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Dawid G. i inni: Infants of Diabetic Monthers: Morphological
Heart Parameters, Cord Blood Insulin, Glucose Concentration at
Birth and Echocardiographic...
Vol. 8/2009 Nr 4(29)
Endokrynologia PediatrycznaPediatric Endocrinology
ABSTRACT/STRESZCZENIE
Objective. One of the well known disturbances in infants of
diabetic mothers (IDM) is hypertrophic cardiomyopathy (HCM). We
analyzed the relationship between morphological heart parameters
and cardiac function, cord blood insu-lin, fructosamine and glucose
concentration at birth and the natural history of echocardiographic
findings during the first year of life. Material and methods. 77
infants: 44 infants of diabetic mothers (IDM) and 30 control
subjects from birth to the age of 12 months were prospectively
evaluated by echocardiography. The diabetic group covered 7
prege-stational diabetes mothers (PGDM) and 37 gestational diabetes
mothers (GDM), 18 treated with diet only (G-1) and 19 with insulin
(G-2). 18.2% of IDM were born as large for gestational age (LGA),
while in the control group all but one neonates were appropriate
for gestational age (AGA). In IDM venous cord blood samples were
collected at deli-very and analyzed for insulin and fructosamine
level, while glycemia was analyzed in capillary blood. Results.
Cord blood insulin (Ic) level was significantly higher in PGDM (p
< 0.01) than in both GDM groups (G-1 and G-2). In the G-2 group
a significant positive association was found between Ic level and
blood flow through mitral valve (MV). In-terventricular septum
(IVS) diameter was significantly higher (p < 0.01) in diabetic,
especially in G-2 group. In 38.6% of IDM, the enlargement of the
IVS was noticed. The ratio of IVS/LVPW in the control group was
1.03 ± 0.14, while
Infants of Diabetic Mothers: Morphological Heart Parameters,
Cord Blood Insulin, Glucose Concentration at Birth and
Echocardiographic Findings During the First Year of Life
Niemowlęta urodzone przez matki z cukrzycą ciężarnych: stężenia
insuliny we krwi pępowinowej, stężenia glukozy, ocena
echokardiograficzna serca przeprowadzona po urodzeniu oraz w
pierwszym roku życia
1Dawid Grażyna, 1Horodnicka-Józwa Anita, 1Biczysko-Mokosa
Agnieszka, 1Petriczko Elżbieta, 2Engel Karina
1Department of Pediatrics, Endocrinology, Diabetology, Metabolic
Diseases and Cardiology of Developmental Age, Pomeranian Medical
University, Szczecin, Poland,2Department of Maternal – Fetal
Medicine, Pomeranian Medical University, Szczecin, Poland
Corresponding author: Grażyna Dawid MD, PhD, Department of
Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and
Cardiology of Developmental Age Pomeranian Medical University,
Szczecin, Poland, 71-252 Szczecin, Poland, ul. Unii Lubelskiej 1,
phone + 48 (91) 425 31 66, fax + 48 (91) 425 31 67, e-mail address:
[email protected]
Key words: gestational diabetes, infant of diabetic mother,
hypertrophic cardiomyopathySłowa kluczowe: cukrzyca ciężarnych,
noworodek matki chorującej na cukrzycę, kardiomiopatia
przerostowa
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Dawid G. i inni: Infants of Diabetic Monthers: Morphological
Heart Parameters, Cord Blood Insulin, Glucose Concentration at
Birth and Echocardiographic...
in IDM it was significantly (p < 0.001) higher – 1.32 ± 0.52.
During 12-month observation the resolution of HCM was confirmed.
Conclusions. Infants born to mothers with diabetes first recognized
during pregnancy and treated with in-sulin (G-2) are at high risk
of developing HCM. The Resolution of HCM to normality was confirmed
during 12 mon-ths. Pediatr. Endocrinol. 8/2009;4(29):35-44.
Cel pracy. Kardiomiopatia przerostowa częściej występuje u
noworodków matek chorujących na cukrzycę. Celem pracy była ocena
zmian echokardiograficznych u noworodków matek chorujących na
cukrzycę a także ustalenia dyna-miki ustępowania zmian w trakcie
12-miesięcznej obserwacji oraz ocena korelacji między zmianami
występującymi w sercu a poziomem insuliny, fruktozaminy i glukozy u
noworodka w momencie urodzenia. Materiał i metody. Pro-spektywnymi
badaniami echokardiograficznymi od urodzenia do 12 miesiąca życia
objęto 74 noworodki: 44 nowo-rodki matek chorujących na cukrzycę
(IDM) i 30 noworodków matek zdrowych. Grupę matek chorujących na
cukrzy-cę stanowiło: 7 noworodków matek z cukrzycą przedciążową
(PGDM) i 37 noworodków matek z cukrzycą ciężarnych (GDM), w tym 18
leczonych dietą (G1) i 19 leczonych insuliną (G2). 18,2% of IDM
stanowiły noworodki z cecha-mi makrosomii (LGA) a w grupie
kontrolnej wszystkie z wyjątkiem jednego były urodzone z masą ciała
odpowied-nią do wieku ciążowego. U noworodków matek cukrzycowych
poziom insuliny i fruktozaminy był oznaczony z krwi pępowinowej a
poziom glukozy z krwi włośniczkowej. Wyniki. Poziom insuliny we
krwi pępowinowej był istotnie statystycznie wyższy w grupie
noworodków matek z cukrzycą przedciążową (p < 0,01) w porównaniu
z grupą nowo-rodków matek z cukrzycą rozpoznaną w trakcie ciąży
(G-1 and G-2). W grupie G-2 stwierdzono istotną statystycznie
korelację między poziomem insuliny we krwi pępowinowej a prędkością
przepływu przez zastawkę mitralną (MV). Średni wymiar przegrody
międzykomorowej IVS był istotnie statystycznie wyższy w grupie
noworodków matek cu-krzycowych, szczególnie w grupie G2. U 38,6%
noworodków matek cukrzycowych stwierdzono przerost przegro-dy
międzykomorowej. Stosunek wymiaru przegrody międzykomorowej do
tylnej ściany lewej komory (IVS/LVPW) w grupie kontrolnej wynosiło
1,03 ± 0,14 a w grupie noworodków matek chorujących na cukrzycę
było istotnie staty-stycznie wyższe (p < 0,001) i wynosiło –
1,32 ± 0,52. Podczas 12-miesięcznej obserwacji zmiany ustąpiły.
Wnioski. Noworodki matek chorujących na cukrzycę rozpoznaną po raz
pierwszy w trakcie ciąży i leczonych insuliną znajdują się w grupie
zwiększonego ryzyka występowania kardiomiopatii przerostowej,
zmiany w sercu miały charakter przej-ściowy i ustąpiły podczas
pierwszego roku życia. Endokrynol. Ped. 8/2009;4(29):35-44.
Introduction
The term cardiomyopathy refers to a variety of myocardial
abnormalities. Among them, hypertrophic cardiomyopathy observed in
infants born to diabetic mothers was described [1–4]. This
asymmetric septal enlargement with disproportional hypertrophy
septum is an anabolic result of fetal hyperinsulinemia caused by
maternal hyperglycemia during the third trimester [5–7]. In the
patients with HCM the M-mode echocardiography shows hypertrophy of
the left ventricle (LV), usually with much more striking
involvement of the ventricular septum (IVS). That may result in
dynamic and clinically significant left ventricular outflow
obstruction. It was described that in IDM, the ratio of the
ventricular septal thickness to the left ventricular posterior wall
thickness in diastole (IVS/LVPW ratio) greatly exceeds the upper
limit of normality, which means the value of 1.3 [1, 6, 7].
Left-ventricular end-diastolic dimension is normal or decreased and
shortening fraction (SF%) is normal or supranormal [5, 7]. The
severity of cardiomyopathy can vary from an incidental finding on
echocardiography to an infant with severe symptoms of congestive
heart failure. All symptoms
spontaneously regress within a few weeks. The resolution of
septal hypertrophy occurred during the first two to twelve months
of life [5].
It is believed that careful management of diabe-tes with a well
glycemic control during pregnancy may reduce the severity of
hypertrophic cardiomy-opathy [6–12]. It was also noticed that
cardiac sep-tum hypertrophy in IDM correlates with high le-vels of
fetal insulin better than with macrosomia [13, 7].
The aim of this study was to analyze the relation-ship between
morphological heart parameters and cardiac function assessed during
echocardiography examination in infants of diabetic mothers, cord
blo-od insulin, and fructosamine concentration at birth as well as
to follow the natural history of echocardio-graphic findings during
the first year of life.
Material
The total of 74 infants (30 of healthy mothers and 44 infants
born to diabetic mothers) were pro-spectively evaluated in the
study. The diabetic gro-up covered 7 infants born to
insulin-dependent PGDM, and 37 born to GDM.
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Dawid G. i inni: Infants of Diabetic Monthers: Morphological
Heart Parameters, Cord Blood Insulin, Glucose Concentration at
Birth and Echocardiographic...
Gestational diabetes mellitus was recognized on the basis of
oral glucose tolerance test (OGTT) per-formed between 24–28 week of
pregnancy with load of 75 g glucose. In 18 pregnant women diabetes
was treated only with diet and classified as G-1; in 19 others
treated with insulin it was classified as G-2.
Gestational age was in the range between 35 to 40 week of
pregnancy in the diabetic group and be-tween 30 to 41 in the
control group. However, the rate of pre-term deliveries in the
diabetic group (43.3%) was significantly higher (p < 0.01) than
in the control one (20.4%).
Birth weight was in the range from 1950 g to 4450 g in the
diabetic group, and between 1000 g to 4300 g in control subjects.
The Comparison of the birth weight between the diabetic and control
group is shown in Figure 1. The mean birth weight in the diabetic
groups was significantly higher than
in the control group. Furthermore, macrosomia de-fined by a
birth weight above the 90th percentile was recognized in 9
neonates. In the diabetic group 8 (18.2%) out of 44 IDM were born
as large for gesta-tional age (LGA), and 35 as appropriate for
gesta-tional age (AGA). In the control group all but one neonates
were born as appropriate for gestational age (AGA).
Methods
In offsprings of diabetic mothers venous cord blood samples were
collected at the delivery and analyzed for insulin and fructosamine
level; next, one hour after delivery glucose level was measured in
capillary blood. Fructosamine and insulin levels served as indirect
markers of maternal glycemic control during the last days before
delivery.
Fig. 1. The Comparison of the birth weight [g] in the analyzed
groupsRyc. 1. Porównanie masy urodzeniowej ciała (g) w
analizowanych grupach
birth weigh: ANOVA Kruskal-Wallis H(3, n = 72) = 13.55, p =
0.004;F(3.68) = 5.91, p = 0.001
(a)" tBF(45) = −4.42, p = 0.00006;UMW = 100 (Z = −3.52), p =
0.0004
(b)" tBF(45) = −2.25, p = 0.03;UMW = 166 (Z = −2.08), p =
0.04
(c) t(34) = 2.37, p = 0.02heteroscedasticity
11 2 F = 3.64, p = 0.007;Levene (45) = 8.11, p =
0.007;Brown-Forsyth(45) = 7.03, p = 0.01
11 3 F = 2.60 p = 0.04
[g]
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Dawid G. i inni: Infants of Diabetic Monthers: Morphological
Heart Parameters, Cord Blood Insulin, Glucose Concentration at
Birth and Echocardiographic...
Electrochemiluminescency method “Eclia” ana-lyzer Cobas 6000
Roches Company was used to measure insuline levels. Colorimetric
method Inte-gra 400 analyzer was used for the determination of
fructosamine level and enzymatic method based on hexokinase with
Cobas 6000 Roches Company was used for glucose levels.
Echocardiography was performed in all patients over the period
of one year; first measurements were done at the age of the first
48 hours of life and next at every 2–4 months up to 12 months of
life. The values obtained after the delivery and at the age of 12
months were compared between diabetic and control group, and
analyzed statistically.
Echocardiography measurements were done according to the
recommendations of The American Society of Echocardiography.
Morphological para-meters were determined using M-mode
echo-cardiography, and two-dimensional and Doppler techniques were
used to diagnose congenital heart disease [14]. Echocardiography
was performed with the patient at rest in the partial left
decubitus position utilizing standard parasternal, short axis and
apical views. M-mode echocardiographic view of the left ventricular
cavity was recorded under two-dimensional control. Measurements or
calculation of the following parameters: end diastolic dimension of
interventricular septal thickness (IVSd), left ventricular
posterior wall thickness (LVPW), left ventricular end diastolic
dimension (LVDd), left ventricular end systolic dimension (LVDs),
left atrium diastolic dimension (LAD), aortic diameter on the level
of aortic valve (vAo) were carried out. In addition, blood flow
through mitral valve (MV), tricuspid valve (TV), aortic valve (Ao),
pulmonary artery valve (PA) was measured. All measurements were
done according to the recommendations of The American Society of
Echocardiography [15, 16]. Fractional shortening (SF%) was also
calculated according to the rule [16, 17]:
The Data were analyzed using Statistica 6.0 com-puter software.
The Shapiro–Wilk test was used to assess distribution normality for
each variable. The Data were compared between groups using ANOVA
procedures and Mann–Withney U-test. Depending on the normality the
data were expressed as mean ± standard deviation or median and
ranges (mini-mum, maximum). Moreover, to compareg the fre-quency
between the analyzed groups, χ2 and Yates χ2 were used. P values
less than 0.05 were conside-red significant.
Results
The values of insulin, fructosamine and glucose level evaluated
at birth are presented in Table 1.
Cord blood insulin (Ic) level was significantly higher in PGDM
(p < 0.01) than in both GDM gro-up (G-1 and G-2) (Fig. 2). A
tendency to positive association between LVDd and Ic levels was
noti-ced, however the relationship did not reach a signi-ficant
level (p < 0.08). No significant correlation be-tween Ic levels
and IVS, IVS/LVPW ratio, and SF% was observed.
Cord blood fructosamine levels did not differ si-gnificantly
between the diabetic groups (Table 1). In the G-2 group a
significant positive association was found between Ic level and
LAD, and blood flow through mitral valve (MV). Yet, any
signifi-cant correlation between cord blood fructosamine levels and
IVS, and IVS/LVPW ratio, and SF% was not found. Similarly, no
significant correlations be-tween cord blood fructosamine levels
and IVS, and IVS/LVPW ratio and SF% were found.
There was no significant difference of glycemia levels between
the diabetic groups and in all groups glycemia levels were in a
normal range (Table 1).
During echocardiography examinations some anatomic abnormalities
were found in 11 newborns. 8 heart abnormalities were recognized in
IDM and 3 in control subjects. In the diabetic group, 4 cases of
ventricular septum defect (VSD) were recogni-zed. Furthermore, one
newborn had an atrio-ven-tricular septum defect and 3 others
displayed atrial septum defect (ASD). In the control group 2, VSD
and 1 ASD were noticed. During one year of echo-cardiography and
cardiology observation, none of the examined IDM needed
pharmacology or surgi-cal treatment.
The echocardiographic results found in diabetic group are
compared with normal values obtained in matched age and birth
weight newborns from the
LVDd – LVDsLVDd( (x 100%
Furthermore, the ratio of the left ventricular septal thickness
to the left ventricular posterior wall thickness in diastole
(IVS/LVPW ratio) was calculated. Echocardiography examination was
per-formed using HDI Phillips model with either a 3.5 or 5.0 mHz
transducer. All echocardiographic measurements were carried out by
the same observer (G. David).
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Dawid G. i inni: Infants of Diabetic Monthers: Morphological
Heart Parameters, Cord Blood Insulin, Glucose Concentration at
Birth and Echocardiographic...
insulin: ANOVA Kruskal-Wallis H(2, n = 36) = 9.68, p =
0.008;(a)"UMW = 1.00 (Z = −3.22), p = 0.001(b)"UMW = 9.00 (Z =
−2.49), p = 0.001
Fig. 2. The Comparison of the cord blood insulin levels [µU/ml]
between the analyzed groups of neonates from diabetic mothersRyc.
2. Porównanie poziomu insuliny we krwi pępowinowej [µU/ml] w
analizowanych grupach noworodków matek chorujących na cukrzycę
Table 1. Cord blood insulin, fructosamine and newborns’ glycemia
in the analyzed groups of infants of diabetic mothersTabela 1.
Poziom insuliny, fruktozaminy we krwi pępowinowej i glikemia
noworodkowa w analizowanych grupach noworod-ków matek chorujących
na cukrzycę
G1 G2 PGDM
N
Mea
n±
SD
Med
ian±
qua
rtile
rang
e
Min
imum
Max
imum
N
Mea
n±
SD
Med
ian±
qua
rtile
rang
e
Min
imum
Max
imum
N
Mea
n±
SD
Med
ian±
qua
rtile
rang
e
Min
imum
Max
imum
Fructosamine/Fruktozamina [µmol/L]
11207.15 204.00 183.00
12197.30 203.25 144.00
5213.00 222.00 181.00
22.69 16.00 261.00 29.63 24.68 243.00 29.25 19.50
251.00Glycemia/Glikemia [mg%]
1659.19 54.00 42.00
1756.35 59.00 38.00
661.17 60.50 51.00
18.82 2.50 122.00 10.42 6.00 75.00 9.66 7.50
76.00Insulin/Insulina [µU/ml]
164.03 4.05 0.20
159.71 3.60 0.30
527.22 15.00 7.60
2.65 1.73 10.80 5.70 9.05 72.00 21.02 14.60 55.50
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Dawid G. i inni: Infants of Diabetic Monthers: Morphological
Heart Parameters, Cord Blood Insulin, Glucose Concentration at
Birth and Echocardiographic...
control group in the first 48 hours of life. Interven-tricular
septum (IVS) diameter was significantly hi-gher (p < 0.01) in
diabetic, especially in G-2 group, than in control newborns (Figure
3). In the group of neonates born to diabetic mothers, in 17 out of
44 evaluated cases, the enlargement of the ventricular septum was
noticed. In 15 out of 17 cases, asymme-trical septal hypertrophy
was observed, and in two cases symmetrical hypertrophy was noticed.
Thick-ness of the ventricular septum was found in the nor-mal range
in all newborns from the control group.
During the study the ratio of the ventricular septum thickness
to the left ventricular posterior wall thickness in diastole
(IVSd/LVPW) was calculated. In the control group the ratio of
IVSd/LVPW was 1.03 ± 0.14, while in newborns of diabetic mothers
the ratio was significantly (p < 0.001) higher 1.32 ± 0.52. The
highest ratio of IVS/LVPW was found in the G-2 group (Figure 4).
The Analysis of
IVS: ANOVA Kruskal-Wallis H(3, n = 70) = 8.76, p = 0.03;F(3.66)
= 3.82, p = 0.01(a)"t(43) = −3.41, p = 0.001; UMW = 120 (Z =
−2.92), p = 0.004(b)"t(42) = −1.78, p = 0.08; heteroscedasticity41
1 F = 7.99, p = 0.0001; Levene (31) = 15.49, p = 0.0004;
Brown-Forsyth(31) = 9.83, p = 0.00441 2 F = 4.47 p = 0.01 Levene
(23) = 6.35, p = 0.02;41 3 F = 4.71, p = 0.001; Levene (24) = 7.04,
p = 0.01; Brown-Forsyth(24) = 4.25, p = 0.05
Fig. 3. Comparison of the IVS [mm] diameter between the analyzed
groupsRyc. 3. Porównanie średniego wymiaru IVS [mm] w analizowanych
grupach
variance indicates significant differences of the ratio of
IVSd/LVPW between all groups.
The results of echocardiographic evaluation performed after 12
months of age are presented in Table 3. In contrast to on early
postnatal period, the IVS thickness in diabetic group did not
differ significantly at that time, in comparison to control
subjects. Furthermore, during one–year observation the ratio of
IVS/LVPW significantly decreased for about 0.17 and reached normal
values of – 1.13 in comparison to neonatal period.
Discussion
The risk of congenital anomalies is increased in in-fants of
diabetic mothers with an over-representation of congenital heart
defects. Cardiac abnormalities occur in approximately 2.5% – 4.0%
of babies born to mothers with insulin-dependent pregestational
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Dawid G. i inni: Infants of Diabetic Monthers: Morphological
Heart Parameters, Cord Blood Insulin, Glucose Concentration at
Birth and Echocardiographic...
diabetes mellitus [18, 19]. That fact was also con-firmed in our
study, although most of IDM were born to GDM mothers. It may prove
the some cases of GDM were recognized too late. Ventricular and
atrial septal defect were the most frequent cardiac anomalies
recognized in our neonates.
Most of the examined infants born to diabetic mothers were not
large for gestational age. Thesefindings suggest that their mothers
were probably well controlled during pregnancy and their infants
did not experience maternal hyperglycemia or fe-tal
hyperinsulinemia late in gestation. On the other hand, cord blood
hyperinsulinemia, especially in neonates born to insulin treated
mothers (PGDM and G-2 group), was detected during our study. It is
a generally accepted opinion that newborns of dia-betic mothers are
at high risk of hypoglycemia due to transient hyperinsulinemia in a
few days after de-livery [18]. However, despite increasing levels
of cord blood insulin, hypoglycemia in the examined neonates was
not detected.
Infants of diabetic mothers are ata high risk of developing
hypertrophic cardiomyopathy. The hy-pertrophy occurs primarily in
the interventricu-lar septum but can affect any portion of the
ven-tricular walls [7, 8]. Features of IVS hypertrophywere found in
17 out of 44 examined by us neona-tes born to diabetic mothers.
Most of the neonateswith HCM were born by GDM mothers, especial-ly
from G-2 group. Newborns from the last group had significantly
higher IVS diameters and valu-es of IVS/LVPW ratio compare to
control subjects. These findings indicate that unrecognized
mater-nal diabetes onset before 24–28 weeks of pregnan-cy (time of
OGTT) may be responsible for develo-ping HCM. Furthermore our
findings indicate that good metabolic control of gestational
diabetes from recognition until delivery is not sufficient to
norma-lize some cardiac diameter size, e.g. IVS enlarge-ment. Next
few months out of maternal hyperglyce-mic environment are reguired
to achieve there solu-tion of HCM feature.
IVS/LVPW: ANOVA Kruskal-Wallis H(3, n = 68) = 10.27, p =
0.02;(a)"UMW = 96.5 (Z = −3.28), p = 0.001(b)"UMW = 97.5 (Z =
−1.83), p = 0.07;
Fig. 4. The Comparison of the IVS/LVPW ratio between the
analyzed groupsRyc. 4. Porównanie stosunku przegrody
międzykomorowej do tylnej ściany lewej komory w analizowanych
grupach
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Dawid G. i inni: Infants of Diabetic Monthers: Morphological
Heart Parameters, Cord Blood Insulin, Glucose Concentration at
Birth and Echocardiographic...
Waldman and co-workers [1] described that HCM is the most common
cardiac abnormality seen in IDM. This is thought to be related to
high insu-lin levels in the fetus, an increased number of insu-lin
receptors in the fetal heart, and increased pro-tein and fat
synthesis resulting in myocardial cell hyperplasia and hypertrophy
as well as glycogen deposition [6, 8]. Cooper et al. [20] found a
strict correlation between the appearance and degree of HCM with
metabolic control during the third tri-mester. Conversedy, Rizzo et
al. [13] found an ac-celerated increase in the cardiac size in
fetuses of diabetic mothers, in spite of a careful metabolic
control. We did not detect any significant correlation between cord
blood fructosamine level, IVSd dia-meter, LVPW diameter and
IVS/LVPW ratio either. Also, We did not found any significant
correlation between cord blood insulin levels, and IVSd diame-ter,
LVPW diameter as well as IVS/LVPW ratio. On the other hand, the
observed levels of fructosami-ne and the lack of hypoglycemia in
the examined newborns allows to assume that maternal diabetes was
well controlled during the last days before deli-very. However,
cord blood insulin levels in exami-ned IDM were increased,
especially in PGDM and G-2 groups. In the last group a positive
correlation between cord blood insulin and LAD, and between LADd
blood flow through MV and abdominal aorta was found. Furthermore,
all but LADd relationship were statistically significant. That
allows assuming that hyperinsulinemia may lead to the enlargement
of left heart size and function. Waldman [1] repor-ted that in IDM
with HCM, Doppler may show high velocity from the left ventricle
into the aorta and co-lour flow Doppler often reveals
turbulence.
According to the data described by Waldman [1],left ventricular
shortening fraction may be normal or increased in infants with HCM.
A tendency to a positive correlation between SF% and cord blo-od
fructosamine and insulin levels in neonates from G-2 group was
observed in our study. However, the values of correlation
coefficient have not reached si-gnificant levels. It is not
possible to compare our re-sults with other authors’ findings
because up to now such relationship has not been analyzed.
In our study, the ratio of IVSd/LVPW evaluated in neonates born
to diabetic mothers during the first
48 hours was found to be significantly higher, espe-cially in
G-2 group, in comparison to control sub-jects. As it is described
in literature, macrosomic infants of diabetic mothers may face
circulatory fa-ilure due to hypertrophic cardiomyopathy. Howe-ver,
the observed HCM was generally mild and did not affect cardiac
function.
The significant difference of the IVSd/LVPW ratio between
diabetic and control patients detec-ted at birth was not
demonstrated after 12 months of age. This means that features of
HCM disappe-ared without any treatment during the first months of
life. Our results confirmed findings concerning infants born to
insulin-dependent diabetes mothers by Akcoral et al. [5], and
Waldman et al. [1]. It is generally believed that PGDM is a main
risk factor for developing fetal macrosomia and hypertrophic
cardiomyopathy [6, 7, 20, 21]. Our results show ho-wever that the
highest risk for both these abnormali-ties is present in neonates
born to mothers with dia-betes first recognized during pregnancy,
especially type G-2.
According to the excess of frequency of gesta-tional diabetes
[22, 23], diabetes-related obstetrical complications as well as
problems in IDM will in-crease in next generations.
Conclusions
1. Infants born to mothers with diabetes first recognized during
pregnancy and treated with insulin (G-2) are at a high risk of
developing hypetrophic cardiomyopathy.
2. Cord blood insulin and fructosamine levels present no
significant association with IVS and IVS/LVPW ratio in infants of
diabetic mothers.
3. Fetal hyperinsulinemia may lead to the increased left heart
diastolic diameter and to the increased blood flow through mitral
valve, and abdominal aorta in neonates born to gestational diabetic
mothers treated with insulin.
4. Resolution to normality of echocardiographic findings noticed
in the newborns born to diabetic mothers (HCM) was confirmed during
12-month echocardiography observation.
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42
Praca oryginalne Endokrynol. Ped., 8/2009;4(29):35-44
43
Dawid G. i inni: Infants of Diabetic Monthers: Morphological
Heart Parameters, Cord Blood Insulin, Glucose Concentration at
Birth and Echocardiographic...
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