Fetuses Of Diabetic Mothers Research Articles

Neonatal heart rate variability in type 1 diabetic pregnancy

IntroductionIn adult diabetic patients, abnormalities in heart rate variability can predict mortality post myocardial infarction. Fetuses of diabetic mothers are at increased risk of unexplained death in utero and it...

250: Neonatal heart rate variability in type 1 diabetic pregnancy

Fetuses of diabetic mothers are at increased risk of death in utero, the exact aetiology of which is unclear. It adult diabetic patients it is known that abnormalities in heart rate variability can predict mortality post myocardial infarction and development of autonomic neuropathy. We hypothesised that an alteration in fetal autonomic function may have a role in unexplained fetal death in utero. The objective of this study, therefore, is to determine if neonatal autonomic function differs between normal and pre-gestational diabetic pregnancy.

Effects of maternal glycemia on fetal heart rate in pregnancies complicated by pregestational diabetes mellitus

Objective To investigate the influence of maternal glycemia on fetal heart rate (FHR) parameters analyzed by computerized cardiotocography in fetuses of diabetic mothers in the third trimester. Study design Thirty-nine pregnant women with pregestational diabetes mellitus were studied prospectively. The inclusion criteria were a diagnosis of pregestational diabetes, singleton pregnancy between 36 and 40 weeks, and absence of fetal abnormalities. Computerized cardiotocography (System 8002) was performed over a period of 60 min and capillary glycemia was measured immediately before and 30 and 60 min after the beginning of the exam. The evaluations were done 2 h after lunch. Results Nineteen patients (48.7%) presented mean glycemia ≥120 mg/dL. The mean basal FHR was 136.7 ± 10.0 bpm in the group with glycemia <120 mg/dL and 144.8 ± 9.4 bpm in the group with glycemia ≥120 mg/dL ( p = 0.013, Student's t test). There was a significant positive correlation (Pearson's test, p = 0.0001, r = 0.57) between basal FHR and mean glycemia. A significant negative correlation was observed between short-term variation and mean glycemia (Pearson's test, p = 0.003, r = −0.47). No significant differences were observed between the other indices evaluated by computerized cardiotocography and glycemia. Conclusions Maternal hyperglycemia at the time of cardiotocography is associated with elevated FHR. It seems to be important to understand how FHR parameters are influenced by maternal glycemic status at the time of fetal assessment in pregnancies complicated by diabetes.

Fetal and Neonatal Habituation in Infants of Diabetic Mothers

To evaluate whether maternal diabetes alters the habituation ability of fetuses and newborns. Two nonrandomized clinical trials were performed. First, we studied prenatal fetuses of women with pregestational diabetes, and control subjects matched for gestational age, and then we studied infants of diabetic mothers (IDM) and control subjects matched for gestational age and mode of delivery. Fetus and newborns were stimulated with vibroacoustic stimulus. In fetuses of diabetic mothers, the ability to habituate was lower, and the habituation rate was higher than in control subjects to all habituation tests. In the neonatal period, ability to habituate was lower (59% vs 100%; P< .001), and the habituation rate was higher (18 [14-21] vs 4 [1.2-6.8]; P< .001) in the IDM than in the control infants. We found a significant negative correlation between maternal glycosylated hemoglobin in each trimester of pregnancy and habituation ability in IDM. Fetuses and infants of diabetic mothers have impaired habituation ability, which is related to the degree of maternal metabolic control.

OC014: Left atrial dynamics in fetuses of diabetic mothers

Approximately 7% of pregnancies are affected by diabetes and the risk of complications has not been reduced. Myocardial hypertrophy may occur in up to a third of fetuses of diabetic women. In adults with myocardial hypertrophy, left atrial shortening fraction (LASF) may be more reliable to assess diastolic function than mitral Doppler. To test the hypothesis that LASF decreases in fetuses of diabetic women with myocardial hypertrophy, compared to those without hypertrophy and to fetuses of mothers with no systemic pathology. Echocardiography was used to examine fetuses of women with previous or gestational diabetes and fetuses of normal women at gestational ages from 25 weeks onwards. LASF was obtained by the ratio: telesystolic diameter - presystolic diameter/telesystolic diameter. Data were compared using ANOVA and Tukey's test, and Pearson's coefficient for association between variables. Ninety-eight fetuses were studied, being 45 from control mothers. Out of the 53 fetuses of diabetic women, 14 had myocardial hypertrophy and 39 had normal septal thickness. Gestational age was similar (P = 0.577). Fetuses of diabetic mothers with hypertrophy presented a mean LASF of 0.32 ± 0.11, without hypertrophy of 0.46 + 0.12, and those of normal mothers of 0.53 ± 0.09 (P = 0.001). A significant inverse linear correlation was observed between LASF and septal thickness (r = − 0.510, P = 0.001). LASF is lower in fetuses of diabetic women with myocardial hypertrophy as compared to those without hypertrophy and to those of normal mothers. It is suggested that LASF could be useful as an alternative parameter in the assessment of fetal diastolic function.

OP21.10: Myocardial tissue doppler in fetuses of diabetic mothers

Myocardial performance is diminished in persistent SVT and will lead to hydrops fetalis (HDF). This study sought to determine which methods of fetal echocardiography are best for evaluating treatment and outcome in these fetuses. Methods: Ten infants with HDF due to SVT were included in this study. No fetus has structural heart disease. Serial cardiovascular function was estimated from CC/TC ratio, left ventricular shortening fraction, tricuspid E and A velocities and E/A ratio, mitral E, A velocities and E/A ratio and Doppler flow patterns in the free loop of the umbilical cord, MCA, ductus arteriosus and ductus venosus (DV) as well as maximal velocities and time velocity integrals into the ascending aorta and main pulmonary artery. The Tei index was calculated as the sum of the isovolumetric contraction time (ICT) and the isovolumetric relaxation time (IRT) divided by the ejection time using the ‘‘clicks’’ method. These parameters were compared to age matched normal fetuses from our data base. Changes in the gross measurements of third space effusions were considered demonstrable of improvement of fetal cardiovascular status. Results: The most sensitive indicator of change in fetal function was the Tei index followed by CC/TC ratio. Tei index is the first cardiovascular parameter which gets normalised in these fetuses responding to the treatment. There was no significant change over time with E/A ratios, LV shortening fraction or peripheral arterial Doppler values. DV A wave reversal normalized with cessation of SVT with normal PI values. DV size went from greater than the 95% to normal with cessation of SVT. Conclusions: The Tei index easily performed from 14 weeks through term. It is a useful and likely the most sensitive method of evaluating global myocardial performance in followup of fetuses with HDF especially due to SVT.

Assessment of diastolic ventricular function in fetuses of diabetic mothers using tissue Doppler

To identify the presence of ventricular diastolic dysfunction by tissue Doppler in fetuses of diabetic mothers, with or without septal hypertrophy, in comparison to fetuses of nondiabetic mothers. A contemporary transverse study in fetuses with a gestational age between 25 weeks to term, studying diastolic function by assessment using tissue Doppler and pulsed wave Doppler of the atrioventricular diastolic flow. The mothers of the fetuses all had previous or gestational diabetes, and were referred to the Fetal Cardiology Unit of the Institute of Cardiology in Porto Alegre, Brazil. We analysed variance with the Student-Neumann-Keuls post hoc test. An alfa of 0.05 was considered significant for statistical analysis. The mean myocardial velocities of the E'and A' waves at the mural mitral annulus, in fetuses of diabetic mothers with myocardial hypertrophy, were, respectively, 7.00 plus or minus 1.6 centimetres per second, and 10.24 plus or minus 3.3 centimetres per second. In the fetuses of diabetic mothers group without myocardial hypertrophy, the comparable values were 7.19 plus or minus 2.4 centimetres per second and 10.77 plus or minus 3.77 centimetres per second, respectively. In the control group, they were 4.81 plus or minus 0.85 centimetres per second and 8.01 plus or minus 2.2 centimetres per second. The difference between the velocities in fetuses of diabetic mothers and in fetal normal mothers was statistically significant (p less than 0.05). Statistically significant differences were also observed in E' and A' diastolic waves at the aortic mitral annulus, as well as for the tricuspid annulus when tissue Doppler assessment was carried out in the same sample. The mean ratio between the E and E' of mitral and tricuspid waves in the control fetuses of normal mothers was significantly higher than in fetuses of diabetic mothers. Pulsed tissue Doppler, when used in fetuses of diabetic mothers and compared with fetuses of nondiabetic mothers, shows evidence of impaired diastolic function, independently of the presence of myocardial hypertrophy.

Fetal myocardial performance in pregnancies complicated by gestational impaired glucose tolerance

To determine fetal myocardial performance in pregnancies complicated by mild gestational impaired glucose tolerance (GIGT). Ultrasound examinations were performed in 37 pregnant women with mild GIGT (36 did not require insulin) and in 44 controls at 18-24, 26-30 and 34-37 weeks of gestation. The thickness of the fetal ventricular walls and interventricular septum were measured by M-mode echocardiography. Using conventional Doppler echocardiography, the mitral and tricuspid early (E) and late (A) diastolic velocities and the ventricular myocardial performance index (MPI) were determined. The fetuses of women with GIGT had a greater abdominal circumference (P = 0.02), a larger amniotic fluid index (P = 0.03), and a tendency to be heavier (P = 0.058) at the third scan. There were no significant differences in myocardial thickness, mitral and tricuspid E and A velocities, and E/A ratios between study and control groups. The left and right ventricular MPIs, while similar between the two groups in the first and second scans, had decreased significantly by late gestation in the GIGT fetuses (P for trend = 0.018 and 0.014, respectively) and were significantly lower than those of the control group (P = 0.002 and 0.0008, respectively). Fetuses of women with mild GIGT lack the ventricular hypertrophy and diastolic dysfunction that is common in fetuses of diabetic mothers, and they have a decreased MPI late in gestation. Published by John Wiley & Sons, Ltd.

Fetal growth patterns in fetuses of women with pregestational diabetes mellitus

To assess the effect of glucose control on the rate of growth of fetuses in women with pregestational diabetes mellitus (Types 1 and 2). All pregestational diabetic women booked at Mater Mothers' Hospital, Brisbane, Australia, between 1 January 1994 and 31 December 2002, were included. Pregnancies with congenital fetal anomalies, multiple pregnancies, and pregnancies terminated prior to 20 weeks' gestation were excluded. Dating scans were performed before 14 weeks' gestation and serial scans were performed at 18, 24, 28, 32 and 36 weeks. Fetal parameters, including biparietal diameter, femur length and abdominal circumference, were recorded. The daily growth rates for biparietal diameter, femur length, and fetal abdominal area were calculated and compared with those in a low-risk (non-diabetic) population. The growth rates in fetuses of women with satisfactory diabetic control (HbA1c < 6.5%) and unsatisfactory control (HbA1c > or = 6.5%) in the three trimesters were compared. A total of 174 diabetic pregnancies were included and a total of 997 ultrasound scans were performed. The growth rates for fetuses of mothers with diabetes mellitus were significantly higher than for those in the low-risk population. The z-scores for biparietal diameter, femur length, and fetal abdominal area were 0.18, 0.59 and 1.44, respectively. Fetuses of diabetic mothers with high HbA1c in the first trimester had significantly greater fetal abdominal area growth rate than those with normal HbA1c (fetal abdominal area z-score of 1.7 vs. 0.75, P = 0.009). Although the fetal abdominal area z-scores in fetuses of diabetic mothers with high HbA1c in the second or third trimesters were also higher than those with normal HbA1c levels, the differences did not reach statistical significance. Maternal obesity did not influence the fetal growth rate. The rate of growth of fetuses of diabetic mothers differs from that of the normal population. Growth acceleration persists until the late third trimester. Moreover, periconceptional glucose control appears to have a significant effect on accelerated growth of the fetal abdominal area.

OP04.37: Incidence of congenital heart disease in fetuses of diabetic mothers: a prospective study in a tertiary referral centre

OP04.37: Incidence of congenital heart disease in fetuses of diabetic mothers: a prospective study in a tertiary referral centre

Freqüência cardíaca fetal e doplervelocimetria das artérias umbilicais entre a 18ª e a 20ª semana de gestação em pacientes com diabete melito pré-gestacional

OBJETIVOS: analisar a freqüência cardíaca fetal (FCF) e parâmetros doplervelocimétricos das artérias umbilicais em gestantes com diagnóstico de diabete melito pré-gestacional, entre a 18ª e a 20ª semana de gestação. MÉTODOS: foram incluídas 28 gestantes com diabete melito pré-gestacional e 27 gestantes normais (grupo controle). O estudo é do tipo prospectivo, caso-controle e transversal. Os seguintes critérios de inclusão foram adotados: gestação única entre a 18ª e a 20ª semana, ausência de outras doenças maternas associadas e ausência de anomalias fetais. A ultra-sonografia foi realizada no período gestacional proposto e a FCF foi calculada a partir dos intervalos entre o início de dois ciclos cardíacos consecutivos, em três sonogramas obtidos pela doplervelocimetria da artéria umbilical, avaliada na porção do cordão umbilical próxima à sua inserção na placenta, utilizando-se o mapeamento colorido do fluxo. Em cada traçado de sonograma foram obtidas cinco medidas consecutivas da FCF a partir do início de cada sístole. A média e a variação da FCF foram utilizadas para análise. Foram calculados os seguintes índices doplervelocimétricos: relação A/B (sístole/diástole), índice de pulsatilidade (PI) e índice de resistência (RI). O teste t de Student e o teste de Mann-Whitney U foram utilizados para a análise estatística, adotando-se nível de significância de 5%. Resultados: não foram observadas diferenças significativas entre as médias da FCF entre os grupos estudados (grupo diabéticas: 149,2 bpm e grupo controle: 147,2 bpm; p=0,12). A variação da FCF foi semelhante entre os grupos (grupo diabéticas: 5,3 bpm; grupo controle 5,3 bpm; p=0,5). Não foi constatada diferença significativa em relação aos índices doplervelocimétricos: A/B (p=0,79), PI (p=0,25) e RI (p=0,71). CONCLUSÕES: a inexistência de diferenças nas características da FCF entre a 18ª e a 20ª semana indica que fetos de mães diabéticas apresentam, nesse período, maturação neurológica dos sistemas reguladores da FCF semelhante ao grupo controle. Não foram detectadas anormalidades na resistência ao fluxo útero-placentário nesse período, em gestações complicadas pelo diabete melito pré-gestacional.

Estudo do encurtamento global do átrio esquerdo em fetos de mães diabéticas

To test the hypothesis that left atrial shortening fraction is lower in fetuses of diabetic mothers than in fetuses of mothers with no systemic disease. Forty-two fetuses of mothers with previous diabetes or gestational diabetes and 39 healthy fetuses of mothers with no systemic disease (controls) underwent echocardiographic examination. Their gestational ages ranged from 25 weeks to term. The left atrial shortening fraction was obtained with the following formula: (left atrial maximum diameter - left atrial minimum diameter)/left atrial maximum diameter. Data were compared using the Student t test, with an alpha level of 0.05. Mean left atrial shortening fractions in fetuses of diabetic mothers and in those in the control group were 0.39 +/- 0.15 and 0.51 +/- 0.11, respectively. This difference was significant with P < 0.001. Left atrial dynamics, with a reduction in global left atrial shortening, is increased in fetuses of diabetic mothers. We speculate that this parameter may be useful in assessing fetal left ventricular diastolic function.

Ductus venosus flow and myocardial hypertrophy in fetuses of diabetic mothers.

To test the hypothesis that the pulsatility index of ductus venosus (PIDV) is greater in the fetuses of diabetic mothers (FDM) with myocardial hypertrophy (MH) than in the FDM with no MH and in the control fetuses of nondiabetic mothers (FNDM). Comparing the results with mitral and tricuspid diastolic peak flows. The cross-sectional study included fetuses with gestational ages ranging from 20 weeks to term, divided into the following 3 groups: 56 FDM with MH (group I), 36 FDM with no MH (group II), and 53 FNDM (group III, control). The Doppler echocardiogram assessed the PIDV through the ratio (systolic velocity - presystolic velocity)/mean velocity. The mitral and tricuspid E and A waves were also assessed. The mean PIDV in groups I, II, and III were 1.13 +/- 0.64, 0.84 +/- 0.38, and 0.61 +/- 0.17, respectively. Using ANOVA and the Tukey test, a statistically significant difference was found in the 3 groups (P = 0.015 between groups I and II; P < 0.001 between groups I and III; and P = 0.017 between groups II and III). The mean mitral E wave was significantly greater in group I (0.39 +/- 0.12 m/s) than in groups II (0.32 +/- 0.08 m/s) (P = 0.024) and III (0.32 +/- 0.08 m/s) (P = 0.023). The mean tricuspid E wave was also greater in group I (0.43 +/- 0.1 m/s) than in group III (0.35 +/- 0.10 m/s) (P = 0.031). The PIDV is significantly greater in FDM with MH than in FDM with no MH and in FNDM. Because the PIDV may represent modifications in ventricular compliance, this index may be a more sensitive parameter for assessing fetal diastolic function.

Alterations in segmentary branch pulmonary artery blood flow velocimetry in fetuses of diabetic mothers.

To evaluate pulmonary blood flow in fetuses of diabetic mothers by measuring changes in fetal segmentary pulmonary artery blood flow velocimetry throughout pregnancy. Thirty-eight women with pregestational diabetes between weeks 18 and 38 were compared with 99 women with singleton low-risk gestations as controls. Flow velocity waveforms at the proximal middle and distal segments of the right pulmonary artery were obtained with power and color Doppler sonography in all fetuses. The pulsatility index of each segment was compared between the 2 groups. The mean value and 95% confidence interval for each segment were determined in correlation with gestational age for both groups. The highest mean pulsatility indices were obtained in the proximal segment of the pulmonary artery and were 2.25 in the diabetes group and 2.36 in controls. The mean pulsatility indices were significantly decreased in the middle and distal segments to 1.59 and 1.10 in the diabetes group and to 1.57 and 1.02 in controls (P < .05). There were no significant differences in pulsatility indices measured at the proximal and middle segments between the study and control groups. However, the mean pulsatility index +/- SD measured at the distal segment in the diabetic group was 9% higher than in controls (1.10 +/- 0.13 versus 1.02 +/- 0.12; P = .01). The mean pulsatility index (in the study and control groups) in each arterial segment did not change significantly throughout gestation (P > .1). . In human fetuses throughout gestation, the pulmonary circulation maintains stable vascular resistance in both diabetic and normal pregnancies. However, in all gestations, the pulsatility index in each segment of the pulmonary artery is unique and reflects the proximity to the heart and the impedance at each location. The significantly higher pulsatility index in the diabetes group might be related to alterations in the microcirculation of diabetic patients.

Fetal and embryonic hemoglobins in erythroblasts from fetal blood and fetal cells enriched from maternal blood in pregnancies complicated by maternal diabetes mellitus

Objectives: To determine whether there is a delay or reversal in switch mechanisms from embryonic (ε and ζ) to fetal (γ) hemoglobins accompanying the erythroblastosis in fetuses of diabetic mothers, and whether the increased erythroblast count in the fetal blood is associated with an increase in fetomaternal cell trafficking.Materials and methods: Fetal and maternal blood samples were obtained from 11 fetuses and five pregnant women in pregnancies complicated by maternal diabetes mellitus. Blood samples were also taken as controls from 35 fetuses and 33 mothers. Fetal erythroblasts were isolated by triple density gradient centrifugation and magnetic cell sorting with anti-CD71 antibody. Fluorescent antibodies were used to immunostain for gamma (γ), epsilon (ε) and zeta (ζ) hemoglobin chains. In the maternal samples, fluorescence in situ hybridization for X and Y chromosomes was also carried out, to confirm the presence and proportion of enriched fetal cells from the maternal blood.Results: In both fetal and maternal blood the median percentages of erythroblasts positive for γ-globin, ε-globin and ζ-globin chains were significantly higher in fetuses of diabetic mothers compared to controls (fetus, γ-globin, 76 vs. 64%, p<0.0001; ε-globin, 4 vs. 0%, p<0.0001; ζ-globin, 4 vs. 0%; p<0.0001; mother, γ-globin, 14 vs. 1%, p<0.0005; ε-globin, 0.25 vs. 0%, p<0.0003; ζ-globin, 0.2 vs. 0%, p<0.0003). The median percentage of cells with Y signals in maternal blood was also higher in diabetic pregnancies compared to normal controls (7.5 vs. 1%, p<0.002).Conclusions: The findings suggest that the fetal erythroblastosis in diabetic pregnancies is accompanied by a delay in the switch from embryonic to fetal hemoglobin chains. In addition, it is associated with an increase in fetomaternal cell trafficking.

Alternative parameters for echocardiographic assessment of fetal diastolic function.

Alternative methods to assess ventricular diastolic function in the fetus are proposed. Fetal myocardial hypertrophy in maternal diabetes was used as a model of decreased left ventricular compliance (LVC), and fetal respiratory movements as a model of increased LVC. Comparison of three groups of fetuses showed that, in 10 fetuses of diabetic mothers (FDM) with septal hypertrophy (SH), the mean excursion index of the septum primum (EISP) (ratio between the linear excursion of the flap valve and the left atrial diameter) was 0.36 +/- 0.09, in 8 FDM without SH it was 0.51 +/- 0.09 (P=0.001), and in the 8 normal control fetuses (NCF) it was 0.49 +/- 0.12 (P=0.003). In another study, 28 fetuses in apnea had a mean EISP of 0.39 +/- 0.05 which increased to 0.57 +/- 0.07 during respiration (P<0.001). These two studies showed that the mobility of the septum primum was reduced when LVC was decreased and was increased when LVC was enhanced. Mean pulmonary vein pulsatility was higher in 14 FDM (1.83 +/- 1.21) than in 26 NCF (1.02 +/- 0.31; P=0.02). In the same fetuses, mean left atrial shortening was decreased (0.40 +/- 0.11) in relation to NCF (0.51 +/- 0.09; P=0.011). These results suggest that FDM may have a higher preload than normal controls, probably as a result of increased myocardial mass and LV hypertrophy. Prenatal assessment of LV diastolic function by fetal echocardiography should include analysis of septum primum mobility, pulmonary vein pulsatility, and left atrial shortening.

Pulmonary vein pulsatility in fetuses of diabetic mothers: prenatal Doppler echocardiographic study.

To verify the hypothesis that the pulmonary vein pulsatility index is higher in fetuses of diabetic mothers than it is in normal fetuses of nondiabetic mothers. Twenty-four fetuses of mothers with either gestational or previous diabetes (cases), and 25 normal fetuses of mothers without systemic disease (control) were examined. Fetuses were examined through prenatal Doppler and color flow mapping. The pulmonary vein pulsatility index was obtained by placing the pulsed Doppler sample volume over the right superior pulmonary vein and applying the formula (systolic velocity - presystolic velocity)/mean velocity. The mean gestational age of the study fetuses was 30.3 2.7 weeks, and gestational age of the controls was 29 3.3 weeks, with no significant difference in gestational age between groups (p=0.14). Fetuses of diabetic mothers had a mean pulmonary vein pulsatility index of 1.6 1, and those of the control group had an index of 0.86 0.27. Fetuses of diabetic mothers had pulmonary vein pulsatility indexes (parameter easily obtained through Doppler echocardiography that may be related to fetal diastolic function) higher than those in fetuses of mothers with normal glycemia.

Spatiotemporal distribution of insulin-like growth factor receptors during nephrogenesis in fetuses from normal and diabetic rats.

Exposure to hyperglycemia in utero impairs rat nephrogenesis. The effect of maternal diabetes on insulin-like growth factors and their receptors in the fetal kidney is associated with an increase in both mRNA and protein of the insulin-like growth factor II/mannose 6-phosphate receptor. However, this receptor has never been localized in the fetal kidney. The spatial and temporal distribution of the three insulin-like growth factor receptors (insulin-like growth factor I receptor, insulin-like growth factor II/mannose 6-phosphate receptor and insulin receptor) in rat metanephros during both normal and streptozotocin-induced diabetic renal development was investigated using in situ hybridization and immunohistochemistry. All receptors were found in the fetal kidney from the start of nephrogenesis. Insulin-like growth factor I receptor expression was ubiquitous and continuously present during metanephric development. Insulin receptor expression was developmentally regulated during kidney maturation with an enhanced expression in proximal tubules at the late stages of development. Insulin-like growth factor II/mannose 6-phosphate receptor expression was ubiquitous in the early stages of development and was dramatically decreased at the late stages of normal kidney development. Insulin receptor and insulin-like growth factor I receptor expressions were unchanged in diabetic metanephroi. Although the spatial expression of insulin-like growth factor II/mannose 6-phosphate receptor was unaffected by hyperglycemia, its expression was not downregulated in the mesenchyme of the nephrogenic zone of diabetic fetuses on gestational day 20. This study suggests a crucial role of insulin-like growth factor II/mannose 6-phosphate receptor in the pathogenesis of the impaired nephrogenesis in fetuses of diabetic mothers.

Behavior of septum primum mobility in third-trimester fetuses with myocardial hypertrophy.

The mobility of the septum primum (SP) in the fetus is a diastolic phenomenon and could be related to left atrial pressure. We studied the linear displacement of the SP in the left atrium in fetuses of diabetic mothers (FDM) with and without septal hypertrophy (SH) and in normal fetuses of normoglycemic mothers. In this study we set out to test the hypothesis that the linear displacement of the SP flap valve is less marked in fetuses with SH than in those without SH. The ratio between the linear displacement of the flap valve and the left atrial diameter (excursion index (EI)) was compared in ten FDM with SH, eight FDM with normal septal thickness and eight normal fetuses of non-diabetic mothers. Atrioventricular flow velocities were also compared in the three groups. Comparison of the three groups showed that in FDM with SH, the mean EI was 0.36 +/- 0.09, in FDM without SH it was 0.51 +/- 0.09 (P = 0.001) and in the control fetuses it was 0.49 +/- 0.12 (P = 0.03). There was a significant negative correlation between septal thickness and EI in FDM with SH. There was no correlation between septal thickness and atrioventricular flow velocities. Mobility of the SP in FDM with SH is reduced and there is an inverse correlation between the linear displacement of the SP and septal thickness. These findings may be related to changes in left ventricular diastolic function secondary to myocardial hypertrophy.

Activin a in Fetuses of Non-Diabetic and Streptozotocin-induced Diabetic Mother Rats.

Background and Aims : Activin is a growth factor which belongs to the TGF-β superfamily and it is produced by several tissues including the feto-placental unit. It is also reported that activin is involved in the regulation of insulin secretion. In the light of these facts it is thought that activin may influence organ development in the fetuses of diabetic mothers. There are few papers on activin in diabetic fetopathy, however, and the links between diabetes in the mother and activin in the fetus was studied. Method : Adult Wistar female rats were injected with streptozotocin and those whose blood glucose levels exceeded 200 mg/dl were determined as diabetic. Fetuses of diabetic and non-diabetic mother rats were delivered by cesarean section on the 20th day of pregnancy and blood was collected. The blood of adult rats was also collected. Serum activin A concentrations were measured by ELISA. Result : There was no significant difference in serum activin A concentrations between diabetic and non-diabetic adult rats. In fetuses, serum. activin A concentrations were higher in those of diabetic mother compared to those of non-diabetic mother. Conclusion : It is suggested that maternal diabetes affects the metabolism of activin in fetuses, but further study is required.