Follow-up of cardiac function in infants of mothers with gestational diabetes mellitus

Abstract

Objective To follow up the changes of postnatal cardiac sizes and function in infants of mothers with gestational diabetes mellitus （GDM）. Methods Eighteen GDM mothers with euglycemia （GDM group） and 24 gestational age matched normal pregnant women （control group）, having prenatal examination and delivered in Women＇s Hospital of Fudan University from January to August in 2007, received fetal echocardiographic examination in late pregnancy. Infants of these GDM mothers and 24 age-matched healthy infants of normal pregnancy （control group） received sonographic follow up. Cardiac sizes and function were evaluated and compared. Results At birth, there were six （33.3%） infants of large for gestational age （LGA） and 12（66.7%） appropriate for gestational age（AGA） in GDM group, while in the control group, there were two LGA （8.3%） and 22（91.7%） AGA infants （Х^2 =3. 840, P=0.05）. Both the interventricular septum and left ventricular walls in GDM fetuses were thicker than in control fetuses （P 〈 0.05）. No increase in the thickness of ventricular walls was observed till infantile period. However, the end-systolic thickness of left ventricular walls in LGA infants was still larger than in control infants [（4.55 ± 0. 37） mm vs （4.13±0.39） mm, P〈0.05], and end-diastolic left ventricular long-diameters were also larger [（37. 3±2. 3） mmvs （34.6±2.6） mm] （P〈0.05）. In GDM fetuses, the peak velocities of aorta and pulmonary artery and left cardiac output were higher than in the controls （P〈 0.01）, and right/left cardiac outputs ratios were lower （1.198±0.206 vs 1.430±0.321, t= 2.668,P=0.011）. Till infantile period, only right/left cardiac outputs ratios in AGA infants of GDM group were larger than in controls （P〈0.05）. GDM fetuses＇ left atrial shortening fraction and tricuspid E/A ratios were smaller （P〈0. 05）. In infantile period, only left atrial shortening fraction in GDM infants was still smaller than in controls （0.356±0.040 vs 0.386±0.041, t=-2.332, P=0.025）. Left and right ventricular Tel index in GDM fetuses were 0. 482±0. 129 and 0. 414±0. 094, both larger than those of control fetuses （0.309±0.074 and 0.283±0.072）（t=5.075 and 5. 129, P=0.000）. Till infantile period they both became significantly lower and no differences were found among LGA, AGA and control infants. Conclusions The cardiac sizes and function at 2-3 months of age, in infants of GDM mothers with good glucose control, became better than that in uterus. Key words: Diabetes, gestational; Infant; Ventricular function, left; Stroke volume; Follow up studies