Comparison of Fetal Cardiac Function between Pregnancies with Diabetes Mellitus and Normal Controls

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Podjanee Phadungkiatwattana
Lunthaporn Puttanavijarn


Objectives: The purpose of this study was to compare fetal cardiac function (systolic, diastolic and global) in patients with maternal diabetes mellitus during 35-37 weeks of gestation and to evaluate the association between cardiac function and adverse perinatal outcomes.
Materials and Methods: In this prospective observational cross-sectional study, 138 pregnant women with diabetes and 149 healthy pregnant women underwent fetal echocardiography to evaluate fetal cardiac function. The perinatal outcomes were evaluated after delivery.
Results: This study found that the mean modified myocardial performance index (mod-MPI) was significantly raised in fetuses of diabetic mothers (0.53 ± 0.06 vs. 0.49 ± 0.05, p < 0.001) while the mean E/A ratio ratio and cardiac output (CO) were similar in the diabetes and control groups. A subgroup analysis showed that mitral E/A and tricuspid E/A ratios, Mod-MPI, right, left, and combined CO were similar in women with gestational diabetes (GDM) with diet control and those with GDM or pre-gestational diabetes (PDM) with insulin usage. The neonatal outcomes (Apgar score at 1 min, Apgar score at 5 min, Apgar score ≤ 6 at 5-min, cesarean delivery due to fetal non-reassuring, neonatal intensive care unit admission, stillbirth, and perinatal death) were similar in the two groups. No correlation was observed between the fetal cardiac function and adverse perinatal outcomes.
Conclusion: Mod-MPI in the diabetic group was the only fetal cardiac function that was significantly higher than in the healthy pregnant women. No significant correlation was observed between fetal cardiac function and adverse perinatal outcomes.


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1. Lisowski LA, Verheijen PM, Copel JA, Kleinman CS, Wassink S, Visser GH, et al. Congenital heart disease in pregnancies complicated by maternal diabetes mellitus. An international clinical collaboration, literature review, and meta-analysis. Herz 2010;35:19-26.
2. Correa A. Pregestational Diabetes Mellitus and Congenital Heart Defects. Circulation 2016;133:2219-21.
3. Leirgul E, Brodwall K, Greve G, Vollset SE, Holmstrom H, Tell GS, et al. Maternal Diabetes, Birth Weight, and Neonatal Risk of Congenital Heart Defects in Norway, 1994-2009. Obstet Gynecol 2016;128:1116-25.
4. Han SS, Wang G, Jin Y, Ma ZL, Jia WJ, Wu X, et al. Investigating the Mechanism of Hyperglycemia-Induced Fetal Cardiac Hypertrophy. PLoS One 2015;10:e0139141.
5. Ullmo S, Vial Y, Di Bernardo S, Roth-Kleiner M, Mivelaz Y, Sekarski N, et al. Pathologic ventricular hypertrophy in the offspring of diabetic mothers: a retrospective study. Eur Heart J 2007;28:1319-25.
6. Balli S, Pac FA, Ece I, Oflaz MB, Kibar AE, Kandemir O. Assessment of cardiac functions in fetuses of gestational diabetic mothers. Pediatr Cardiol 2014;35:30-7.
7. Asoglu MR, Gabbay-Benziv R, Turan OM, Turan S. Exposure of the developing heart to diabetic environment and early cardiac assessment: A review. Echocardiography 2018;35:244-57.
8. Bhorat I, Pillay M, Reddy T. 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. J Matern Fetal Neonatal Med 2018;31:2019-26.
9. Figueroa H, Silva MC, Kottmann C, Viguera S, Valenzuela I, Hernandez-Andrade E, et al. Fetal evaluation of the modified-myocardial performance index in pregnancies complicated by diabetes. Prenat Diagn 2012;32:943-8.
10. Pilania R, Sikka P, Rohit MK, Suri V, Kumar P. Fetal Cardiodynamics by Echocardiography in Insulin Dependent Maternal Diabetes and Its Correlation with Pregnancy Outcome. J Clin Diagn Res 2016;10:QC01-4.
11. Weiner Z, Zloczower M, Lerner A, Zimmer E, Itskovitz-Eldor J. Cardiac compliance in fetuses of diabetic women. Obstet Gynecol 1999;93:948-51.
12. Gonzalez AB, Young L, Doll JA, Morgan GM, Crawford SE, Plunkett BA. Elevated neonatal insulin-like growth factor I is associated with fetal hypertrophic cardiomyopathy in diabetic women. Am J Obstet Gynecol 2014;211:290 e1-7.
13. Jaeggi ET, Fouron JC, Proulx F. Fetal cardiac performance in uncomplicated and well-controlled maternal type I diabetes. Ultrasound Obstet Gynecol 2001;17:311-5.
14. Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: A large, population-based study. Diabetes Care 2009;32:2005-9.
15. Castelijn B, Hollander K, Hensbergen JF, RG IJ, Valkenburg-van den Berg AW, Twisk J, et al. Peripartum fetal distress in diabetic women: a retrospective case-cohort study. BMC Pregnancy Childbirth 2018;18:228.
16. Lai FY, Johnson JA, Dover D, Kaul P. Outcomes of singleton and twin pregnancies complicated by pre-existing diabetes and gestational diabetes: A population-based study in Alberta, Canada, 2005-11. J Diabetes 2016;8:45-55.
17. Hernandez-Andrade E, Lopez-Tenorio J, Figueroa-Diesel H, Sanin-Blair J, Carreras E, Cabero L, et al. A modified myocardial performance (Tei) index based on the use of valve clicks improves reproducibility of fetal left cardiac function assessment. Ultrasound Obstet Gynecol 2005;26:227-32.
18. Thaithumyanon P, Bhongvej S, Chitinand S. Intrauterine growth in Thai population. J Pediatr Soc Thai 1984;23:99-106.
19. Bhorat IE, Bagratee JS, Pillay M, Reddy T. Use of the myocardial performance index as a prognostic indicator of adverse fetal outcome in poorly controlled gestational diabetic pregnancies. Prenat Diagn 2014;34:1301-6.
20. Sanhal CY, Daglar HK, Kara O, Uygur D, Yucel A. Assessment of fetal myocardial performance index in women with pregestational and gestational diabetes mellitus. J Obstet Gynaecol Res 2017;43:65-72.
21. Russell NE, Foley M, Kinsley BT, Firth RG, Coffey M, McAuliffe FM. Effect of pregestational diabetes mellitus on fetal cardiac function and structure. Am J Obstet Gynecol 2008;199:312 e1-7.
22. Garcia-Flores J, Janez M, Gonzalez MC, Martinez N, Espada M, Gonzalez A. Fetal myocardial morphological and functional changes associated with well-controlled gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2011;154:24-6.
23. Luewan S, Tongprasert F, Srisupundit K, Traisrisilp K, Tongsong T. Reference ranges of myocardial performance index from 12 to 40 weeks of gestation. Arch Gynecol Obstet 2014;290:859-65.