Non-diabetic Pregnant Women Research Articles

Preeclampsia in women with pregestational diabetes – a cohort study

ABSTRACTAims: To evaluate risk factors for preeclampsia (PE) in women with pregestational diabetes.Methods: Retrospective cohort study of women with pregestational diabetes cared for at a specialized prenatal care facility. Maternal characteristics at booking and during pregnancy were studied for their association with preeclampsia. Multivariable models were tested using Poisson regression with robust estimates; results were expressed as relative risk (RR) and 95% confidence interval (CI).Results: Preeclampsia was diagnosed in 62 of 206 women (30%, 95% CI 24–37%). Previous chronic hypertension was found in 53 subjects (26%; 95% CI 20–32%), of whom 41 (77%, 95% CI 64–88) were type 2 women. Type 1 diabetes, chronic hypertension, systolic blood pressure >124 mmHg at booking and gestational weight gain, either total or excessive for body mass index category, behaved as independent risk factors.Conclusions: In women with pregestational diabetes, some risk factors may predict PE, similar to those found in non-diabetic pregnant women. Two non-modifiable factors (type of diabetes and chronic hypertension) and two modifiable ones (systolic blood pressure levels and gestational weight gain) were found relevant in this cohort. A policy of close monitoring of blood pressure and weight gain, aiming adequate weight gain, may be added to current recommended measures. The high prevalence of PE in women with prepregnancy diabetes, especially those with initial pregnancy systolic blood pressure >124 mmHg, supports a policy of early institution of low dose aspirin. Further multicentric studies will help define the role of these risk factors as contributors to PE in pregestational diabetes.

The role of first trimester fetal heart rate in the prediction of gestational diabetes: A multicenter study

ObjectiveEarly pregnancy models for prediction of GDM have been proposed, mostly using anamnestic and biochemical parameters. The aim of our study was to evaluate the strength of association of first trimester fetal heart rate (FHR) in predicting the development of gestational diabetes (GDM). Study designWe considered in our analysis singleton non-diabetic pregnant women who underwent a first trimester screening at 11–14 weeks. Data on maternal age, BMI, cigarette smoking, NT, FHR, CRL, DV-PVI, β-hCG and PAPP-A were included in the analysis. Multivariate logistic regression analysis was used to estimate the association between maternal characteristics and first-trimester ultrasound measurements and GDM. We evaluated the efficacy of different models for the prediction of GDM. ResultsWe considered 603 women, of whom 199 (33%) were subsequently diagnosed with GDM. ROC analysis showed that first trimester FHR was highly predictive of GDM (AUC 0.809, 95% CI 0.769–0.849, p < 0.001). At FPR of 20%, first trimester FHR had a detection rate of 65.2% for GDM (positive likelihood ratio: 3.26; negative likelihood ratio: 0.43), which increased to 89.5% at FPR of 40% (positive likelihood ratio: 2.24; negative likelihood ratio: 0.17). When considering as threshold 162 bpm, FHR showed detection rate of 76.9%, specificity of 67.1% and negative predictive value of 85.5% for GDM. ConclusionThis is the first study to highlight the potential role of first trimester FHR as early predictor of GDM. In our cohort, a threshold of 162 bpm has shown high detection rate and NPV for GDM.

Nonalcoholic fatty liver disease is a risk factor for large-for-gestational-age birthweight.

ObjectiveNonalcoholic fatty liver disease (NAFLD) is a well-recognized hepatic manifestation of metabolic disease in adults and has been associated with the development of gestational diabetes (GDM). Hepatic insulin resistance can result in increased release of glucose (from gluconeogenesis) and free fatty acids (due to enhanced lipolysis), which can lead in turn to fetal overgrowth. However, the relationship between maternal metabolic factors (such as circulating levels of triglycerides, free fatty acids [FFA], or adipokines) and excessive fetal birthweight in NAFLD has not been carefully examined. In this study, we evaluated the relationship between NAFLD and the subsequent risk of large-for-gestational-age (LGA) birthweight.MethodSingleton nondiabetic pregnant women were evaluated for the presence of fatty liver at 10–14 weeks of gestation by abdominal ultrasound. The degree of fatty liver was classified as Grade 0–3 steatosis. At the time of liver ultrasound, maternal blood was taken after fasting and measured for adiponectin and FFA. LGA was defined as birthweight >90th percentile for gestational age.ResultsA total of 623 women were included in the analysis. The frequency of LGA was 10.9% (68/623), and the frequency of NAFLD was 18.9%. The risk of LGA increased significantly in patients with Grade 2–3 steatosis in the first trimester. The relationship between Grade 2–3 steatosis and LGA remained significant after adjustment for maternal age, pre-pregnancy BMI, GDM, and maternal serum triglyceride levels. The concentration of maternal blood adiponectin at 10–14 weeks was significantly lower in cases with LGA than non-LGA, but the maternal blood FFA concentrations were not different between the groups.ConclusionThe presence of Grade 2–3 steatosis on ultrasound in early pregnancy was associated with the increased risk of delivering an LGA infant, even after adjustment for multiple confounding factors including GDM. Adiponectin may be the linking biomarker between NAFLD and LGA.

198-LB: Maternal Plasma AGEs and Preeclampsia in Women with Type 1 Diabetes

Preeclampsia (PE) occurs four times more frequently in pregnant women with type 1 diabetes (T1D) than in nondiabetic women. We hypothesized that elevated plasma advanced glycoxidation products (AGEs) predict PE in T1D women. In a prospective T1D pregnancy cohort (study visits at 12, 22, 32 weeks' gestation), we used liquid chromatography/mass spectrometry, with internal stable heavy isotope substituted standards, to determine plasma levels of nine AGE and oxidation products (carboxymethyl-lysine [CML], carboxyethyl-lysine [CEL], methylglyoxal-hydroimidazolone [MGHI], 3-deoxyglucosone hydroimidazolones [3DGH], methionine sulfoxide [MetSO], glyoxal hydroimidazolone [GHI], 3-nitrotyrosine [3NT], dityrosine [DT], 2-aminoadipic acid [2AAA]) in 23 women with T1DM who developed PE vs. 24 who did not, and in 19 nondiabetic normotensive pregnant women. These products have been associated with CVD and renal failure in non-pregnant cohorts. All women were free of microalbuminuria and hypertension at enrolment, and all visits preceded clinical PE onset. GFR was estimated (Chronic Kidney Disease Epidemiology Collaboration equation). Results: Plasma CML, CEL, MGHI, 3DGH, MetSO, GHI, and 2AAA did not differ between the three groups at any study visit, and thus did not predict preeclampsia in T1D. In T1D women who later developed PE, eGFR was inversely associated at V3 with CML (p=0.008), CEL (p=0.03), MGH1 (p=0.03), 3DGH (p=0.03), GHI (p&amp;lt;0.001), and 2AAA (p&amp;lt;0.05); and at V2 with CEL (p=0.04), MGHI (p=0.02), and GHI (p=0.02). No such associations were observed in normotensive T1D or in nondiabetic pregnant women. Plasma levels of 3NT and DT were undetectable in all participants. Conclusions: Plasma AGEs did not predict PE in well-controlled, previously healthy T1D women, and levels did not differ from healthy nondiabetic controls. Uniquely, in T1D women who developed PE, plasma AGEs were associated with renal function, consistent with the notion that subclinical alterations in renal function precede PE. Disclosure H. Karanchi: None. C.B. Kelly: None. S.M. Hammad: None. R.L. Klein: None. M.F. Lopes-Virella: None. M.J. Leyva: None. J. Yu: None. A.J. Jenkins: Advisory Panel; Self; Abbott, Australian Diabetes Society, Medtronic. Research Support; Self; Abbott, GlySens Incorporated, Medtronic, Mylan. Speaker’s Bureau; Self; Eli Lilly and Company, Novo Nordisk Inc. A.J. Nankervis: None. K.F. Hanssen: None. C.E. Aston: None. S. Howell: Employee; Self; PreventAGE Health Care, LLC. P.J. Beisswenger: Other Relationship; Self; PreventAGE Health Care, LLC. T. Lyons: None.

1391-P: Longitudinal Changes of Plasma Sphingomyelins during Gestation in Women With and Without Type 1 Diabetes and Preeclampsia

Preeclampsia (PE), a major cause of maternal and fetal morbidity and mortality worldwide, has significantly higher incidence in women with type 1 diabetes mellitus (T1DM) than in nondiabetic populations (∼20% vs. 5%, respectively). Sphingolipids are key signaling molecules, and have many roles in the structure and regulation of cellular functions. Sphingomyelin (SM) is the most abundant sphingolipid in plasma lipoproteins. There is evidence that altered SM metabolism may contribute to cardiovascular and renal complications in diabetes. We aimed to determine whether plasma concentrations of 12 SM species were associated with PE in T1DM in a prospective study of pregnancy of 23 T1DM women who developed PE and 24 T1DM who remained normotensive. Additionally, 19 normotensive nondiabetic pregnant women were included for reference. All subjects were free of microalbuminuria and hypertension at enrolment, and all visits (12, 22, 32 weeks’ gestation) preceded clinical PE onset. Results: There were no cross-sectional differences in total SM, or in any individual SM species, between diabetic women with and without PE, or between normotensive women with and without diabetes at any stage of gestation. With advancing gestation in all groups, C18-SM, C18:1-SM, C20-SM, C20:1-SM, C22-SM, C22:1-SM, C24-SM, and C24:1-SM increased (all p&amp;lt;0.001). LDL- and VLDL-cholesterol also increased, while HDL-cholesterol did not change. In contrast, C14-SM, C16-SM, C26-SM and C26:1-SM decreased (all p&amp;lt;0.001). There were no correlations between any SM species and conventional lipid profiles. Conclusions: With advancing gestation, plasma concentrations of most SM species increased, as did LDL and VLDL; however, two long-chain and two very long-chain SM species decreased. Although there were no differences in SM according to diabetes or PE status at any time point, further studies should address the significance of differential changes of SM species during pregnancy. Disclosure C.B. Kelly: None. S.M. Hammad: None. R.L. Klein: None. M.F. Lopes-Virella: None. M.J. Leyva: None. J. Yu: None. A.J. Jenkins: Advisory Panel; Self; Abbott, Australian Diabetes Society, Medtronic. Research Support; Self; Abbott, GlySens Incorporated, Medtronic, Mylan. Speaker's Bureau; Self; Eli Lilly and Company, Novo Nordisk Inc. A.J. Nankervis: None. K.F. Hanssen: None. S.K. Garg: Advisory Panel; Self; Eli Lilly and Company, Roche Pharma, Sanofi-Aventis, Zealand Pharma A/S. Research Support; Self; Eli Lilly and Company, WebMD. J.A. Scardo: None. C.E. Aston: None. T. Lyons: None. Funding JDRF; Novo Nordisk; National Institutes of Health

1390-P: Maternal Plasma Ceramides Predict Preeclampsia in Women with Type 1 Diabetes

The risk for preeclampsia (PE) is increased 4-fold in women with type 1 diabetes (T1D), in whom we previously demonstrated that elevated cholesterol-rich lipoproteins confer risk at the 1st trimester. Sphingolipids, including ceramides (Cer) and glycosphingolipids (hexosyl- (HexCer) and lactosyl-ceramides (LacCer)), are lipoprotein constituents that regulate cell signaling. We propose that these bio-active lipids could be modulators of PE risk. In a prospective T1D pregnancy cohort (studied at 12, 22, 32 weeks’ gestation), we used liquid chromatography/electrospray ionization-tandem mass spectrometry to determine plasma levels of 12 species of Cer, HexCer, and LacCer in 23 women with T1DM who did vs. 24 who did not develop PE, and in 19 normotensive nondiabetic pregnant women. All were free of microalbuminuria and hypertension at enrolment; all visits preceded clinical PE onset. Results: Plasma levels of C22-Cer (1st and 3rd study visits); C26:1-Cer (1st and 2nd visits); C26-Cer (1st visit); C18-Cer and C18:1-Cer (2nd visit) were significantly higher in women with T1DM who did vs. did not develop PE. C22-Cer and C26-Cer were significantly lower in T1DM vs. non-T1DM (1st visit). There were no overall PE- or diabetes-related differences in any HexCer- or LacCer species. Longitudinally, most Cer and HexCer species increased throughout pregnancy in all groups (except C14- and C18-Cer; and C14 and C26-HexCer). C16-LacCer increased, while C22:1-, C26-, and C26:1-LacCer decreased as pregnancy advanced, independent of PE status. Independent of LDL-C, total Cer increased throughout pregnancy in all groups. Conclusions: Maternal Cer species may serve as early biomarkers for PE in women with T1DM. T1DM was associated with lower levels of two Cer species. Like cholesterol-rich lipoproteins, Cer, HexCer and some LacCer species increase as pregnancy advances in all groups, but other LacCer species decrease: the significance of these findings requires further study. Disclosure C.B. Kelly: None. S.M. Hammad: None. R.L. Klein: None. M.F. Lopes-Virella: None. M.J. Leyva: None. J. Yu: None. A.J. Jenkins: Advisory Panel; Self; Abbott, Australian Diabetes Society, Medtronic. Research Support; Self; Abbott, GlySens Incorporated, Medtronic, Mylan. Speaker's Bureau; Self; Eli Lilly and Company, Novo Nordisk Inc. A.J. Nankervis: None. K.F. Hanssen: None. S.K. Garg: Advisory Panel; Self; Eli Lilly and Company, Roche Pharma, Sanofi-Aventis, Zealand Pharma A/S. Research Support; Self; Eli Lilly and Company, WebMD. J.A. Scardo: None. C.E. Aston: None. T. Lyons: None. Funding JDRF; Novo Nordisk; National Institutes of Health

Metformin reduces maternal weight gain in obese pregnant women: A systematic review and meta-analysis of two randomized controlled trials.

SummaryObese pregnant women are likely to face several gestational and neonatal complications. Metformin is an effective oral antihyperglycaemic agent that is considered to be effective during pregnancy. The aim of our study was to evaluate the effect of metformin on obstetric and perinatal outcomes in obese pregnant women. Electronic databases were searched (MEDLINE, EMBASE, Web of Science, Scopus, ClinicalTrials.gov, OVID, and Cochrane Library). The selection criteria included only randomized clinical trials (RCTs) of obese pregnant women randomized to a daily metformin regimen or to a placebo condition. The type of participants included women with a body mass index (BMI) ≥ 30 kg/m2 who did not have diabetes mellitus, any other disease, or a contraindication to metformin use. The summary measures were reported as relative risk (RR) with 95% confidence intervals (CIs). The primary outcome was the effect on maternal weight gain (MWG). Two double‐blind RCTs, including 849 obese pregnant women, were included in the meta‐analysis: 428 (50.4%) were randomized to the metformin group, and 421 (49.6%) were randomized to the placebo group. The use of metformin was significantly associated with lower MWG. Metformin was also associated with a significantly lower incidence of preeclampsia (PE) and admission to the neonatal intensive care unit (NICU). Metformin could be considered a useful drug for the treatment of obese, nondiabetic pregnant women because it can significantly decrease weight gain in pregnant women and improve perinatal outcomes by reducing the incidence of PE and NICU admission. However, women should be aware of the uncertainties concerning the long‐term effects of metformin transplacental passage on metabolic outcomes.

Gestational diabetes mellitus increases the detection rate and the number of oral bacteria in pregnant women.

In the present study, we aimed to investigate the association between gestational diabetes mellitus (GDM) and the oral microbial imbalance in the second trimester of pregnancy.Three hundred thirtyone women in the second trimester of pregnancy who underwent prenatal examinations at the Third Affiliated Hospital of Soochow University from February 2018 to August 2018 were included in this study. Personal parameters including the age, education level, and body mass index (BMI) at 28 weeks of gestation were recorded. Gestational diabetes mellitus (GDM) was diagnosed according to the Standards of Medical Care in Diabetes-2011 recommended by American Diabetes Association (ADA). After the significant difference of each parameter was erased by a propensity-score matched (PSM) analysis at a 1:1 ratio, the oral health conditions and the oral flora in pregnant women with GDM were compared with those in nondiabetic pregnant women.Our data demonstrated that 65 of the 331 pregnant women (19.6%) were diagnosed with GDM. Results from the matched data including 59 matched pairs of pregnant women showed that the gingival index (GI), plaque index (PI), tooth mobility degree (TMD), probing depth (PD), and bleeding on probing (BOP) of pregnant women with GDM were higher or more severe than those of nondiabetic pregnant women (P < .05). The detection rate of tuberculosis bacilli, Black-pigmented bacteria, and Capnocytophaga in pregnant women with GDM was higher than those in nondiabetic pregnant women (P = .000, P = .026, and P = .030, respectively). In addition, pregnant women with GDM had fewer oral streptococci (P = .000) and lactobacilli (P = .000) and more oral anaerobic bacteria (P = .000), tuberculosis bacilli (P = .000), Black-pigmented bacteria (P = .007), Capnocytophaga (P = .000), and actinomycetes (P = .000).The detection rate and the number of oral bacteria in pregnant women with GDM were higher than those in nondiabetic pregnant women in the second trimester of pregnancy.

The effect of prophylactic betamethasone for fetal lung maturity on glycemic status of diabetic and non-diabetic pregnant women

The effect of prophylactic betamethasone for fetal lung maturity on glycemic status of diabetic and non-diabetic pregnant women

Serum Ferritin, Iron Deficiency Anaemia and Haemoglobin A1c in Non-diabetic Pregnant Women

Serum Ferritin, Iron Deficiency Anaemia and Haemoglobin A1c in Non-diabetic Pregnant Women

Fatty Liver Index and Serum Copeptin as Early Predictors of Gestational Diabetes Mellitus in Non-diabetic Pregnant Women

Fatty Liver Index and Serum Copeptin as Early Predictors of Gestational Diabetes Mellitus in Non-diabetic Pregnant Women

Admission plasma glucose and maternal prognostic factors in preeclampsia

Aims: We aimed to investigate if admission plasma glucose (PG) level was a significant and independent risk factor for the patients' length of stay at the intensive care unit (ICU), as the primary outcome parameter, and also for the maternal and fetal complications, as the secondary outcome parameters, among a group of nondiabetic pregnant women with severe preeclampsia. Materials and Methods: In this prospective case–control study including 63 pregnant women, admission PG, glycosylated hemoglobin, neutrophil–lymphocyte ratio, platelet count, liver enzymes, and other laboratory parameters and clinical characteristics including length of stay at the hospital, maternal, and fetal complications were investigated. Results: Admission PG levels were found to be significantly elevated in preeclamptic women with poor outcome. Furthermore, platelet count, fibrinogen, alanine aminotransferase, and aspartate aminotransferase values were significantly associated with the length of stay at ICU. Conclusion: We claimed that hyperglycemia was an acute reaction, reflecting the severity of preeclampsia and PG levels to be added to the routine high-risk pregnancy panel on initial presentation to the hospital.

Osteocalcin Serum Levels in Gestational Diabetes Mellitus and Their Intrinsic and Extrinsic Determinants: Systematic Review and Meta-Analysis.

Background Undercarboxylated osteocalcin (ucOC) increases insulin release and insulin resistance in mice. In humans, evidence is scarce but a correlation of ucOC and total osteocalcin (tOC) with glycemic status markers has been demonstrated. The relationship of ucOC and tOC with gestational diabetes mellitus (GDM) has been even less characterized. Objective To assess the mean difference of tOC and ucOC serum concentrations among nondiabetic pregnant women and women diagnosed as GDM in the second trimester of pregnancy and to determine the possible intrinsic and extrinsic contributors to this difference. Methods A systematic search was performed to identify relevant studies published in English and Spanish using PubMed, SCOPUS, ISI Web of Knowledge, and PROSPERO database for meta-analysis. Observational studies measuring mean serum levels of osteocalcin among GDM, with at least 10 subjects analyzed in each group were selected. Mean difference (MD) by random effects model was used. Heterogeneity between studies was assessed using Cochran's Q, H, and I 2 statistics. Results From 38 selected studies, 5 were retained for analysis for a total of 1119 pregnant women. Serum concentrations of tOC were not significantly different among women with GDM and nondiabetic pregnant controls (MD: 1.56; 95% CI: −0.70 to 3.82; p = 0.175). Meanwhile, ucOC serum levels were significantly higher among women with GDM (MD: 1.17; 95% CI: 0.24 to 2.11; p = 0.013). The only factor influencing tOC was the UV index, showing a reduction in mean difference between GDM and controls when exposed to higher concentrations of UV rays. Conclusions This meta-analysis provides evidence to support the use of ucOC as a potential marker for GDM rather than tOC, yielding very little variability among studies and no difference among methods or brands used for its analysis.

The role of Umbilical Cord thickness, Interventricular Septum thickness and HbA1c levels in the prediction of Fetal Macrosomia in patients with Gestational Diabetes Mellitus

Objective: To evaluate the role of measuring umbilical cord thickness, interventricular septum thickness and HbA1c level in prediction of fetal macrosomia in patients with gestational diabetes mellitus. Methods: This prospective case-control study included 80 pregnant women. They were divided into two groups: 40 pregnant women as case group with gestational diabetes mellitus and 40 non-diabetic pregnant women as control group. Ultrasound examination was performed where the sonographic cross sectional area of umbilical cord. The umbilical arteries and the umbilical vein were measured in a free loop of the umbilical cord, using the software of the ultrasound machine. The cross-sectional area of Wharton’s jelly was computed by subtracting the cross sectional area of the vessels from that of the umbilical cord and the interventricular septum thickness was measured. HbA1c level was measured for diabetic patients.

Measuring fetal thymus size: a new method for diabetes screening in pregnancy

Objective: To investigate the correlation between fetal thymus size and diabetes in pregnancy.Method: Fetal thymus size was assessed in 160 pregnant women with gestational age of 19–39 weeks. They included 80 diabetic (investigation group) and 80 nondiabetic (control group) women. Fetal thymus size was measured by thymic–thoracic ratio. We did this with dividing the thymus’ anteroposterior diameter by anteroposterior of mediastinum.Results: Thymic–thoracic ratio was significantly smaller in fetuses of diabetic mothers compared to the nondiabetic group (p = .001). It remained significant after subgrouping diabetic mothers into overt diabetes, insulin-dependent gestational diabetes, and noninsulin-dependent gestational diabetes.Conclusion: Although thymus size was smaller in fetuses of diabetic pregnant women compared to nondiabetic pregnant women, it seems that thymic–thoracic ratio can be a predictor of diabetes and its other related adverse effects during pregnancy.

Body fat index: A novel alternative to body mass index for prediction of gestational diabetes and hypertensive disorders in pregnancy

ObjectivesTo evaluate the association of ultrasound measurement of maternal abdominal subcutaneous and pre-peritoneal fat thickness in relation to the subsequent diagnosis of gestational diabetes (GDM), and to assess the association of body fat index (BFI), compared to conventional body mass index (BMI), with respect to the development of some obstetric related complications. Study designA prospective study included non-diabetic pregnant women who were scheduled for fetal anatomic survey. Women underwent fat measurements and BFI (pre-peritoneal fat x subcutaneous fat/height) was calculated. They underwent routine glucose screening and diagnostic tests for GDM. Obstetric complications, mode of delivery, and delivery related events were reported. Multivariable logistic regression was used to test potential predictors for development of obesity-related complications. Primary outcome was development of GDM. Secondary outcomes included development of hypertensive disorders during pregnancy and need for cesarean delivery due to labor dystocia. The optimal cut-off points for continuous variables were obtained using a receiver operating characteristic (ROC) curve analyses. Results389 women met study criteria. Median gestational age at time of ultrasound evaluation was 19.1 weeks. Positive family history of diabetes (adjusted odds ratio “OR” 2.30, 95% CI 1.35–3.92), history of GDM (adjusted OR 6.87, 95% CI 3.03–15.61), subcutaneous fat≥13 mm (adjusted OR 4.63, 95% CI 1.60–13.38) and pre-peritoneal fat≥12 mm (adjusted OR 3.32, 95% CI 1.06–10.42) were significant predictors for development of GDM.ROC analysis demonstrated that a BFI > 0.5 was statistically superior to a BMI > 25 or 30 as a predictor of gestational diabetes (adjusted OR 6.24, 95% CI 1.86–20.96). A Similar ROC analysis demonstrated that a BFI > 0.8 was associated with a higher risk for the development of hypertensive disorders of pregnancy (adjusted OR 2.70 [95% CI 1.60–4.55]), and need for cesarean delivery (adjusted OR 2.01[95% CI 1.23–3.28]) than a BMI > 25 or 30. ConclusionValues obtained by ultrasound measurement of subcutaneous and pre-peritoneal fat are associated with development of GDM and hypertensive disorders in pregnancy. Our data suggest that BFI was a better predictor than BMI for development of GDM and hypertensive disorders in pregnancy and should be studied further.

Prenatal Diagnosis of Fetal Hypertrophic Cardiomyopathy in Diabetic Mothers Using 5D Fetal Echocardiography

Background: Diabetes mellitus is a common condition, affecting approximately 7% of pregnant women. Appropriate management has reduced morbidity and mortality. Diabetes mellitus in pregnancy can cause many problems for the fetus as significant congenital disorders, risk of premature delivery and increased prenatal morbidity and mortality. In addition, it causes neonatal hypoglycemia, macrosomia and transient hypertrophic cardiomyopathy HCM (observed in up to 35% of fetuses). Fetal Intelligent Navigation Echocardiography (FINE) is a novel method for visualization of standard fetal echocardiography views from volume datasets obtained with spatiotemporal image correlation (STIC).This method can simplify examination of the fetal heart and reduce operator dependency. Objectives: The aim of this study was to investigate the utility of 5D fetal echocardiography in the prenatal diagnosis of fetal hypertrophic cardiomyopathy in healthy mothers, controlled diabetic mothers and uncontrolled diabetic mothers. Patients and Methods: Cross sectional observational study was conducted at Ain Shams University Maternity Hospital at the ultrasound fetal special care unit, Study duration: September 2017- July 2018. This study was conducted on healthy and diabetic pregnant women divided into 3 groups Sampling Method: This study included 111 pregnant women between the 28th and 36th weeks of gestation. After approval of the Local Institutional Review Board, the study was explained and an informed written consent was obtained from all participants. This study included 3 groups of pregnant women which were: Group A: Control group which consist of 37 healthy non-diabetic pregnant women, group B: Controlled group which consist of 37 diabetic pregnant women with good glycemic control, group C: Uncontrolled group which consist of 37 diabetic pregnant women with poor glycemic control. Results: The current study showed that, as regards the thickness of the interventricular septum IVS, there were significant differences between the three groups. The mean IVS thickness in Group A was 0.38±0.05 cm; in Group B, it was 0.44±0.05cm and in Group C, it was 0.57±0.08cm. In a similar study, compared the IVS thickness between GDM, DM type 2 and DM type 1,showed that the mean fetal IVS thickness was 3.73 + 0.84 mm in the DM type1 group; 4.08 + 0.75 mm in the GDM group; and 3.99 + 0.59 mm in the DM type 2 group and found that there was a statistically significant difference between HbA1c and IVS thickness in the DM type1 group only P=0.013.But in the GDM group (P=0.723) and the DM type2 group (P=0.380), there were no significant differences. Conclusion: Infants of diabetic mothers are prone to have multiple problems during the neonatal period which makes them a very high risk infant. These neonates must be screened for any associated congenital anomalies and metabolic abnormalities. Hypertrophic cardiomyopathy of IDM have good prognosis and this cardiomyopathy is reversible in nature but these neonates requires close monitoring and regular follow-up and early intrauterine detection.

Macular choroidal thickness in pregnant women with type 1, type 2 and gestational diabetes mellitus measured by spectral-domain optical coherence tomography.

PurposeTo analyze choroidal thickness (CT) of pregnant women with type 1 diabetes mellitus (DM), type 2 DM and gestational diabetes mellitus (GDM) using spectral-domain optical coherence tomography.Patients and methodsThis cross-sectional study included 144 eyes of 72 pregnant women in the third trimester divided into four groups: 27 non-diabetic pregnant women; 15 pregnant women with GDM; 16 with type 2 DM and 14 with type 1 DM. CT was measured using optical coherence tomography at ten different locations. We also analyzed possible confounding factors, such as gestational age, glycosylated hemoglobin, time from DM diagnosis, hypertension and severity of diabetic retinopathy.ResultsThe comparison between the four groups showed a thinner choroid in patients with type 1 DM in all locations, with statistical significance in subfoveal and temporal measurements. When comparing only patients with type 1 and type 2 DM, adjusting for confounding factors, the choroid of patients with type 1 DM remained thinner at all macular points, also with statistical significance in subfoveal and temporal measurements.ConclusionPregnant women with type 1 DM had significantly thinner CT measurements on subfoveal and temporal locations. No differences were found in CT between the control group and pregnant women with GDM and type 2 DM.

Prenatal Diagnosis of Fetal Hypertrophic Cardiomyopathy in Diabetic Mothers Using 5D Fetal Echocardiography

Background: Diabetes mellitus is a common condition, affecting approximately 7% of pregnant women. Appropriate management has reduced morbidity and mortality. Diabetes mellitus in pregnancy can cause many problems for the fetus as significant congenital disorders, risk of premature delivery and increased prenatal morbidity and mortality. In addition, it causes neonatal hypoglycemia, macrosomia and transient hypertrophic cardiomyopathy HCM (observed in up to 35% of fetuses). Fetal Intelligent Navigation Echocardiography (FINE) is a novel method for visualization of standard fetal echocardiography views from volume datasets obtained with spatiotemporal image correlation (STIC).This method can simplify examination of the fetal heart and reduce operator dependency. Objectives: The aim of this study was to investigate the utility of 5D fetal echocardiography in the prenatal diagnosis of fetal hypertrophic cardiomyopathy in healthy mothers, controlled diabetic mothers and uncontrolled diabetic mothers. Patients and Methods: Cross sectional observational study was conducted at Ain Shams University Maternity Hospital at the ultrasound fetal special care unit, Study duration: September 2017- July 2018. This study was conducted on healthy and diabetic pregnant women divided into 3 groups Sampling Method: This study included 111 pregnant women between the 28th and 36th weeks of gestation. After approval of the Local Institutional Review Board, the study was explained and an informed written consent was obtained from all participants. This study included 3 groups of pregnant women which were: Group A: Control group which consist of 37 healthy non-diabetic pregnant women, group B: Controlled group which consist of 37 diabetic pregnant women with good glycemic control, group C: Uncontrolled group which consist of 37 diabetic pregnant women with poor glycemic control. Results: The current study showed that, as regards the thickness of the interventricular septum IVS, there were significant differences between the three groups. The mean IVS thickness in Group A was 0.38±0.05 cm; in Group B, it was 0.44±0.05cm and in Group C, it was 0.57±0.08cm. In a similar study, compared the IVS thickness between GDM, DM type 2 and DM type 1,showed that the mean fetal IVS thickness was 3.73 + 0.84 mm in the DM type1 group; 4.08 + 0.75 mm in the GDM group; and 3.99 + 0.59 mm in the DM type 2 group and found that there was a statistically significant difference between HbA1c and IVS thickness in the DM type1 group only P=0.013.But in the GDM group (P=0.723) and the DM type2 group (P=0.380), there were no significant differences. Conclusion: Infants of diabetic mothers are prone to have multiple problems during the neonatal period which makes them a very high risk infant. These neonates must be screened for any associated congenital anomalies and metabolic abnormalities. Hypertrophic cardiomyopathy of IDM have good prognosis and this cardiomyopathy is reversible in nature but these neonates requires close monitoring and regular follow-up and early intrauterine detection.

Macular Choroidal Thickness in Pregnant Women with Type 1, Type 2, and Gestational Diabetes Mellitus

Pregnancy is an independent risk factor for the progression of diabetic retinopathy (DR). A possible relation with morphological changes of the choroid should be studied. The aim of this study was to analyze choroidal thickness measurements of nondiabetic pregnant women and of pregnant women with type 1, type 2 and gestational diabetes mellitus using spectral-domain optical coherence tomography (OCT). This cross-sectional study included 144 eyes of 72 pregnant women in the third trimester divided into four groups: Group 1 consisted of 27 nondiabetic pregnant women (control group); Group 2 consisted of 15 pregnant women with gestational diabetes mellitus (GDM); Group 3 consisted of 16 pregnant women with type 2 diabetes mellitus (T2DM); and Group 4 consisted of 14 pregnant women with type 1 diabetes mellitus (T1DM). Choroidal thickness was measured using EDI-OCT at ten different locations: at the fovea and every 500µm from the fovea up to 2500µm temporally and up to 2000µm nasally. Other variables such as gestational age, glycosylated hemoglobin values (HbA1c), time from DM diagnosis, hypertension and severity of DR were analyzed. The analysis of the 4 groups adjusted for the presence of hypertension showed a thinner choroid in patients with T1DM in all locations, with statistical significance in subfoveal and temporal measurements. In the comparison only between patients with DM, adjusted for HbA1c, time from diagnosis and presence of hypertension and DR, choroid of patients with T1DM remained thinner at all macular points. In conclusion, our study showed no statistically difference in choroidal thickness between nondiabetic pregnant women, pregnant women with GDM and pregnant women with T2DM during the third trimester. On the other hand, pregnant women with T1DM had significantly thinner choroidal thickness measurements. Disclosure C.Z. Benfica: None. T. Zanella: None. L.B. Farias: None. M.R. Oppermann: None. L.H.S. Canani: None. D. Lavinsky: None.