糖尿病母亲的子女中持续存在的主动脉僵硬和左心室肥厚
Persistent Aortic Stiffness and Left Ventricular Hypertrophy in Children of Diabetic Mothers.
作者信息
Do Victor, Eckersley Luke, Lin Lily, Davidge Sandra T, Stickland Michael K, Ojala Tiina, Serrano-Lomelin Jesus, Hornberger Lisa K
机构信息
Fetal and Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.
出版信息
CJC Open. 2020 Nov 13;3(3):345-353. doi: 10.1016/j.cjco.2020.10.020. eCollection 2021 Mar.
BACKGROUND
Fetuses of diabetic mothers develop left ventricular (LV) hypertrophy and are at increased long-term risk of cardiovascular disease. In our previous longitudinal study from midgestation to late infancy we showed persistence of LV hypertrophy and increased aortic stiffness compared with infants of healthy mothers, the latter of which correlated with third trimester maternal hemoglobin A1c. In the present study, we reexamined the same cohort in early childhood to determine if these cardiovascular abnormalities persisted.
METHODS
Height, weight, and right arm blood pressure were recorded. A full functional and structural echocardiogram was performed with offline analysis of LV posterior wall and interventricular septal diastolic thickness (IVSd), systolic and diastolic function, and aortic pulse wave velocity. Vascular reactivity was assessed using digital thermal monitoring. Participants also completed a physical activity questionnaire.
RESULTS
Twenty-five children of diabetic mothers (CDMs) and 20 children from healthy pregnancies (mean age, 5.6 ± 1.7 and 5.3 ± 1.3 years, respectively; = not significant) were assessed. Compared with controls, IVSd z score was increased in CDMs (1.2 ± 0.6 vs 0.5 ± 0.3, respectively; = 0.006), with one-fifth having a z score of more than +2.0. Aortic pulse wave velocity was increased in CDMs (3.2 ± 0.6 m/s vs 2.2 ± 0.4 m/s; = 0.001), and correlated with IVSd z score ( = 0.81; = 0.001) and third trimester maternal A1c ( = 0.65; < 0.0001). Body surface area, height, weight, blood pressure, vascular reactivity, and physical activity scores did not differ between groups. Our longitudinal analysis showed that individuals with greater IVSd, and aortic stiffness in utero, early and late infancy also tended to have greater measures in early childhood ( < 0.001 and < 0.0001, respectively).
CONCLUSIONS
CDMs show persistently increased interventricular septal thickness and aortic stiffness in early childhood.
背景
患有糖尿病母亲的胎儿会出现左心室肥厚，并且长期患心血管疾病的风险增加。在我们之前从中孕期到婴儿晚期的纵向研究中，我们发现与健康母亲的婴儿相比，左心室肥厚持续存在，主动脉僵硬度增加，后者与孕晚期母亲的糖化血红蛋白A1c相关。在本研究中，我们在儿童早期对同一队列进行了重新检查，以确定这些心血管异常是否持续存在。
方法
记录身高、体重和右臂血压。进行了完整的功能和结构超声心动图检查，并对左心室后壁和室间隔舒张期厚度（IVSd）、收缩和舒张功能以及主动脉脉搏波速度进行离线分析。使用数字热监测评估血管反应性。参与者还完成了一份身体活动问卷。
结果
评估了25名患有糖尿病母亲的儿童（CDM）和20名来自健康妊娠的儿童（平均年龄分别为5.6±1.7岁和5.3±1.3岁；差异无统计学意义）。与对照组相比，CDM的IVSd z评分增加（分别为1.2±0.6和0.5±0.3；P=0.006），五分之一的儿童z评分超过+2.0。CDM的主动脉脉搏波速度增加（3.2±0.6米/秒对2.2±0.4米/秒；P=0.001），并且与IVSd z评分相关（r=0.81；P=0.001）以及孕晚期母亲的糖化血红蛋白A1c相关（r=0.65；P<0.0001）。两组之间的体表面积、身高、体重、血压、血管反应性和身体活动评分没有差异。我们的纵向分析表明，在子宫内、婴儿早期和晚期IVSd和主动脉僵硬度较大的个体在儿童早期也往往有更大的测量值（分别为P<0.001和P<0.0001）。
结论
患有糖尿病母亲的儿童在儿童早期室间隔厚度和主动脉僵硬度持续增加。
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