Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2024

Open Access 01-12-2024 | Diabetes | Research

Changes in the shape and function of the fetal heart of pre- and gestational diabetes mothers

Authors: Shuang Li, Linlin Wang, Huixia Yang, Lixin Fan

Published in: BMC Pregnancy and Childbirth | Issue 1/2024

Login to get access

Abstract

Background

Hyperglycemia during pregnancy can affect fetal heart in many ways, including causing cardiac malformation, leading to hypertrophic cardiomyopathy and cardiac dysfunction. Echocardiographic evaluation can assist identify alterations in heart structure, morphology and function, enabling prompt monitoring and management. However, according to earlier research, the cardiac alterations are modest in hyperglycemic mothers’ fetuses, and might not be detectable using conventional methods and it is also unclear whether these changes are related to the metabolism of mothers. Fetal Heart Quantification (Fetal HQ) can assess ventricular geometry and function more sensitively and thoroughly, and identify sub-clinical cardiac dysfunction. The purpose of this study was to evaluate fetal heart by Fetal HQ in fetuses of hyperglycemic mothers who either had pre-gestational or gestational diabetes and to correlate them with maternal metabolic indices.

Methods

The fetuses of 25 gestational age-matched control mothers, 48 women with gestational diabetes mellitus (GDM), and 11 women with diabetes mellitus (DM) were included in the prospective case-control research. Using fetal echocardiography and speckle tracking echocardiography (STE), the heart of the fetus was evaluated. Differences in the groups’ anthropometric, metabolic, and cardiac parameters were examined. It was assessed whether maternal features, prenatal glucose, lipids, and maternal hemoglobin A1c (HbA1c) correlated with fetal cardiac parameters.

Results

The LV EDV and ESV were significantly higher in the GDM group as compared to the DM group (p < 0.05). The GSI% was significantly lower in the GDM group compared with the control (p < 0.05). The LV SV and CO of the GDM group were both significantly higher compared with the DM group (p < 0.05). There was a significant decrease in RV FS for segments 1–7 in GDM fetuses compared to the control (p < 0.05) and for segments 5–10 compared to DM (p < 0.05). Fetal cardiac morphology and function indices correlate with maternal pregestational weight, BMI, early pregnancy fast glucose, lipids, and glycemic control levels.

Conclusions

Fetuses exposed to gestational diabetes have altered heart morphology and function that is linked to maternal metabolic parameters, which presents a special indication for performing geometry and function cardiac assessment. Fetal HQ can be employed to evaluate the fetal cardiac shape and function in fetuses exposed to gestational diabetes.
Literature
1.
Bogo MA, Pabis JS, Bonchoski AB, Santos DCD, Pinto TJF, Simões MA, Silva JC, Pabis FC. Cardiomyopathy and cardiac function in fetuses and newborns of diabetic mothers. J Pediatr (Rio J). 2021;97(5):520–4.CrossRefPubMed
2.
Pooransari P, Mehrabi S, Mirzamoradi M, Salehgargari S, Afrakhteh M. Comparison of parameters of fetal doppler echocardiography between mothers with and without diabetes. Int J Endocrinol Metab. 2022;20(4):e117524.CrossRefPubMedPubMedCentral
3.
Huang P, Deng Y, Feng L, Gao Y, Cheng X, Liu H. Evaluation of fetal cardiac function in maternal gestational diabetes mellitus by speckle-tracking echocardiography. J Ultrasound Med. 2023;42(1):81–9.CrossRefPubMed
4.
Gireadă R, Socolov D, Mihălceanu E, Lazăr IT, Luca A, Matasariu R, Ursache A, Bujor I, Gireadă T, Boiculese VL et al. Evaluation of fetal cardiac geometry and contractility in gestational diabetes mellitus by two-dimensional speckle-tracking technology. Diagnostics (Basel) 2022, 12(9).
5.
Chen Y, Chen Q, Wu Y, Wang H, Fan Q, Lei W, Zhang R, Liang Y, Wang H. Fetal cardiac geometry and function in pregnancies with well-controlled gestational diabetes mellitus using fetal HQ. J Matern Fetal Neonatal Med. 2022;35(25):8331–7.CrossRefPubMed
6.
Miranda JO, Cerqueira RJ, Ramalho C, Areias JC, Henriques-Coelho T. Fetal cardiac function in maternal diabetes: a conventional and speckle-tracking echocardiographic study. J Am Soc Echocardiogr. 2018;31(3):333–41.CrossRefPubMed
7.
8.
Tocantins C, Diniz MS, Grilo LF, Pereira SP. The birth of cardiac disease: mechanisms linking gestational diabetes mellitus and early onset of cardiovascular disease in offspring. WIREs Mech Dis. 2022;14(4):e1555.CrossRefPubMed
9.
Leybovitz-Haleluya N, Wainstock T, Landau D, Sheiner E. Maternal gestational diabetes mellitus and the risk of subsequent pediatric cardiovascular diseases of the offspring: a population-based cohort study with up to 18 years of follow up. Acta Diabetol. 2018;55(10):1037–42.CrossRefPubMed
10.
Mrudhula Tejaswi G, Samanth J, Vasudeva A, Lewis L, Kumar P, Nayak K, Padmakumar R. Fetal echocardiography at term in diabetic pregnancies helps predict the adverse neonatal outcome - results of a prospective observational study from South India. Indian Heart J. 2020;72(6):576–81.CrossRefPubMedPubMedCentral
11.
Peixoto AB, Bravo-Valenzuela NJM, Martins WP, Słodki M, Mattar R, Moron AF, Araujo Júnior E. Impact of type I and type II maternal diabetes mellitus on fetal cardiac function assessment parameters using spectral and tissue Doppler. Int J Cardiovasc Imaging. 2020;36(7):1237–47.CrossRefPubMed
12.
Depla AL, De Wit L, Steenhuis TJ, Slieker MG, Voormolen DN, Scheffer PG, De Heus R, Van Rijn BB, Bekker MN. Effect of maternal diabetes on fetal heart function on echocardiography: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2021;57(4):539–50.CrossRefPubMedPubMedCentral
13.
DeVore GR, Klas B, Satou G, Sklansky M. Quantitative evaluation of fetal right and left ventricular fractional area change using speckle-tracking technology. Ultrasound Obstet Gynecol. 2019;53(2):219–28.CrossRefPubMed
14.
Nogué L, Gómez O, Izquierdo N, Mula C, Masoller N, Martínez JM, Gratacós E, Devore G, Crispi F, Bennasar M. Feasibility of 4D-Spatio temporal image correlation (STIC) in the Comprehensive Assessment of the fetal heart using FetalHQ(®). J Clin Med 2022, 11(5).
15.
Huntley ES, Hernandez-Andrade E, Soto E, DeVore G, Sibai BM. Novel Speckle Tracking Analysis showed excellent reproducibility for size and shape of the fetal heart and good reproducibility for strain and fractional shortening. Fetal Diagn Ther. 2021;48(7):541–50.CrossRefPubMed
16.
Obstetrics Science Group of Obstetrics and Gynecology Branch of Chinese Medical Association PMBoCMA, Pregnancy Combined with Diabetes Professional Committee of China Maternal and Child Health Care Association. Guidelines for diagnosis and treatment of hyperglycaemia in pregnancy (2022)[Part I]. Chin J Obstet Gynecol. 2022;57(1):3–12.
17.
DeVore GR, Polanco B, Satou G, Sklansky M. Two-dimensional speckle tracking of the fetal heart: a practical step-by-step approach for the fetal sonologist. J Ultrasound Med. 2016;35(8):1765–81.CrossRefPubMed
18.
DeVore GR. Computing the Z score and centiles for cross-sectional analysis: a practical approach. J Ultrasound Med. 2017;36(3):459–73.CrossRefPubMed
19.
DeVore GR, Klas B, Satou G, Sklansky M. 24-segment sphericity index: a new technique to evaluate fetal cardiac diastolic shape. Ultrasound Obstet Gynecol. 2018;51(5):650–8.CrossRefPubMed
20.
DeVore GR, Klas B, Satou G, Sklansky M. Twenty-four segment transverse ventricular fractional shortening: a new technique to evaluate fetal cardiac function. J Ultrasound Med. 2018;37(5):1129–41.CrossRefPubMed
21.
Poon LC, McIntyre HD, Hyett JA, da Fonseca EB, Hod M. The first-trimester of pregnancy - A window of opportunity for prediction and prevention of pregnancy complications and future life. Diabetes Res Clin Pract. 2018;145:20–30.CrossRefPubMed
22.
Yu Y, Arah OA, Liew Z, Cnattingius S, Olsen J, Sørensen HT, Qin G, Li J. Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up. BMJ. 2019;367:l6398.CrossRefPubMedPubMedCentral
23.
Aguilera J, Semmler J, Coronel C, Georgiopoulos G, Simpson J, Nicolaides KH, Charakida M. Paired maternal and fetal cardiac functional measurements in women with gestational diabetes mellitus at 35–36 weeks’ gestation. Am J Obstet Gynecol. 2020;223(4):574e571–574e515.CrossRef
24.
Popescu MR, Bouariu A, Ciobanu AM, Gică N, Panaitescu AM. Pregnancy complications lead to subclinical maternal heart dysfunction-the importance and benefits of follow-Up using speckle tracking echocardiography. Med (Kaunas) 2022, 58(2).
25.
Yovera L, Zaharia M, Jachymski T, Velicu-Scraba O, Coronel C, de Paco Matallana C, Georgiopoulos G, Nicolaides KH, Charakida M. Impact of gestational diabetes mellitus on fetal cardiac morphology and function: cohort comparison of second- and third-trimester fetuses. Ultrasound Obstet Gynecol. 2021;57(4):607–13.CrossRefPubMed
26.
Wang D, Liu C, Liu X, Zhang Y, Wang Y. Evaluation of prenatal changes in fetal cardiac morphology and function in maternal diabetes mellitus using a novel fetal speckle-tracking analysis: a prospective cohort study. Cardiovasc Ultrasound. 2021;19(1):25.CrossRefPubMedPubMedCentral
27.
Song Y, Yin H, Wang W, Zou YF, Liu DQ, Zhang G, Ji XP. Evaluation of fetal cardiac functions in the setting of maternal diabetes: application of the global spherical index, global strain and fractional area change by the speckle tracking technique. Eur J Obstet Gynecol Reprod Biol. 2021;264:162–7.CrossRefPubMed
28.
Patey O, Carvalho JS, Thilaganathan B. Perinatal changes in fetal cardiac geometry and function in diabetic pregnancy at term. Ultrasound Obstet Gynecol. 2019;54(5):634–42.CrossRefPubMed
29.
Kulkarni A, Li L, Craft M, Nanda M, Lorenzo J, Danford D, Kutty S. Fetal myocardial deformation in maternal diabetes mellitus and obesity. Ultrasound Obstet Gynecol. 2017;49(5):630–6.CrossRefPubMed
30.
Li W, Li Z, Liu W, Zhao P, Che G, Wang X, Di Z, Tian J, Sun L, Wang Z. Two-dimensional speckle tracking echocardiography in assessing the subclinical myocardial dysfunction in patients with gestational diabetes mellitus. Cardiovasc Ultrasound. 2022;20(1):21.CrossRefPubMedPubMedCentral
31.
Cade WT, Levy PT, Tinius RA, Patel MD, Choudhry S, Holland MR, Singh GK, Cahill AG. Markers of maternal and infant metabolism are associated with ventricular dysfunction in infants of obese women with type 2 diabetes. Pediatr Res. 2017;82(5):768–75.CrossRefPubMedPubMedCentral
32.
Hufnagel A, Dearden L, Fernandez-Twinn DS, Ozanne SE. Programming of cardiometabolic health: the role of maternal and fetal hyperinsulinaemia. J Endocrinol. 2022;253(2):R47–r63.CrossRefPubMedPubMedCentral
33.
Lin X, Yang P, Reece EA, Yang P. Pregestational type 2 diabetes mellitus induces cardiac hypertrophy in the murine embryo through cardiac remodeling and fibrosis. Am J Obstet Gynecol 2017, 217(2):216.e211-216.e213.
34.
Seed M, van Amerom JF, Yoo SJ, Al Nafisi B, Grosse-Wortmann L, Jaeggi E, Jansz MS, Macgowan CK. Feasibility of quantification of the distribution of blood flow in the normal human fetal circulation using CMR: a cross-sectional study. J Cardiovasc Magn Reson. 2012;14(1):79.CrossRefPubMedPubMedCentral
35.
Sferruzzi-Perri AN, Lopez-Tello J, Napso T, Yong HEJ. Exploring the causes and consequences of maternal metabolic maladaptations during pregnancy: lessons from animal models. Placenta. 2020;98:43–51.CrossRefPubMedPubMedCentral
36.
Zhang J, Cao L, Tan Y, Zheng Y, Gui Y. N-acetylcysteine protects neonatal mice from ventricular hypertrophy induced by maternal obesity in a sex-specific manner. Biomed Pharmacother. 2021;133:110989.CrossRefPubMed
37.
Hosni A, El-Twab SA, Abdul-Hamid M, Prinsen E, AbdElgawad H, Abdel-Moneim A, Beemster GTS. Cinnamaldehyde mitigates placental vascular dysfunction of gestational diabetes and protects from the associated fetal hypoxia by modulating placental angiogenesis, metabolic activity and oxidative stress. Pharmacol Res. 2021;165:105426.CrossRefPubMed
38.
Drop MV, Möllers M, Hammer K, Oelmeier de Murcia K, Falkenberg MK, Braun J, Eveslage M, Köster HA, Klockenbusch W, Steinhard J, et al. Strain and dyssynchrony in fetuses with congenital heart disease compared to normal controls using speckle tracking echocardiography (STE). J Perinat Med. 2019;47(6):598–604.CrossRefPubMed
39.
DeVore GR, Haxel C, Satou G, Sklansky M, Pelka MJ, Jone PN, Cuneo BF. Improved detection of coarctation of the aorta using speckle-tracking analysis of fetal heart on last examination prior to delivery. Ultrasound Obstet Gynecol. 2021;57(2):282–91.CrossRefPubMed
40.
Semmler J, Garcia-Gonzalez C, Sanchez Sierra A, Gallardo Arozena M, Nicolaides KH, Charakida M. Fetal cardiac function at 35–37 weeks’ gestation in pregnancies that subsequently develop pre-eclampsia. Ultrasound Obstet Gynecol. 2021;57(3):417–22.CrossRefPubMed
41.
van Oostrum NHM, de Vet CM, Clur SB, van der Woude DAA, van den Heuvel ER, Oei SG, van Laar J. Fetal myocardial deformation measured with two-dimensional speckle-tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses. Ultrasound Obstet Gynecol. 2022;59(5):651–9.CrossRefPubMedPubMedCentral
Metadata
Title
Changes in the shape and function of the fetal heart of pre- and gestational diabetes mothers
Authors
Shuang Li
Linlin Wang
Huixia Yang
Lixin Fan
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2024
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-024-06262-z

Other articles of this Issue 1/2024

BMC Pregnancy and Childbirth 1/2024 Go to the issue

Case Report

A prenatal case misunderstood as specimen confusion: 46,XY/46,XY chimerism

Correction

Correction: Using complaints from obstetric care for improving women’s birth experiences – a cross sectional study

Research

Validity and reliability of the Turkish version of the transition of primiparas becoming mothers scale

Research

Breastfeeding self-efficacy in terms of sleep quality, perceived social support, depression and certain variables: a cross-sectional study of postpartum women in Turkey

Research

Analysis of risk factors of preeclampsia in pregnant women with chronic hypertension and its impact on pregnancy outcomes

Research

Pre-pregnancy body mass index and caesarean section in Andean women in Peru: a prospective cohort study