Wong S F, Chan F Y, Cincotta R B, McIntyre H D, Oats J J N
Department of Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Qld., Australia.
Gynecol Obstet Invest. 2003;56(2):113-6. doi: 10.1159/000073191. Epub 2003 Aug 26.
Cardiac impairment is frequently found in babies of diabetic mothers. It is still controversial whether this is due to poor glucose control. The aim of this study is to compare the cardiac function in fetuses of well- and poorly-controlled pre-gestational diabetic pregnancy in third trimester.
Women with type 1 pre-gestational diabetes were enrolled at 30-32 weeks. Cardiac size and interventricular septal wall thickness were measured by M-mode at end-diastolic phase. The right and left ventricular ejection fractions were calculated. At the mitral and tricuspid valves inflow, the ratio between early ventricular filling and active atrial filling (E/A) at both atrioventricular valves were measured by Doppler echocardiography. Peak velocities of ascending aorta and pulmonary artery were assessed. The angle of isonation was kept at <20 degrees. Women with poorly-controlled diabetes (HbA1c>6.5%) were compared with those with satisfactorily controlled diabetes (HbA1c < or = 6.5%).
A total of 21 women with pre-gestational diabetes were recruited for this study. Eight women with well-controlled diabetes were compared with 9 women who had poorly-controlled diabetes. HbA1c in the poorly-controlled group was 7.3% and in the well-controlled group it was 5.4% (p<0.001). There was no difference between the two groups in cardiac size, interventricular septal wall thickness, ejection fraction, aorta and pulmonary artery peak flow velocities. The right atrioventricular E/A ratio was significantly lower among the poorly-controlled diabetic pregnancies (0.71 vs. 0.54; p<0.05).
Fetuses of poorly-controlled diabetic mothers had a lower right atrioventricular E/A ratio. This may be due to metabolic acidosis, non-hypertrophic cardiac dysfunction or fetal polycythemia.
糖尿病母亲的婴儿中经常发现心脏损害。这是否归因于血糖控制不佳仍存在争议。本研究的目的是比较妊娠晚期孕前糖尿病控制良好和控制不佳的胎儿的心脏功能。
纳入孕30 - 32周的1型孕前糖尿病女性。在舒张末期通过M型测量心脏大小和室间隔壁厚度。计算右心室和左心室射血分数。在二尖瓣和三尖瓣流入处，通过多普勒超声心动图测量两个房室瓣处早期心室充盈与主动心房充盈之比（E/A）。评估升主动脉和肺动脉的峰值速度。声束入射角保持在<20度。将糖尿病控制不佳（糖化血红蛋白>6.5%）的女性与糖尿病控制良好（糖化血红蛋白≤6.5%）的女性进行比较。
本研究共纳入21名孕前糖尿病女性。将8名糖尿病控制良好的女性与9名糖尿病控制不佳的女性进行比较。控制不佳组的糖化血红蛋白为7.3%，控制良好组为5.4%（p<0.001）。两组在心脏大小、室间隔壁厚度、射血分数、主动脉和肺动脉峰值流速方面无差异。糖尿病控制不佳的妊娠中右房室E/A比值显著较低（0.71对0.54；p<0.05）。
糖尿病控制不佳的母亲的胎儿右房室E/A比值较低。这可能是由于代谢性酸中毒、非肥厚性心脏功能障碍或胎儿红细胞增多症。
