational diabetes. glucose; insulin; cortisol; pregnancy MATERNAL CORTISOL IS INCREASED in normal human pregnancy and is thought to contribute to the increase in maternal glucose concentration, as well as supporting increases in maternal plasma volume and cardiac output. In studies done in our laboratory, we have found that increasing maternal cortisol beyond the normal doubling in ovine pregnancy led to increased uterine blood flow and maternal and fetal glucose and lactate concentrations, whereas decreasing maternal cortisol to concentrations similar to those of nonpregnant ewes resulted in reduced uterine blood flow as gestation advanced (12, 13). Either increased or decreased maternal cortisol concentrations slowed the rate of fetal growth between 115 and 130 days of gestation. In women with Cushing's disease or Cushing's syndrome in pregnancy, there is also an increased incidence of small-for-gestational-age babies, as well as an increased risk of adverse pregnancy outcomes (26, 34). Maternal glucocorticoid treatme...

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“…37 (Figure 4). Yli and colleagues 38 more frequent occurrence of ST depression in fetuses from mothers with diabetes mellitus, a disorder known to be associated with fetal myocardial dystrophy. 38 The relationship between gestational age and hypoxia has recently been elucidated by Mallard et al, Perinatal Centre, University of Gothenburg, by observing the type of ST patterns emerging in connection with cord occlusion and endotoxin administration in the mid gestation fetal lamb.…”

Section: St Depression -Biphasic St Changesmentioning

confidence: 96%