Sonaglioni Andrea, Bruno Antonino, Nicolosi Gian Luigi, Bianchi Stefano, Lombardo Michele, Muti Paola
Division of Cardiology, IRCCS MultiMedica, 20123 Milan, Italy.
Laboratory of Innate Immunity, IRCCS MultiMedica, 20138 Milan, Italy.
Children (Basel). 2024 Nov 28;11(12):1451. doi: 10.3390/children11121451.
Gestational diabetes mellitus (GDM) is the most common complication in pregnancy, representing a serious risk for the mother and fetus. Identifying new biomarkers to ameliorate the screening and improving GDM diagnosis and treatment is crucial. During the last decade, a few studies have used speckle tracking echocardiography (STE) for assessing the myocardial deformation properties of fetuses (FGDM) and infants (IGDM) of GDM women, providing not univocal results. Accordingly, we performed a meta-analysis to examine the overall influence of GDM on left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) in both FGDM and IGDM.
All echocardiographic studies assessing conventional echoDoppler parameters and biventricular strain indices in FGDM and IGDM vs. infants born to healthy pregnant women, selected from PubMed and EMBASE databases, were included. The studies performed on FGDM and IGDM were separately analyzed. The subtotal and overall standardized mean differences (SMDs) in LV-GLS and RV-GLS in FGDM and IGDM studies were calculated using the random-effect model.
The full texts of 18 studies with 1046 babies (72.5% fetuses) born to GDM women and 1573 babies of women with uncomplicated pregnancy (84.5% fetuses) were analyzed. Compared to controls, FGDM/IGDM were found with a significant reduction in both LV-GLS [average value -18.8% (range -11.6, -24.2%) vs. -21.5% (range -11.8, -28%), < 0.05)] and RV-GLS [average value -19.7% (range -13.7, -26.6%) vs. -22.4% (range -15.5, -32.6%), <0.05)]. Large SMDs were obtained for both LV-GLS and RV-GLS studies, with an overall SMD of -0.91 (95%CI -1.23, -0.60, < 0.001) and -0.82 (95%CI -1.13, -0.51, < 0.001), respectively. Substantial heterogeneity was detected for both LV-GLS and RV-GLS studies, with an overall I statistic value of 92.0% and 89.3%, respectively (both < 0.001). Egger's test gave a -value of 0.10 for LV-GLS studies and 0.78 for RV-GLS studies, indicating no publication bias. In the meta-regression analysis, none of the moderators (gestational age, maternal age, maternal body mass index, maternal glycosylated hemoglobin, white ethnicity, GDM criteria, ultrasound system, frame rate, FGDM/IGDM heart rate, and anti-diabetic treatment) were significantly associated with effect modification in both groups of studies (all > 0.05). The sensitivity analysis supported the robustness of the results.
GDM is independently associated with biventricular strain impairment in fetuses and infants of gestational diabetic mothers. STE analysis may allow for the early detection of subclinical myocardial dysfunction in FGDM/IGDM.
妊娠期糖尿病（GDM）是妊娠期间最常见的并发症，对母亲和胎儿均构成严重风险。识别新的生物标志物以改善筛查并提高GDM的诊断和治疗水平至关重要。在过去十年中，一些研究使用斑点追踪超声心动图（STE）评估GDM女性胎儿（FGDM）和婴儿（IGDM）的心肌变形特性，但结果并不一致。因此，我们进行了一项荟萃分析，以研究GDM对FGDM和IGDM左心室（LV）和右心室（RV）整体纵向应变（GLS）的总体影响。
纳入所有从PubMed和EMBASE数据库中选取的评估FGDM和IGDM与健康孕妇所生婴儿的传统超声多普勒参数和双心室应变指标的超声心动图研究。对FGDM和IGDM的研究分别进行分析。使用随机效应模型计算FGDM和IGDM研究中LV-GLS和RV-GLS的汇总和总体标准化均数差（SMD）。
分析了18项研究的全文，其中有1046名GDM女性所生婴儿（72.5%为胎儿）和1573名正常妊娠女性所生婴儿（84.5%为胎儿）。与对照组相比，发现FGDM/IGDM的LV-GLS[平均值-18.8%（范围-11.6，-24.2%）对-21.5%（范围-11.8，-28%），P<0.05]和RV-GLS[平均值-19.7%（范围-13.7，-26.6%）对-22.4%（范围-15.5，-32.6%），P<0.05]均显著降低。LV-GLS和RV-GLS研究均获得了较大的SMD，总体SMD分别为-0.91（95%CI -1.23，-0.60，P<0.001）和-0.82（95%CI -1.13，-0.51，P<0.001）。LV-GLS和RV-GLS研究均检测到显著的异质性，总体I统计值分别为92.0%和89.3%（均P<0.001）。Egger检验得出LV-GLS研究的P值为0.10，RV-GLS研究的P值为0.78，表明无发表偏倚。在荟萃回归分析中，两组研究中的任何调节因素（胎龄、母亲年龄、母亲体重指数、母亲糖化血红蛋白、白人种族、GDM标准、超声系统、帧率、FGDM/IGDM心率和抗糖尿病治疗）均与效应修饰无显著关联（均P>0.05）。敏感性分析支持了结果的稳健性。
GDM与妊娠期糖尿病母亲的胎儿和婴儿双心室应变受损独立相关。STE分析可能有助于早期检测FGDM/IGDM中的亚临床心肌功能障碍。
