Department of Cardiovascular Technology, Manipal College of Health Professions, MAHE, Manipal, India.
Department of Cardiology, Kasturba Medical College, MAHE, Manipal, India.
J Diabetes Complications. 2022 Jan;36(1):108079. doi: 10.1016/j.jdiacomp.2021.108079. Epub 2021 Oct 21.
Offspring of diabetic mothers have five times higher risk of cardiovascular abnormalities than in normal pregnancies. These cardiac anomalies involve fetal cardiac morphological and functional changes. Here, we investigate subclinical cardiovascular abnormalities, including structural and functional changes among infants of diabetic mothers.
A prospective cohort study was carried out from March 2017 to September 2020 at a South Indian tertiary care center. One hundred ninety-eight newborns delivered from non-diabetic mothers, well-controlled diabetic mothers (WCDM), and poorly controlled diabetic mothers (PCDM) were studied. Neonates and infantile echocardiographic imaging were performed at the first week of life, at 6-weeks, and 6-months of life. Cardiac structure and function were assessed using 2D, M-mode, Conventional Doppler, and Tissue Doppler imaging.
Out of the total (198) infants, 66 (33.3%) were from the non-diabetic (control) mothers, 60 (30.3%) from the WCDM, and 72 (36.4%) were from the PCDM groups. In both WCDM and PCDM groups, the mean gestational ages at birth were shorter than the control group (37.19 ± 0.82, 36.02 ± 2.15, and 37.91 ± 1.33 weeks respectively). There was a high incidence of neonatal hypoglycemia (p-value <0.001), NICU stay >7 days (p-value <0.018), and persistent fetal transitional cardiac shunt (p-value <0.03) among poorly controlled DM group in comparison to others. Tissue deformation imaging showed a significant reduction in left ventricular global strain and strain rate in the neonatal heart from poorly controlled diabetic mothers. Myocardial wall thickness among neonates of diabetic mothers was higher compared to controls. LV TEI was higher in PCDM groups in comparison with WCDM and control groups; (0.59 ± 0.11, 0.46 ± 0.35, and 0.37 ± 0.12 respectively, p-value =0.01). Similarly, RV TEI was high in the PCDM (0.56 ± 0.09) group compared to the WCDM group (0.33 ± 0.12) and control group (0.28 ± 0.10).
Infants of diabetic mothers are at higher risk of developing cardiac abnormalities, including structural and functional defects. The highest increase in interventricular septal thickening found in poorly controlled diabetic mothers' neonates will disrupt both ventricles' functions, followed by WCDM and the control group.
糖尿病母亲的后代患心血管异常的风险比正常妊娠高五倍。这些心脏异常涉及胎儿心脏形态和功能的变化。在这里，我们研究了糖尿病母亲所生婴儿的亚临床心血管异常，包括结构和功能变化。
这是一项于 2017 年 3 月至 2020 年 9 月在印度南部一家三级护理中心进行的前瞻性队列研究。研究了 198 名来自非糖尿病母亲、血糖控制良好的糖尿病母亲（WCDM）和血糖控制不佳的糖尿病母亲（PCDM）的新生儿。在新生儿生命的第一周、6 周和 6 个月时进行新生儿和婴儿超声心动图成像。使用二维、M 模式、常规多普勒和组织多普勒成像评估心脏结构和功能。
在总共（198）名婴儿中，66 名（33.3%）来自非糖尿病（对照组）母亲，60 名（30.3%）来自 WCDM 组，72 名（36.4%）来自 PCDM 组。在 WCDM 和 PCDM 组中，出生时的平均胎龄均短于对照组（分别为 37.19 ± 0.82、36.02 ± 2.15 和 37.91 ± 1.33 周）。与其他组相比，血糖控制不佳的 DM 组新生儿低血糖（p 值 <0.001）、NICU 住院时间 >7 天（p 值 <0.018）和持续胎儿过渡性心脏分流（p 值 <0.03）的发生率较高。与 WCDM 和对照组相比，来自血糖控制不佳的糖尿病母亲的新生儿左心室整体应变和应变率的组织变形成像明显降低。与对照组相比，糖尿病母亲新生儿的心肌壁厚度较高。与 WCDM 和对照组相比，PCDM 组的左室心肌指数（LVTEI）较高（分别为 0.59 ± 0.11、0.46 ± 0.35 和 0.37 ± 0.12，p 值 =0.01）。同样，PCDM 组的右心室心肌指数（RVTEI）较高（0.56 ± 0.09），而 WCDM 组（0.33 ± 0.12）和对照组（0.28 ± 0.10）较低。
糖尿病母亲的婴儿患心脏异常的风险较高，包括结构和功能缺陷。血糖控制不佳的糖尿病母亲新生儿的室间隔增厚增加最多，这将破坏两个心室的功能，其次是 WCDM 和对照组。
