Paired maternal and fetal cardiac functional measurements in women with gestational diabetes mellitus at 35–36 weeks’ gestation

Aguilera, Jesica; Semmler, J.; Coronel, Carla; Georgiopoulos, Georgios; Simpson, John; Nicolaides, Kypros H.; Charakida, Marietta

doi:10.1016/j.ajog.2020.04.019

Cited by 36 publications

(67 citation statements)

References 49 publications

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“…A number of studies have demonstrated that in utero exposure to hyperglycaemia can adversely affect the fetal heart. 4,5,6 Consistent with this, in our study, we showed that fetuses exposed to GDM have altered heart morphology with more globular right ventricles compared with that seen in controls. By using a variety of echocardiographic modalities we showed that right and left longitudinal myocardial deformation was reduced in fetuses exposed to GDM compared with controls but that diastolic indices were similar between the two groups when analysis was adjusted for differences in maternal characteristics, estimated fetal weight and heart rate.…”

Section: Interpretation Of Results and Comparison With Existing Litersupporting

confidence: 90%

“…Details about the recruitment have been reported previously and the prenatal data from this study constitute part of data included in a previous publication from our group. 4 Mothers were asked to bring their children for a repeat cardiovascular assessment at around 6 months after delivery. Women provided written informed consent to participate in the Advanced Cardiovascular Imaging Study which received ethical approval (REC No 18/NI/0013, 2018, IRAS ID:237936).…”

Section: Study Populationstudy Designmentioning

confidence: 99%

“…The methodology has been described in detail previously. 4 Essentially, fetal heart was assessed using Canon Aplio i900 machines equipped with a convex transducer (10C3 and i8CX1). Left and right ventricular sphericity indices were measured on images from an apical 4-chamber view at enddiastole.…”

Section: Fetal Cardiac Assessmentmentioning

confidence: 99%

“…We and others have shown that GDM is associated with fetal cardiac morphological and functional changes which are mostly noted in the right ventricle, which is consistent with the dominance of the right heart late in gestation. [4][5][6] However, it remains unknown whether these cardiac changes in response to a relative mild and transient maternal disease persist in postnatal life and whether they identify the subgroup of children who are at increased longterm cardiovascular risk. To date, only a few studies have carried out postnatal assessment in offspring of mothers with GDM and these studies were confined to the neonatal period.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac function in gestational diabetes mellitus: A longitudinal study from fetal life to infancy

Aguilera

Semmler

Anzoategui

et al. 2020

BJOG

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Objective To determine whether cardiac functional and structural changes in fetuses of mothers with gestational diabetes mellitus (GDM) persist in the offspring beyond the neonatal period. Design Longitudinal study. Setting Fetal Medicine Unit in a UK teaching hospital. Methods 73 women with GDM and 73 women with uncomplicated pregnancy were recruited and fetal cardiac scans were performed at 35-36 weeks' gestation. Repeat echocardiogram was performed in their offspring during infancy. Main outcome measures Fetal and infant cardiac functional and structural changes. Results Fetuses of mothers with GDM, compared with controls, had more globular right ventricles (sphericity index 0.7, interquartile range [IQR] 0.6/0.7 versus 0.6, IQR 0.5/0.6, P < 0.001) and reduced right global longitudinal systolic strain (À16.4, IQR À18.9/À15.3 versus À18.5, IQR À20.6/À16.8, P = 0.001) and left global longitudinal systolic strain (À20.1, IQR À22.5/À16.9 versus À21.3, IQR À23.5/À19.5), P = 0.021). In the GDM group, compared with controls, in infancy there was higher left ventricular E/e' (

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Section: Interpretation Of Results and Comparison With Existing Litersupporting

confidence: 90%

Section: Study Populationstudy Designmentioning

confidence: 99%

Section: Fetal Cardiac Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cardiac function in gestational diabetes mellitus: A longitudinal study from fetal life to infancy

Aguilera

Semmler

Anzoategui

et al. 2020

BJOG

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“…Previously, we have demonstrated that women with GDM at 35-36 weeks' gestation, compared to controls, have evidence of subclinical left ventricular dysfunction with higher diastolic and lower systolic functional indices 8 , but it remains unclear whether these functional changes persist in the postpartum period. The objective of this study was to compare maternal cardiac function and structure in women with GDM and those with uncomplicated pregnancy at 35-36 weeks' gestation and at about 6 months after delivery and assess whether the rate of cardiovascular recovery differs between women with GDM and controls.…”

Section: Introductionmentioning

confidence: 98%

Maternal cardiac function in gestational diabetes mellitus at 35–36 weeks' gestation and 6 months postpartum

Aguilera

Sierra

Azim

et al. 2020

Ultrasound in Obstet & Gyne

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Objective Women with gestational diabetes mellitus (GDM) are at increased risk for adverse cardiovascular outcome later in life. However, it is uncertain whether this increased risk is due to cardiovascular changes occurring during pregnancy and persisting thereafter or to an adverse underlying cardiovascular risk factor profile. Some studies have reported that GDM is associated with reduced systolic and diastolic left ventricular function in pregnancy; however, it remains unknown whether these changes persist after delivery. The objective of this study was to compare cardiac function and structure in women with GDM and those with uncomplicated pregnancy at 35–36 weeks' gestation and about 6 months after delivery. Methods This was a longitudinal study in which women with GDM and those with uncomplicated pregnancy had detailed cardiovascular assessment at 35–36 weeks' gestation and repeat examination around 6 months after delivery. In all women, left ventricular systolic and diastolic indices were measured and left ventricular mass indexed for body surface area was calculated. Cardiac output and peripheral vascular resistance were also calculated using echocardiography. Linear mixed model analysis accounting for differences in maternal characteristics was carried out to compare findings of cardiovascular function between the GDM group and controls and within each group at 35–36 weeks' gestation and at 6 months after delivery. Results We studied 73 women with GDM and 73 controls with uncomplicated pregnancy. At 35–36 weeks' gestation, women with GDM, compared to controls, had higher E/e′ ratio and lower E/A ratio and global longitudinal systolic strain; there were no significant differences between the groups in ejection fraction. Left ventricular mass indexed for body surface area was also increased in women with GDM. There were no significant differences between the groups in cardiac output and peripheral vascular resistance. At 6 months after delivery, cardiac functional indices improved in both patients with GDM and controls, but in the GDM group, compared to controls, there was a lower degree of improvement in E/A ratio and global longitudinal systolic strain. Conclusion In the third trimester, patients with GDM have subtle differences in diastolic and systolic left ventricular function compared to controls and, despite improvement after delivery, these changes persist for at least 6 months. Long‐term follow‐up is therefore needed to assess whether women with GDM are at risk for an accelerated decline in their cardiac function and, if so, whether this trend can be reversed or delayed by optimal cardiovascular risk factor modification. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

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Fetal Cardiac Function at Midgestation in Women Who Subsequently Develop Gestational Diabetes

et al. 2023

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ImportanceFetuses in women with gestational diabetes (GD) compared with those without GD show evidence of subclinical cardiac functional and morphological changes. However, it is uncertain whether glycemia or the adverse maternal underlying risk factor profile is the main driver for fetal cardiac remodeling.ObjectiveTo assess cardiac morphology and function at midgestation in fetuses of mothers prior to development of GD and compare them with those of unaffected controls.Design, Setting, and ParticipantsDuring this prospective nonintervention screening study at 19 to 23 weeks’ gestation, fetal cardiac morphology and function were assessed in all participants. Pregnancy complications were obtained from the medical records of the women. Fetal cardiac morphology and function were assessed in all participants at Harris Birthright Research Institute at King’s College Hospital, London, United Kingdom. Participants included pregnant women with singleton pregnancy who attended their routine fetal ultrasound examination at midgestation and agreed to participate in the Advanced Cardiovascular Imaging Study in pregnancy.Main Outcome and MeasuresComparison of fetal cardiac morphology and function between mothers who subsequently developed GD and those who did not develop GD.MethodsThis was a prospective nonintervention screening study of 5620 women with singleton pregnancies at 19 to 23 weeks’ gestation. Conventional and more advanced echocardiographic modalities, such as speckle tracking, were used to assess fetal cardiac function in the right and left ventricle. The morphology of the fetal heart was assessed by calculating the right and left sphericity index.ResultsThe 5620 included patients had a mean age of 33.6 years. In 470 cases, the women were diagnosed with GD after the midgestation echocardiographic assessment (8.4%). Women with GD, compared with the non-GD group, were older, had higher BMI, higher prevalence of family history of diabetes, non-White ethnicity, chronic hypertension, and GD in a previous pregnancy. In fetuses of the GD group compared with the non-GD group, there was mild increase in interventricular millimeter thickness (0.04; 95% CI, 0.03-0.06 mm) and left atrial area (0.04; 95% CI, 0.04-0.05), whereas left and right functional indices were comparable between groups with the exception of left ventricular ejection fraction, which was marginally improved in the GD group (0.02; 95% CI, 0.03-0.03).Conclusions and RelevanceThis study demonstrates that prior to development of GD, there was mild alteration in fetal cardiac morphology without affecting cardiac function. This suggests that the adverse maternal risk factor profile and not only the glycemia might contribute to cardiac remodeling noted in fetuses of women with GD.

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Paired maternal and fetal cardiac functional measurements in women with gestational diabetes mellitus at 35–36 weeks’ gestation

Cited by 36 publications

References 49 publications

Cardiac function in gestational diabetes mellitus: A longitudinal study from fetal life to infancy

Cardiac function in gestational diabetes mellitus: A longitudinal study from fetal life to infancy

Maternal cardiac function in gestational diabetes mellitus at 35–36 weeks' gestation and 6 months postpartum

Fetal Cardiac Function at Midgestation in Women Who Subsequently Develop Gestational Diabetes

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