Kozák-Bárány Andrea, Jokinen Eero, Kero Pentti, Tuominen Juhani, Rönnemaa Tapani, Välimäki Ilkka
Department of Paediatrics, University of Turku, Vähä-Hämeenkatu 1A3, 20520 Turku, Finland.
Early Hum Dev. 2004 Apr;77(1-2):13-22. doi: 10.1016/j.earlhumdev.2003.11.006.
We assessed by echocardiography the left ventricular systolic and diastolic function in newborn infants of mothers with well-controlled pregestational type 1 or gestational diabetes (IDM) in comparison to normal term neonates.
Two-dimensional/M-mode and Doppler transmitral flow velocity measurements were performed in 18 IDM and 26 control infants of non-diabetic mothers (gestational ages 36-40 and 36-41 weeks, respectively) between days 2 and 5 after birth. In the IDM, there were nine mothers with pregestational (White class C or D) and nine mothers with gestational diabetes (White class A or A/B). Peak early and atrial filling velocity, early deceleration time, early acceleration time, early, atrial and total time velocity integrals were used to examine the left ventricular diastolic performance. We also calculated the early/atrial velocity ratio, early/atrial integral ratio and early/total integral ratio. The fractional shortening, fractional shortening area, midwall fractional shortening (mFS), left ventricular mass and indexed left ventricular mass for body surface area (BSA) and birth weight were used in assessment of left ventricular systolic performance.
The early deceleration time was longer, resulting in higher early integral and early filling fraction (EFF) in the IDM than in the control infants (p<0.01). In the IDM, the fractional shortening was somewhat greater and the left ventricular mass/body surface area ratio was higher than in the control group (p<0.05), although the measures of systolic performance were within the normal range. There were no significant differences in the systolic or diastolic function parameters between the gestational and pregestational groups.
In the infants of mothers with well-controlled pregestational or gestational diabetes, we found prolonged deceleration time of early left ventricular diastolic filling, probably reflecting an impaired left ventricular relaxation rather than compliance. The mechanism for the findings may be maternal hyperglycemia during the third trimester and subsequent fetal hyperinsulinaemia leading to neonatal cardiac hypertrophy.
我们通过超声心动图评估了患有孕前1型糖尿病或妊娠期糖尿病且病情控制良好的母亲所生新生儿（糖尿病母亲婴儿）的左心室收缩和舒张功能，并与足月正常新生儿进行比较。
对18例糖尿病母亲婴儿和26例非糖尿病母亲的对照婴儿（分别为孕龄36 - 40周和36 - 41周）在出生后第2至5天进行二维/M型及多普勒二尖瓣血流速度测量。在糖尿病母亲婴儿组中，9例母亲患有孕前糖尿病（White分级C或D级），9例母亲患有妊娠期糖尿病（White分级A或A/B级）。采用早期和心房充盈峰值速度、早期减速时间、早期加速时间、早期、心房及总时间速度积分来检测左心室舒张功能。我们还计算了早期/心房速度比值、早期/心房积分比值和早期/总积分比值。采用缩短分数、缩短分数面积、室壁中层缩短分数（mFS）、左心室质量以及根据体表面积（BSA）和出生体重计算的左心室质量指数来评估左心室收缩功能。
糖尿病母亲婴儿的早期减速时间更长，导致其早期积分和早期充盈分数（EFF）高于对照婴儿（p<0.01）。在糖尿病母亲婴儿中，尽管收缩功能指标在正常范围内，但缩短分数略高，左心室质量/体表面积比值高于对照组（p<0.05）。妊娠期糖尿病组和孕前糖尿病组之间的收缩或舒张功能参数无显著差异。
在患有孕前或妊娠期糖尿病且病情控制良好的母亲所生婴儿中，我们发现左心室早期舒张充盈减速时间延长，这可能反映左心室舒张功能受损而非顺应性降低。这些发现的机制可能是孕晚期母亲高血糖及随后胎儿高胰岛素血症导致新生儿心脏肥大。
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