Balli Sevket, Pac Feyza Aysenur, Ece İbrahim, Oflaz Mehmet Burhan, Kibar Ayse Esin, Kandemir Ömer
Department of Pediatric Cardiology, Balıkesir Atatürk Hospital, Yıldız Mahallesi, Soma Caddesi, Balıkesir, Turkey,
Pediatr Cardiol. 2014 Jan;35(1):30-7. doi: 10.1007/s00246-013-0734-0. Epub 2013 Jun 19.
We investigated cardiac function in 67 fetuses of gestational diabetic mothers (FGDMs) and 122 fetuses of healthy mothers between 24 and 36 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. Fetal echocardiograms were performed at 24, 28, 32, and 36 weeks of gestation. Glycated hemoglobin (HbA1c) levels were obtained from all pregnant women at 24 weeks of gestation. The mean age of diabetic pregnant women was significantly greater than that of controls. Serum HbA1c values of both groups were within normal limits, but they were significantly greater in the diabetic group (p = 0.003). The increase in peak aortic and pulmonary artery velocities were greater in FGDM (p < 0.001). No pathological interventricular septal (IVS) hypertrophy was observed. There was a significant increase in IVS thickness in FGDM compared with controls, which was more prominent at the end of the third trimester (p < 0.001). During the course of pregnancy, mitral E-wave (p < 0.001), A-wave (p = 0.007), tricuspid E-wave (p < 0.001) and A-wave (p = 0.002) velocities were greater in FGDM. The increases in mitral E/A and tricuspid E/A ratios were lower in FGDM with advancing gestation. The E a-wave (p = 0.02), A a-wave (p = 0.04), and S a-wave (p < 0.001) velocities of the right-ventricular (RV) free wall and the E a (p = 0.02) and A a (p = 0.01) velocities of the left-ventricle (LV) posterior wall were greater in FGDM during the course of pregnancy. The E a/A a ratio of the RV posterior wall was greater in FGDM with advancing gestation (p < 0.03). LV and RV E/E a ratios were similar in both groups. The LV myocardial performance index measured by pulsed-wave Doppler was greater in FGDM (p < 0.001). We detected diastolic dysfunction in FGDM. The data suggest that gestational diabetes mellitus may impair ventricular diastolic functions without causing pathological fetal myocardial hypertrophy. We detected subclinical diastolic dysfunction using both pulsed-wave and tissue Doppler imaging in FGDM.
我们研究了67例妊娠糖尿病母亲的胎儿（FGDM）和122例健康母亲的胎儿在妊娠24至36周期间的心脏功能。通过M型、脉冲波和组织多普勒超声心动图评估心脏功能。在妊娠24、28、32和36周时进行胎儿超声心动图检查。在妊娠24周时获取所有孕妇的糖化血红蛋白（HbA1c）水平。糖尿病孕妇的平均年龄显著高于对照组。两组的血清HbA1c值均在正常范围内，但糖尿病组显著更高（p = 0.003）。FGDM中主动脉和肺动脉峰值速度的增加更大（p < 0.001）。未观察到病理性室间隔（IVS）肥厚。与对照组相比，FGDM中IVS厚度显著增加，在妊娠晚期结束时更为明显（p < 0.001）。在妊娠过程中，FGDM中的二尖瓣E波（p < 0.001）、A波（p = 0.007）、三尖瓣E波（p < 0.001）和A波（p = 0.002）速度更高。随着妊娠进展，FGDM中二尖瓣E/A和三尖瓣E/A比值的增加较低。妊娠期间，FGDM中右心室（RV）游离壁的E a波（p = 0.02）、A a波（p = 0.04）和S a波（p < 0.001）速度以及左心室（LV）后壁的E a（p = 0.02）和A a（p = 0.01）速度更高。随着妊娠进展，FGDM中RV后壁的E a/A a比值更大（p < 0.03）。两组的LV和RV E/E a比值相似。通过脉冲波多普勒测量的LV心肌性能指数在FGDM中更大（p < 0.001）。我们在FGDM中检测到舒张功能障碍。数据表明，妊娠糖尿病可能损害心室舒张功能而不引起病理性胎儿心肌肥厚。我们使用脉冲波和组织多普勒成像在FGDM中检测到亚临床舒张功能障碍。
