Ghandi Yazdan, Habibi Danial, Nasri Khadijeh, Alinejad Saeed, Taherahmad Hassan, Arjmand Shabestari Ali, Nematinejad Ali
a Amirkabir Hospital, Department of Pediatric Cardiology, School of Medicine , Arak University of Medical Sciences , Arak , Iran.
J Matern Fetal Neonatal Med. 2019 Jul;32(13):2101-2106. doi: 10.1080/14767058.2018.1425832. Epub 2018 Jun 17.
There are some evidences supporting the relation between gestational diabetes mellitus (GDM) and diastolic dysfunction. The aim of our study was to investigate the effect of well-controlled GDM on morphological and functional myocardium.
We designed a prospective cross-sectional study to evaluate left ventricular (LV) diastolic function of 60 neonates born from mothers with well-controlled GDM (case group) on days of 3-5 after birth. The infants of diabetic mothers (IDM) group were divided into two groups: diabetic mothers treated only with diet (class A) and group of mothers on medical therapy by insulin or metformin (class B). Traditional echocardiography and pulsed-wave Doppler (PWD), tissue Doppler imaging (TDI) were performed for all the neonates.
The study group consisted of 60 neonates as males (M) = 32, (0.53%) and females (F) = 28, (0.46%). Using M-mode echocardiography, interventricular septum thickness (IVS), and LV mass were significantly higher in IDM than control group (p = .0001). The PWD showed both a significantly more peak mitral flow at early diastolic wave (E) and an early filling deceleration time (E-DT) (p = .0001). Tissue Doppler echocardiography parameters A' (cm/s) (p = .0001), E' (cm/s) (p = .002), and E'/A' ratio (p = .0001), left ventricular myocardial performance index (LVMPI), and isovolumetric relaxation time (IVRT) were outstandingly different between the two groups (p = .0001, respectively). Evaluating the GDM group mothers of class A and class B, no significant difference was noted in PWD or TDI parameters compared with the healthy ones.
It seems that neonates of mothers with well-controlled GDM are still at increased risk of cardiac hypertrophy, subclinical diastolic dysfunction, and impaired left ventricular relaxation. This can be interpreted that focusing only on glycemic control is not enough to prevent cardiac dysfunction.
有一些证据支持妊娠期糖尿病（GDM）与舒张功能障碍之间的关系。我们研究的目的是调查血糖控制良好的GDM对心肌形态和功能的影响。
我们设计了一项前瞻性横断面研究，以评估60例出生后3至5天来自血糖控制良好的GDM母亲的新生儿（病例组）的左心室（LV）舒张功能。糖尿病母亲的婴儿（IDM）组分为两组：仅接受饮食治疗的糖尿病母亲（A类）和接受胰岛素或二甲双胍药物治疗的母亲组（B类）。对所有新生儿进行传统超声心动图和脉冲波多普勒（PWD）、组织多普勒成像（TDI）检查。
研究组由60例新生儿组成，男性（M）=32例（0.53%），女性（F）=28例（0.46%）。使用M型超声心动图，IDM组的室间隔厚度（IVS）和左心室质量显著高于对照组（p = 0.0001）。PWD显示舒张早期二尖瓣血流峰值（E）和早期充盈减速时间（E-DT）均显著增加（p = 0.0001）。两组之间组织多普勒超声心动图参数A'（cm/s）（p = 0.0001）、E'（cm/s）（p = 0.002）和E'/A'比值（p = 0.0001）、左心室心肌性能指数（LVMPI）和等容舒张时间（IVRT）有显著差异（p分别为0.0001）。评估A类和B类GDM组母亲，与健康母亲相比，PWD或TDI参数无显著差异。
似乎血糖控制良好的GDM母亲的新生儿仍有心脏肥大、亚临床舒张功能障碍和左心室舒张受损的风险增加。这可以解释为仅关注血糖控制不足以预防心脏功能障碍。
