Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
Prenat Diagn. 2011 May;31(5):459-65. doi: 10.1002/pd.2717. Epub 2011 Mar 10.
To assess fetal cardiac structure and function in normal pregnancy and in the presence of gestational diabetes mellitus (GDM) using echocardiography measurements.
We studied fetal cardiac structure and function in 169 uncomplicated singleton pregnancies and in 92 complicated by GDM. Maternal glycemic control was deemed adequate in 75 women and inadequate in 17. Fetal two-dimensional ultrasound, pulsed wave Doppler and tissue Doppler imaging (TDI) were used to assess cardiac walls thickness and cardiac function, both systolic [with ejection fraction (EF)] and diastolic [using early diastolic peak flow velocity (E)/late peak of diastolic velocity (A) and early diastolic peak velocity at the annulus (Ea)/late diastolic peak velocity at the annulus (Aa) ratios].
In normal pregnancies, fetal ventricular walls and interventricular septum thickness increased progressively with advancing gestation and were significantly thicker in the presence of GDM (P < 0.001) independently of maternal glycemic control. Fetal cardiac systolic function indicated by EF did not change during normal pregnancy, but was significantly increased (P < 0.001) in the presence of GDM independently of maternal glycemic control. Both pulsed wave Doppler and TDI indicators of fetal diastolic cardiac function increased during normal pregnancy, reaching a maximum at 36 to 40 weeks of gestation (P < 0.001). The presence of GDM did not affect pulsed wave Doppler indicators of diastolic function [ratio of early/late diastolic peak flow velocity (E/A ratio)], whereas TDI indices [ratio of early/late diastolic peak velocity at the annulus (Ea/Aa ratio)] were significantly lower after adjustment for gestational age and estimated fetal weight (EFW); and such changes were independent of maternal diabetic control (P < 0.001).
Fetal cardiac wall thickness, cardiac systolic and diastolic functions are affected by GDM independently of glycemic control.
运用超声心动图测量技术评估正常妊娠及妊娠期糖尿病（GDM）孕妇胎儿的心脏结构和功能。
我们研究了 169 例正常单胎妊娠和 92 例 GDM 孕妇的胎儿心脏结构和功能。其中 75 例孕妇的血糖控制良好，17 例孕妇的血糖控制不佳。我们使用二维超声、脉冲波多普勒和组织多普勒成像（TDI）评估胎儿心脏壁的厚度和心功能，包括收缩功能（射血分数 EF）和舒张功能[使用早期舒张峰速度（E）/晚期舒张速度（A）和瓣环处早期舒张速度（Ea）/晚期舒张速度（Aa）比值]。
在正常妊娠中，胎儿心室壁和室间隔厚度随孕周的增加而逐渐增加，且在 GDM 孕妇中显著增厚（P<0.001），而与母体血糖控制无关。EF 提示胎儿心脏收缩功能在正常妊娠期间没有变化，但在 GDM 孕妇中显著增加（P<0.001），而与母体血糖控制无关。脉冲波多普勒和 TDI 提示胎儿舒张功能的各项指标在正常妊娠期间均增加，在 36-40 孕周达到峰值（P<0.001）。GDM 并不影响舒张功能的脉冲波多普勒指标[早期/晚期舒张峰速度比值（E/A 比值）]，但 TDI 指标[瓣环处早期/晚期舒张速度比值（Ea/Aa 比值）]在调整孕周和估计胎儿体重（EFW）后显著降低；且这些变化与母体糖尿病控制无关（P<0.001）。
胎儿心脏壁厚度、收缩和舒张功能均受 GDM 影响，而与血糖控制无关。
