Chivers Sian, Ovadia Caroline, Vasavan Tharni, Lucchini Maristella, Hayes-Gill Barrie, Pini Nicolò, Fifer William Paul, Williamson Catherine
Department of Women's and Children's Health, King's College London, London, UK.
Department of Fetal and Paediatric Cardiology, Evelina London children's Hospital, London, UK.
BJOG. 2025 Mar;132(4):473-482. doi: 10.1111/1471-0528.18010. Epub 2024 Nov 25.
Establish whether pregnancies complicated by gestational diabetes mellitus (GDM) are associated with a fetal cardiac phenotype that predisposes to arrhythmia; utilising measurements derived from non-invasive abdominal fetal ECG.
Prospective observational study.
Three tertiary obstetric units, United Kingdom.
Women aged ≥ 16 years with either GDM or uncomplicated pregnancy (control) who were > 20 weeks gestational age.
The MonicaAN24 non-invasive abdominal fetal ECG monitor was fitted for overnight recording.
Calculation of the fetal heart rate (FHR) and fetal heart rate variability (HRV) time domain metrics standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD) and the PR, QRS, QT intervals was performed. Groups were compared using linear regression models (stratified by sleep state) and adjusted for fetal sex and ethnicity.
Ninety-six participants were included. For HRV in sleep state 1F, SDNN was higher for GDM than control participants 12.56 (10.45-16.62)ms versus 8.58 (5.83-9.73)ms [p = 0.01] [median (IQR)]. There were no differences in SDNN in sleep state 2F. No differences were identified in RMSSD in either sleep states or in the cardiac time intervals. We observed a negative correlation between HRV and body mass index/HbA1c and a positive correlation between FHR and body mass index/HbA1c in sleep states 1F/2F.
Alterations of HRV and FHR rate may be associated with a diagnosis of GDM, likely secondary to altered autonomic function in utero.
确定合并妊娠期糖尿病（GDM）的妊娠是否与易发生心律失常的胎儿心脏表型相关；利用从无创腹部胎儿心电图获得的测量值。
前瞻性观察性研究。
英国的三个三级产科单位。
年龄≥16岁、孕周>20周、患有GDM或妊娠未合并并发症（对照组）的女性。
使用MonicaAN24无创腹部胎儿心电图监测仪进行夜间记录。
计算胎儿心率（FHR）和胎儿心率变异性（HRV）时域指标，即正常到正常间期的标准差（SDNN）、连续差值的均方根（RMSSD）以及PR、QRS、QT间期。使用线性回归模型（按睡眠状态分层）对组间进行比较，并对胎儿性别和种族进行校正。
纳入96名参与者。对于睡眠状态1F下的HRV，GDM组的SDNN高于对照组，分别为12.56（10.45 - 16.62）ms和8.58（5.83 - 9.73）ms [p = 0.01] [中位数（四分位间距）]。睡眠状态2F下的SDNN无差异。在任何睡眠状态下，RMSSD或心脏间期均无差异。我们观察到在睡眠状态1F/2F下，HRV与体重指数/HbA1c呈负相关，FHR与体重指数/HbA1c呈正相关。
HRV和FHR的改变可能与GDM的诊断相关，可能继发于子宫内自主神经功能的改变。
