Abstract 16806: Assesment of Diastolic Ventricular Function in Fetuses of Gestational Diabetic Mothers

Abstract

Objectives: To identify ventricular diastolic disfunction by tissue Doppler in fetuses of diabetic mothers and compare with control groups. Material and methods: Between November 2009, April 2011 36 mother with gestational diabetes mellitus and 55 control subjects were recruited prospectively. Fetal echocardiogram was performed at 24, 28, 32 and 36 weeks of gestation to assess cardiac diastolic function by using tissue Doppler and pulse wave Doppler echocardiography. Early(Ea) and late (Aa) diastolic peak tissue Doppler imaging at the base of right ventricular free wall, ventricular septum, left ventricular free wall and both atrioventricular valves early(E), late(A) inflow velocities were analyzed and compared between groups. Haemoglobin glycated(HbA1c) levels were obtained at 24 week of gestation. Values above 6,5 % were excluded. Blood glucose levels of gestational diabetic mothers were under control. Results: Fetal interventricular septal thickness increasing progressively with advanced gestation were significantly more than control group in the presence of gestational diabetes mellitus (p< 0.001). Mean levels of HbA1c were 5,79±0.73 % in gestational diabetic mothers, 5.02±0.36 % in control group(p<0.003). HbA1c was significantly higher in the gestational diabetic mothers. E, A, Ea, Aa, Ea/Aa and E/A ratios increased with gestational age at all sites in both group. Peak velocities of mitral E (p<0.001), mitral A(p<0,007), tricuspid E(p<0.001) and tricuspid A (p<0.002) were significantly higher in diabetic group. The ratio of E/A and Ea/Aa increase as a function of more rapid augmentation in early when compared with late diastolic velocities in both group. Increases of mitral E/A and tricuspid E/A ratios were lower in diabetic group with advancing gestation. Ea:Aa ratio of right ventricle was higher in fetuses of diabetic mothers with advancing gestation (p<0,03). Conclusions: We conlude that maternal diabetes mellitus is associated with alterations ventricular diastolic function in the fetus. This is not closely related with interventricular septal hypertrophy. Impaired ventricular diastolic function develops as a result of decreased relaxation and compliance.