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Perinatal changes in fetal cardiac geometry and function in diabetic pregnancy at term

Patey, O; Carvalho, J; Thilaganathan, B (2019) Perinatal changes in fetal cardiac geometry and function in diabetic pregnancy at term. ULTRASOUND IN OBSTETRICS & GYNECOLOGY, 54 (5). pp. 634-642. ISSN 0960-7692 https://doi.org/10.1002/uog.20187
SGUL Authors: Carvalho, Julene

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Abstract

Objective To evaluate the effect of diabetes in pregnancy on fetal and neonatal cardiac geometry and function around the time of delivery. Methods This was a prospective study of 75 pregnant women delivering at term, comprising 54 normal pregnancies and 21 with a diagnosis of pregestational or gestational diabetes mellitus. Fetal and neonatal conventional and spectral tissue Doppler and two‐dimensional speckle‐tracking echocardiography were performed a few days before and within hours after delivery. Fetal and neonatal cardiac geometry, global myocardial deformation and performance, diastolic and systolic function and left ventricular (LV) torsion were compared between normal pregnancies and those with diabetes, and perinatal changes within the diabetes group were assessed. Results Compared with normal pregnancies, diabetic pregnancies demonstrated significant differences in fetal ventricular geometry, myocardial deformation and cardiac function (right ventricular (RV) sphericity index, 0.56 vs 0.65; LV torsion, 2.1 °/cm vs 5.6 °/cm; LV isovolumetric relaxation time, 101 ms vs 115 ms; and RV isovolumetric contraction time, 107 ms vs 119 ms; P < 0.001 for all). Compared with normal pregnancies, diabetic pregnancies demonstrated significant differences in neonatal cardiac parameters (mean RV sphericity index, 0.43 vs 0.55; mean LV torsion, 1.30 °/cm vs 2.78 °/cm; median LV myocardial performance index (MPI′), 0.39 vs 0.51; median RV‐MPI′, 0.34 vs 0.40; P < 0.01 for all). Paired comparison between fetal and neonatal cardiac indices in diabetic pregnancies demonstrated that delivery resulted in a significant improvement in some, but not all, cardiac indices (mean RV sphericity index, 0.65 vs 0.55; mean LV torsion, 5.60 °/cm vs 2.78 °/cm; median RV‐MPI′, 0.51 vs 0.40; P < 0.01 for all). Conclusions Compared with normal term fetuses and neonates, those of diabetic women exhibit cardiac indices indicative of myocardial impairment, reflecting a response to a relatively hyperglycemic intrauterine environment with alteration in fetal loading conditions (LV preload deprivation and increased RV afterload) and adaptation to subsequent acute changes in hemodynamic load at delivery. Elucidating mechanisms that contribute to the alterations in perinatal cardiac function in diabetic pregnancy could help in refining management and developing better therapeutic strategies to reduce the risk of adverse pregnancy outcomes.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Patey, O. , Carvalho, J. S. and Thilaganathan, B. (2019), Perinatal changes in fetal cardiac geometry and function in diabetic pregnancy at term. Ultrasound Obstet Gynecol, 54: 634-642, which has been published in final form at https://doi.org/10.1002/uog.20187. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Keywords: 1114 Paediatrics And Reproductive Medicine, Obstetrics & Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: ULTRASOUND IN OBSTETRICS & GYNECOLOGY
ISSN: 0960-7692
Dates:
DateEvent
5 November 2019Published
8 October 2019Published Online
26 November 2018Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
UNSPECIFIEDChildren's Heart Unit Fund, Royal Brompton and Harefield Hospital CharityUNSPECIFIED
14EDI01Sparkshttp://dx.doi.org/10.13039/501100000861
URI: https://openaccess.sgul.ac.uk/id/eprint/110454
Publisher's version: https://doi.org/10.1002/uog.20187

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