Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
Department of Endocrinology, First Hospital of Handan City, Handan, Hebei Province, China.
Echocardiography. 2022 Aug;39(8):1101-1112. doi: 10.1111/echo.15425. Epub 2022 Jul 21.
Gestational diabetes mellitus (GDM) is a complication of pregnancy strongly associated with an increased risk of structural fetal abnormalities. As the fetal heart grows quickly during the late-term pregnancy period, it is important to understand fetal heart growth before birth. This study explored how GDM affects fetal heart growth by evaluating basic echocardiography indicators during late pregnancy.
This prospective, longitudinal study included 63 GDM patients (GDM group) and 67 healthy pregnant women (control group). All subjects underwent fetal echocardiography scans at gestational weeks 28-32, 32-36, and 36-40. Twelve echocardiographic indicators were assessed at each observation and analyzed by using a mixed model.
The left atrial diameter (LA) and left ventricular end-diastolic diameter (LV) similarly increased from the first to the third observation. The right ventricular end-diastolic diameter (RV) was significantly different between the groups, and a group × time interaction was detected. The tricuspid annular peak systolic velocity (s') increased more rapidly in the GDM than the control group during the first to second observations, and the group × time interaction was significant. The increase in the tricuspid annular plane systolic excursion (TAPSE) of the GDM group was "slow-fast", while that of the control group was "fast-slow", during three observations. After adjusting covariates, the group difference and interaction effect of TAPSE and RV remained significant.
The differences in fetal right heart indicators between the GDM and control groups suggest that GDM may affect the structure and functional growth of the fetal right heart during late-term pregnancy.
妊娠期糖尿病（GDM）是一种与胎儿结构畸形风险增加密切相关的妊娠并发症。由于胎儿心脏在晚期妊娠期间快速生长，因此了解胎儿出生前的心脏生长情况非常重要。本研究通过评估晚期妊娠期间基本的超声心动图指标，探讨了 GDM 如何影响胎儿心脏生长。
这是一项前瞻性、纵向研究，纳入了 63 例 GDM 患者（GDM 组）和 67 例健康孕妇（对照组）。所有受试者均在妊娠 28-32 周、32-36 周和 36-40 周时进行胎儿超声心动图检查。在每个观察点评估了 12 项超声心动图指标，并使用混合模型进行分析。
左心房直径（LA）和左心室舒张末期直径（LV）均从第一次观察到第三次观察逐渐增加。右心室舒张末期直径（RV）在两组间存在显著差异，且存在组×时间的交互作用。在第一次到第二次观察期间，GDM 组三尖瓣环收缩期峰值速度（s'）的增加速度快于对照组，且组×时间的交互作用显著。GDM 组三尖瓣环平面收缩期位移（TAPSE）的增加呈“慢-快”模式，而对照组呈“快-慢”模式。调整协变量后，TAPSE 和 RV 的组间差异和交互作用仍有统计学意义。
GDM 组和对照组胎儿右心指标的差异表明，GDM 可能会影响晚期妊娠胎儿右心的结构和功能生长。
