Maternal Heart Research Articles

Preliminary study on the relationship between biological rhythm changes and pregnancy complications during pregnancy

To study the characteristics of heart rate rhythm in pregnant women at different trimester of pregnancy, and to explore the relationship between the basic rhythm of heart rate and pregnancy complications. Thirteen pregnant women who were diagnosed with normal early pregnancy in the Reproductive Center of the Second Affiliated Hospital of Soochow University from June 2018 to December 2019 were prospectively selected. Personal files were created and the heart rate data of pregnancy women was collected 24 hours a day by wearable devices until delivery. Prenatal examination and pregnancy outcomes were surveyed at follow-up. The cosine analysis method and the designed statistical module were used to analyze the long-term rhythm of pregnant women's heart rate. The heart rate of pregnant women showed a significant rhythm at different gestational weeks. Compared with the gestational week of 12, the midline-estimating statistic of rhythm(MESOR) increased significantly at the gestational week of 28 and 32 (t=-2.751,P=0.013;t=-2.314,P=0.032).The phase of rhythm shifted from 14∶00 pm in the first trimester of pregnancy (12 weeks) to 16∶00 pm in the second trimester (24 weeks) (t=2.613,P=0.018) and returned to 14∶00 pm at the third trimester (32 weeks) (t=-2.176,P=0.046). Season had no significant effect on the changes of MESOR, amplitude and phase of maternal heart rate in the first trimester (t=-0.356,P=0.729;t=-0.777,P=0.464;t=-0.434,P=0.673), while season had no significant effect on the changes of MESOR, amplitude and phase in the third trimester (t=-0.663,P=0.532;t=-0.209,P=0.841;t=0.625,P=0.592). The heart rate of one pregnant woman with natural delivery had rhythm disorder from the start of labor to delivery. The heart rate of one pregnant woman with premature rupture of membranes showed rhythm disorder before and after the rupture of membranes, and smaller amplitude. Rhythm disturbance may play a suggestive role in preterm delivery and labor initiation. In conclusion, pregnancy may cause changes in the internal heart rate rhythm. Maternal internal rhythm disturbance may occur when delivery or premature rupture of membranes occurs. The heart rate rhythm of pregnant women may be related to some common complications of pregnancy such as premature rupture of membranes.

Abstract P1176: What Is The Nature Of The Hypertrophic Response Contributing To Pregnancy-induced Cardiac Growth And Its Reversal?

During pregnancy, the maternal heart undergoes physiological cardiac growth, reversing following parturition; however, the contributing underlying processes are largely unknown. Changes in cardiac metabolism appear to be associated with cardiac growth through a reduction in glucose catabolism. We have also shown that several cardiac metabolic transcripts, proteins, and liver-derived metabolites that are elevated during pregnancy are associated with cardiac growth. However, the nature of the hypertrophic response observed in the maternal heart is unclear. Therefore, this study aimed to examine the metabolic and hypertrophic changes associated with pregnancy-induced cardiac growth and reversal. Studies revealed that both heart weight (HW: TL; p < 0.0001) and liver weight (LIV: TL; p <0.0001) were highest in lactating 1-week post-birth (PB) mice versus mid-pregnant (8 d), late-pregnant (LP; 16 d), and non-pregnant (NP) 12-week-old FVB/NJ mice. Of note, we also found that HW: TL ( p < 0.01) and LIV: TL ( p < 0.0001) were significantly reduced in non-lactating 1-week post-birth mice (PBNL) compared with PB mice. However, the changes in cardiac size observed during pregnancy and post-birth were not associated with changes in either cardiomyocyte cross-sectional area or cardiac fluid content. Hearts and livers remained significantly larger, irrespective of lactation status, following parturition through 6 weeks post birth (PB) versus NP. Consistent with these changes, we found significant reductions in Pdk4 protein between 1- and 3-week PB and PBNL groups that were reversed by six weeks postpartum and a substantial increase in Pdk4 expression at six weeks postpartum, respectively. Interestingly, we see a sustained increase in cardiac Bdh1 expression that persisted at six weeks postpartum, which could contribute to the sustained increases in HW: TL versus NP. Changes in lactation status and metabolism are likely contributing to similar patterns of growth seen in the heart and liver during and following pregnancy. The maternal hypertrophic response is considered eccentric due to the absence of changes in myocyte cross-sectional area and cardiac fluid content.

Pregnancy outcomes in women with Ebstein’s anomaly: data from the Registry of Pregnancy And Cardiac disease (ROPAC)

ObjectiveEbstein’s anomaly is a rare congenital cardiac condition and data regarding pregnancy outcomes in this patient group are scarce. We evaluated the maternal and perinatal risks of pregnancy in 81...

Evaluation of The Fetal Heart Rate Monitoring with The Non-Invasive Electrocardiography Signals.

Fetal heart rate monitoring is a crucial element in determining the health of the fetus during pregnancy. In this paper, we evaluate the fetal heart rate (FHR) and maternal heart rate (MHR) between our non-invasive fetal monitoring system, Femom, developed by a Biorithm and the Huntleigh computerized cardiotocography (cCTG) together with the Sonicaid FetalCare3 software by comparing the accuracy, sensitivity, and reliability through using Bland-Altman analysis, Positive Percent Agreement (PPA) and Intraclass Correlation Coefficient (ICC) respectively. Femom device is a part of the Femom system which collects abdominal electrocardiogram (aECG) signals. Femom sever then processes the collected signals to generate FHR and MHR using novel algorithms. We collected data from 285 pregnant participants who were at least of 28 weeks of gestational age. FHR accuracy consists of mean bias and limit-of-agreement (LoA). The FHR bias is 0.05 beat per minute (BPM) and LoA is [-8.7 8.8] with 95% confidence interval (95% CI) measured using Bland Altman analysis. The PPA of 90.9% reflects FHR sensitivity. Reliability is measured with absolute ICC and consistency ICC. The absolute ICC is of 88% and consistency ICC of 94%. For MHR evaluation, accuracy is measured using Bland Altman analysis which provided a bias of 0.35 BPM and LoA of [-7 6.2] with 95% CI. The MHR sensitivity calculated using PPA is 98% while the MHR reliability is with the absolute value of 99% and consistency ICC of 99%.

Investigating the association of maternal heart rate variability with fetal birth weight.

Maternal heart rate (HR) was reported to affect birth weight and birth outcomes. Low birth weight constitutes a major health problem, and it is estimated that around 15% to 20% of births worldwide are low weight. In our previous study, we discussed the presence of similarities between maternal and fetal HRs, therefore, here, we propose to develop a parameter based on maternal and fetal HR variability (HRV) to divide data into two patterns to investigate the association of fetal birth weight with maternal HR and HRV. The parameter was derived from non-invasive records of maternal and fetal electrocardiograms (ECGs) that were collected from 78 subjects (age: 22 - 44 years old, gestational age (GA): 19 - 40 weeks). The HRV parameter was calculated by first evaluating the standard deviation (SD) of the number of R peaks occurring per 2 seconds (snRpp2s). Then, the difference between maternal and fetal snRpp2s (dmf) was calculated. The correlation between our derived parameter [dmf] with GA revealed a significant correlation that suggested the dmf's association with fetal development. The association analysis results between birthweight with maternal HR and HRV per pattern showed that significant negative correlations exist between them in one pattern. Still, the same correlations were not observed in the other pattern. This study's findings emphasise maternal health's role in fetal development assessment. In addition, this study highlights the importance of developing novel factors for properly assessing fetal development and birth outcomes.

Epidural Anaesthesia Technique in Caesarean Section Operation in Pregnant Patients with Rheumatic Heart Disease and Severe Mitral Stenosis

Introduction: Mitral stenosis (MS) is the most common form of rheumatic heart disease (RHD). Pregnant women with moderate/severe MS are more prone to heart failure and pulmonary edema than normal pregnant women. It is very important to prevent the potential for maternal heart failure before delivery. This study aimed to present a case report on the epidural anaesthesia technique in caesarean section in pregnant patients with rheumatic heart disease and severe mitral stenosis.
 Case presentation: A 31-year-old pregnant woman patient came to the hospital with complaints of shortness of breath and found rheumatic heart disease and severe mitral stenosis. The patient was premedicated with fentanyl 50 mcg and midazolam 1 mg intravenously, followed by oxygen supplementation with a 2 lpm nasal cannula. Anaesthesia was performed using a lumbar epidural technique, with the insertion of an epidural catheter in the L1-L2 intervertebral space, targeting the T10-L1 dermatome and T6-L1 target of the viscerotome. The local anaesthesia agent chosen was plain bupivacaine with a concentration of 0.5% and a volume of 25 ml. The onset of action of epidural anaesthesia is achieved within 15 minutes as long as the operation is reached a total blockade as high as T6. During surgery, the patient is monitored with standard monitors and an artery line. There were no complaints of shortness of breath felt by the patient during the operation.
 Conclusion: Epidural anaesthesia technique can be performed safely in pregnant women with comorbid mitral regurgitation and atrial fibrillation, with good intraoperative hemodynamic stability.

Peripartum Outcomes of Aboriginal Women with Cardiac Disease From the Maternal Heart Clinic in Western Australia

Peripartum Outcomes of Aboriginal Women with Cardiac Disease From the Maternal Heart Clinic in Western Australia

Maternal complete heart block in pregnancy: a case report, literature review and management options

Objective: to discuss the management of maternal complete heart block during pregnancy Methods: This is a case report, discussion, and recommendations for managing complete heart block during pregnancy. Results: Maternal complete heart block was managed successfully during pregnancy. Conclusion: Maternal complete heart block occurring during pregnancy is a rare condition that can first present during pregnancy. Management is guided by expert opinion based on sparse literature, with no established guidelines, and requires a multidisciplinary team approach.

The Epigenetic Link of Perinatal BMI to Maternal Phenotype and Fetal Heart Rate

Obesity is a metabolic stressor associated with a suboptimal physiological milieu including an inflammatory state and a dysregulated stress axis. Perinatal maternal BMI impacts pregnancy and birth outcomes along with child metabolic and neurodevelopmental health that are believed to be mediated by epigenetic mechanisms. Our research examines the impacts of pre-pregnancy BMI in a cohort of healthy pregnancies (n=187); first, by characterizing maternal phenotype throughout pregnancy, including her stress physiology (diurnal salivary cortisol), inflammatory status (blood cytokine levels), perinatal depression (EPDS scores), and the underlying epigenetic signature (DNA methylation) in blood that could mediate these effects. Second, we examine the effects of pre-pregnancy BMI on fetal heart rate measurements as an early marker of programming effects of altered autonomic nervous system and the associated placental DNA methylation with a focus on sex-dimorphic effects. Finally, we explore the impact of increasing the allostatic load of high BMI with stress, which was phenotyped in women early in pregnancy driven by data with 27 variables assessing psychological and physical health, on differential placental DNA methylation. To date: regional analysis revealed about 4500 differentially methylated regions (DMR) overall in response to high BMI. Gene ontology enrichment analysis revealed that DM genes annotated to these DMRs were enriched for biological processes involving inflammation in males and RNA silencing in females. This work highlights that the metabolic stress associated with BMI could leave a molecular fingerprint that mediate other maternal physiological and psychological outcomes, which in turn program the fetal neurodevelopmental outcomes.

MATERNAL LEFT VENTRICULAR ADAPTATION IN TWIN PREGNANCY

Objective: During pregnancy, a maternal left ventricular (LV) remodeling occurs to face significant hemodynamic changes. Although twin pregnancy can require greater modifications than in singleton, limited data are currently available. The aim of the study was to longitudinally investigate maternal changes of LV function and compliance in twin pregnancy. Design and method: 35 uncomplicated twin pregnancy women underwent transthoracic echocardiography at first (T1, 10-15 weeks) and third trimester (T3, 30-35 weeks) of gestation. Left atrial (LA) and LV dimensions, LV volumes, systolic and diastolic function were measured, LV mass was calculated. Speckle-tracking imaging was used to evaluate global longitudinal strain (GLS). Non-invasive pressure-volume curves (PV loops) were reconstructed using a dedicated software. Results: Maternal LA and LV dimensions, LV volumes and mass increased from T1 to T3. Ejection fraction and GLS showed no changes between visits. Assessment of diastolic function (at pulsed wave Doppler and tissue Doppler) showed no changes in E/A ratio, while E/e’ ratio was higher at T3. At PV loops analysis, ventricular-arterial coupling (VAC) was stable due to the reduction of both LV end-systolic elastance (Ees) and arterial elastance (Ea). An increase in stroke work was observed. The increase in LV end-diastolic volumes from T1 to T3 with no changes in LV end-diastolic filling pressure suggested enhanced LV cavity compliance (rightward shift of the end-diastolic pressure-volume relationship, EDPVR). Conclusions: Maternal heart in uncomplicated twin pregnancy adapts to the increased hemodynamic load with an increase in stroke work and enhancement of LV volumes without altering ventricular filling pressure.

RT-TRAQ: An algorithm for real-time tracking of faint quasi-periodic signals in noisy time series.

We present an algorithm for live tracking of quasi-periodic faint signals in non-stationary, noisy, and phase-desynchronized time series measurements that commonly arise in embedded applications, such as wearable health monitoring. The first step of Rt-Traq is to continuously select fixed-length windows based on the rise or fall of data values in the stream. Subsequently, Rt-Traq calculates an averaged representative window, and its spectrum, whose frequency peaks reveal the underlying quasi-periodic signals. As each new data sample comes in, Rt-Traq incrementally updates the spectrum, to continuously track the signals through time. We develop several alternate implementations of the proposed algorithm. We evaluate their performance in tracking maternal and fetal heart rate using non-invasive photoplethysmography (PPG) data collected by a wearable device from animal experiments as well as a number of pregnant women who participated in our study. Our empirical results demonstrate improvements compared to competing approaches. We also analyze the memory requirement and complexity trade-offs between the implementations, which impact their demand on platform resources for real-time operation.

Evaluation of left ventricular function of pregnant women with autoimmune diseases using speckle tracking echocardiography.

Pregnancy can cause fluctuations in autoimmune diseases (AD) women, which may aggravate the cardiac damage. Maternal heart function is very important for maternal and fetal health. Therefore, early and accurate evaluation of the heart function of AD pregnant women is necessary. This study was aimed to evaluate the left ventricular (LV) function of AD pregnant women using two-dimensional speckle tracking echocardiography (2DSTE). A total of 96 subjects, including 26 non-pregnant AD patients (AD group), 33 AD pregnant women (AD-P group), and 37 healthy pregnant women (H-P group) were conducted. Baseline clinical and conventional echocardiography characteristics of all the subjects were collected. The 2DSTE was performed to acquire layer-specific strain parameters of LV. Compared with H-P group, AD-P group showed no significant differences in GLSmid and GLSepi. However, the GLSendo (24.10 [22.30 to 25.40] vs. 21.70 [19.05 to 25.15], P = 0.023) and ΔGLS (5.50 [4.80 to 6.00] vs. 4.90 [4.20 to 5.80], P = 0.017) were decreased, while the PSD (27 [23 to 32] vs. 32 [24 to 44], P = 0.014) was increased. At the segmental level, there was no significant difference in apex LSmid and LSepi between the two groups, while the AD-P group showed transmural dysfunction in basal and middle segments, and the LSendo in apex segments (32.84 [28.34 to 34.25] vs. 27.97 [21.87 to 33.61], P = 0.021) were significantly decreased. Compared with AD group, AD-P group showed no significant difference in ΔGLS, PSD, and GLS parameters of three layers. For the segmental level, there were no significant differences in the LSepi of the apex segment and the LS in three layers of the basal and middle segments between the two groups, while LSendo (32.69 [29.13 to 35.53] vs. 27.97 [21.87 to 33.60], P = 0.017) and LSmid (24.70 [22.24 to 27.78] vs. 21.32 [16.91 to 26.11], P = 0.023) in apex segments were significantly lower in AD-P group. The anti-SSA/Ro antibody were positive independently correlated with PSD. In conclusion, layer-specific strain parameters and PSD by 2DSTE provide an accurate and reproducible measurement of myocardial function. There are subclinical LV myocardial dysfunction in AD pregnant women. Besides, the positive of anti-SSA/Ro antibody maybe associated with LV myocardial dysfunction.

The fetal scalp electrode shortage is an urgent patient safety issue

There is currently a shortage of fetal scalp electrodes because of a recent recall due to concerns about the breakage of the electrode tip with possible injury to the neonate. Although the recall is presumably intended to improve safety, the resulting shortage of fetal scalp electrodes poses risks to patients because of inadequate fetal heart rate monitoring in cases where an adequate signal cannot be obtained with external fetal monitoring and/or when maternal heart rate artifact cannot be resolved by repositioning of transducers and application of a maternal pulse oximeter.

Male fetuses negatively affect the vitality of the litter and the dam's metabolic and physiological state in multifetal pregnant ewe.

In sheep, ~30% of fetuses do not survive till parturition, and 17.7% of the multifetal pregnancies experience partial litter loss (PLL). In humans, multifetal pregnancies are associated with a higher risk of perinatal mortality. Therefore, the objectives were to examine the association between partial litter loss, fetal sex, dam's metabolic and physiological state, and pregnancy outcome in multifetal pregnant ewes. The study includes two parts. The first was a retrospective study, in which we analyzed data of 675 lambings and examined the PLL incidence according to male ratio (MR) for all litter sizes (range 2-6). Lambings were categorized as having a low male ratio (LMR; <50% males) or a high male ratio (LMR; >50% males). In the second part, we monitored 24 ewes from 80 to 138 days in pregnancy every 10 days, and then daily until lambing, by ultrasound scanning for maternal heart rate (HR), and Doppler ultrasound for litter vitality. Blood samples were taken from dams on the days of scanning. Male ratio strongly affected PLL, where the general survival rate (for all lambings) was reduced from 90% in LMR lambings to 85% in HMR lambings. The odds ratio for PLL in HMR vs. LMR litters was 1.82. Birth body weight and the survival rate of female was higher in LMR than HMR lambings, with no differences for male lambs in both parameters. In the second part, dams' HR during the last trimester was 9.4% higher in LMR than in HMR pregnancies, with no differences in fetuses' HR. The plasma glucose and insulin concentrations were not significantly different between groups, but plasma β-hydroxybutyrate and nonesterified fatty acid concentrations were, respectively, 31% and 20% lower in HMR vs. LMR ewes. In conclusion, male fetuses negatively affect pregnancy outcomes and influence dams' metabolic and physiological state in sheep.

Maternal heart rate artifact during electronic fetal monitoring (EFM) in labour and birth

Maternal heart rate artifact (MHRA) impacting interpretation of EFM is a well-recognised phenomenon in case reports. We assessed the proportion of birth asphyxia cases associated with delay in delivery (DD) secondary to MHRA.

On the distinct differences in autonomic regulation between pregnant and non-pregnant women - a heart rate variability analysis

Objective. Appropriate adaptation of the maternal autonomic nervous system to progressing gestation is essential to a healthy pregnancy. This is partly evidenced by the association between pregnancy complications and autonomic dysfunction. Therefore, assessing maternal heart rate variability (HRV)—a proxy measure for autonomic activity—may offer insights into maternal health, potentially enabling the early detection of complications. However, identifying abnormal maternal HRV requires a thorough understanding of normal maternal HRV. While HRV in women of childbearing age has been extensively investigated, less is known concerning HRV during pregnancy. Subsequently, we investigate the differences in HRV between healthy pregnant women and their non-pregnant counterparts. Approach. We use a comprehensive suite of HRV features (assessing sympathetic and parasympathetic activity, heart rate (HR) complexity, HR fragmentation, and autonomic responsiveness) to quantify HRV in large groups of healthy pregnant (n = 258) and non-pregnant women (n = 252). We compare the statistical significance and effect size of the potential differences between the groups. Main results. We find significantly increased sympathetic and decreased parasympathetic activity during healthy pregnancy, along with significantly attenuated autonomic responsiveness, which we hypothesize serves as a protective mechanism against sympathetic overactivity. HRV differences between these groups typically had a large effect size (Cohen’s d > 0.8), with the largest effect accompanying the significantly reduced HR complexity and altered sympathovagal balance observed in pregnancy (Cohen’s d > 1.2). Significance. Healthy pregnant women are autonomically distinct from their non-pregnant counterparts. Subsequently, assumptions based on HRV research in non-pregnant women cannot be readily translated to pregnant women.

PO-01-207 VERNIX CASEOSA DISTRIBUTION MODULATES NON-INVASIVE FETAL ECG SIGNAL: A COMPUTATIONAL STUDY

Non-invasive fetal ECG (FECG) shows promise as a diagnostic method to monitor fetal health. However, extracting the fetal cardiac signal remains a challenge due to low signal-to-noise ratio. An important factor is a low-conducting layer which forms around the fetus from week 28 of gestation called the vernix caseosa (VC). We developed an anatomically detailed and biophysically accurate computational model of a pregnant torso to investigate the effects of the VC on the FECG. The model was constructed by combining geometries of a pregnant woman with a 24 week infant and a torso with ventricles (a). Ionic current properties of the maternal heart is modelled using the Ten Tusscher human ventricular cardiomyocyte model, while a modified version adapted to match fetal electrophysiology is used for the fetal heart. 22 distribution patterns of the VC was generated using combinations of 3 regions and 4 thickness. No VC case was used as control. Electrical propagation was simulated using the pseudo-bidomain formulation. Sinus rhythm was simulated with a baseline cycle of 500 ms and 450 ms for the maternal and fetal hearts, respectively. When VC was represented as homogeneous, changing the VC thickness from 0.5 mm to 3 mm resulted in reduction of QRS maximum amplitude from 6 x 10-5 to 6 x 10-6 mV (c). However, in the heterogeneous VC models, there is no significant difference in signal as thickness was changed (d). The location of the VC significantly affected the signal (e). VC only covering the head was almost identical to control with a relative difference measure of only 1.35%. However, introduction of VC on the back resulted in greatest difference in potential distribution with a relative difference measure ranging between 34.5 and 49%. We have developed a novel, highly-detailed computational model of a pregnant torso that shows how VC distribution affects the FECG. This model can be used to improve techniques in extracting FECG at different gestational stages.

Does cardio-hepatic communication contribute to pregnancy-induced cardiac growth and its reversal?

Introduction: During pregnancy, the maternal heart undergoes physiological cardiac growth, which reverses following parturition; however, the underlying processes that contribute are largely unknown. Changes in both systemic and cardiac metabolism appear to be associated with cardiac growth, which could also contribute during pregnancy. We have shown that several cardiac metabolic transcripts and proteins and liver-derived metabolites are elevated during pregnancy and postpartum and are associated with cardiac growth. Therefore, the goal of this study was to examine the extent to which the cardio-hepatic signaling axis contributes to pregnancy-induced cardiac growth and reversal. Methods and Results: Timed pregnancy studies in 12-week-old FVB/NJ mice revealed that both heart weight (HW:TL; p &lt; 0.0001) and liver weight (LIV:TL; p &lt;0.0001) were highest in lactating 1-week post-birth (PB) mice versus mid-pregnant (8 d), late-pregnant (LP; 16 d), and non-pregnant (NP) mice. Interestingly, we also found that HW:TL ( p &lt; 0.01) and LIV:TL ( p &lt; 0.0001) were significantly reduced in non-lactating 1-week post-birth mice (PBNL) compared with PB mice. Hearts and livers both remained significantly larger, irrespective of lactation status, following parturition through 6 weeks post birth (PB) versus NP. Plasma proteomics revealed significant increases in prolactin at LP in addition to increases in liver-derived proteins including hepatocyte growth factors; however, these levels returned to NP levels by PB. Examination of the liver proteome from the same mice revealed significant increases in fatty acid and ketone body metabolism proteins. Cardiac and liver immunoblot analysis revealed significant reductions in Pdk4 between 1- and 3-week PB and PBNL groups that was reversed by 6-weeks postpartum and a significant increase in Pdk4 expression at 6 weeks postpartum, respectively. Interestingly, we see a sustained increase in cardiac Bdh1 expression that persisted at 6-weeks postpartum which could contribute to the sustained increases in HW:TL versus NP. Conclusion: Changes in both lactation status and metabolism are likely contributing to similar patterns of growth seen in the heart and liver during and following pregnancy. NIGMS COBRE Pilot project grant P30 GM127607; NIH R01 HL147844 (Hill/ Jones); Jewish Heritage Fund for Excellence Faculty Support; Jewish Heritage Fund for Excellence Research Enhancement Award; UofL School of Medicine Basic Science award; NIGMS IDeA state funded proteomics voucher. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Pre-gestational diabetes and the risk of congenital heart defects in the offspring: A French nationwide study

To compare the frequencies and types of congenital heart defects for infants of women without and with pre-gestational diabetes, type 1 and type 2 diabetes (T1DM, T2DM) and to identify risk factors. All live births between 2012 and 2020 were screened for maternal diabetes and infant congenital heart defects using the French Medical Information System Program in Medicine, Surgery and Obstetrics database (PMSI-MCO). Incidences of these defects were estimated, and a logistic model evaluated maternal and fetal prognostic risk factors. Overall, 6,038,703 mothers did not have pre-gestational diabetes (no-diabetes), 23,147 had T1DM, and 14,401 had T2DM. The incidence of infant congenital disease was 6.2% for the no-diabetes group, 8.0%, for women with T1DM, and 8.4% for women with T2DM (P < 0.001); for congenital heart defects, incidences were respectively 0.8%, 3.0% and 2.7% (P < 0.001). In comparison with the no-diabetes group, the odds ratios (95%CI) of coronary heart defects were 2.07 (1.91;2.24) (P < 0.001) for women with T1DM and 2.20 (1.99;2.44) (P < 0.001) for women with T2DM, with no difference between T1DM and T2DM (P=0.336). cesarian section, small and large for gestational age, and prematurity were also associated with an increased risk of congenital heart defects. In this study we observed higher incidences of congenital heart defects in infants of women with pre-gestational diabetes compared to women without pre-gestational diabetes, with no difference between women with T1DM or T2DM. These data call for intensifying preconception care and justify systematic cardiac echography in selected fetuses.

Ambulatory antenatal fetal electrocardiography in high-risk pregnancies (AMBER): protocol for a pilot prospective cohort study

IntroductionFetal heart rate (FHR) monitoring is a vital aspect of fetal well-being assessment, and the current method of computerised cardiotocography (cCTG) is limited to the hospital setting. Non-invasive fetal ECG...