Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Cardiac Electrophysiology Research and Training Center (CERT), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Perinat Med. 2020 Jun 25;48(5):471-476. doi: 10.1515/jpm-2019-0457.
Background The primary objective of this study was to compare the fetal cardiac performance index (Tei index) between the fetuses of gestational diabetes mellitus (GDM) mothers and non-GDM mothers; and the secondary objective was to compare various other parameters of fetal cardiac function as well as maternal oxidative stress levels between the groups of GDM and non-GDM mothers. Methods A cross-sectional study was conducted on pregnant women at 24-28 weeks of gestation. All of the participants underwent 100 g, 3-h oral glucose tolerance test (OGTT) as a diagnostic test for GDM and were categorized as non-GDM and GDM group. All participants had fetal echocardiography performed for cardiac function, and then maternal blood samples were collected for biomarker measurements. Results A total of 80 pregnant women, including 43 in the GDM group and 37 in the non-GDM group, were included in the study. The maternal serum 8-isoprostane (8IsoP), tumor necrosis factor-α (TNF-α) and interleukin (IL)-10 levels were significantly higher in the GDM group than those in the non-GDM group (P: 0.028, P: 0.019 and P: 0.031, respectively). The fetal cardiac function parameters were not significantly different between the two groups. Regardless of the GDM status, the fetuses with high levels of oxidative stress (8Isop ≥1000 pg/mg protein) had a significantly higher rate of impaired shortening fraction (SF) of the left ventricle (P: 0.001). Conclusion GDM is significantly associated with an increase in the oxidative stress process, and a high level of oxidative stress was significantly associated with left ventricular (LV) function impairment. Though a correlation between GDM and fetal cardiac function impairment was not clearly demonstrated in this study, this study suggests that GDM patients with a high level of oxidative stress should be evaluated for fetal cardiac function.
背景 本研究的主要目的是比较患有妊娠期糖尿病（GDM）和非 GDM 的孕妇胎儿的心功能指数（Tei 指数）；次要目的是比较两组孕妇胎儿心脏功能的其他各项参数以及母体氧化应激水平。 方法 对 24-28 周妊娠的孕妇进行横断面研究。所有参与者均行 100 g、3 h 口服葡萄糖耐量试验（OGTT）作为 GDM 的诊断试验，并分为非 GDM 和 GDM 组。所有参与者均行胎儿超声心动图检查以评估心功能，然后采集母血样本进行生物标志物测量。 结果 本研究共纳入 80 名孕妇，其中 GDM 组 43 例，非 GDM 组 37 例。GDM 组孕妇血清 8-异前列腺素（8IsoP）、肿瘤坏死因子-α（TNF-α）和白细胞介素（IL）-10 水平明显高于非 GDM 组（P：0.028、P：0.019 和 P：0.031）。两组胎儿心功能参数无显著差异。无论 GDM 状态如何，氧化应激水平较高（8IsoP≥1000 pg/mg 蛋白）的胎儿左心室短缩分数（SF）受损率显著更高（P：0.001）。 结论 GDM 与氧化应激过程显著相关，高水平的氧化应激与左心室（LV）功能障碍显著相关。虽然本研究未明确显示 GDM 与胎儿心功能损害之间存在相关性，但本研究提示 GDM 患者氧化应激水平较高时应评估胎儿心功能。
