Cardiac Function in Infants Born to Mothers With Gestational Diabetes - Estimation of Early Diastolic Intraventricular Pressure Differences

Abstract

Background: This study compared the myocardial performance of infants born to mothers with gestational diabetes mellitus (IGDM) and without GDM (controls) under the new GDM definitions. Methods and Results: The subjects consisted of 36 IGDM and 39 control infants. GDM diagnosis was based on oral glucose tolerance test during pregnancy or the presence of diabetes prior to the current pregnancy. Between-group infant cardiac function was determined and compared using 2-D speckle tracking analysis, intraventricular pressure difference (IVPD) and IVP gradient (IVPG), using color M-mode Doppler imaging. IVPD and IVPG were higher in IGDM than in the controls, particularly the mid-apical IVPG. The global circumferential strain (GCS) and endocardial GCS were higher in IGDM than in controls. Increased maternal glycated hemoglobin was correlated with reduced transmural and epicardial GCS in the IGDM. Maternal maximum fasting blood sugar had a mild, positive correlation with IVPD and IVPG. Conclusions: Ventricular sucking force, measured as the IVPD, IVPG, and endocardial GCS, were higher in IGDM than in the controls. A hyperglycemic environment during pregnancy leads to impaired cardiac performance in IGDM, compared with control infants. IGDM might have favorable systolic and diastolic cardiac performance due to cardiac metabolic adaptations occurring before poor glucose control causes impaired cardiac performance.

Keywords: Color M-mode Doppler imaging; Diabetic cardiomyopathy; Infant with gestational diabetes mother; Intraventricular pressure difference.

Figure 1.

Study design and subject selection. DM, diabetes mellitus; GDM, gestational diabetes; IGDM, infants born to mothers with gestational diabetes; OGTT, oral glucose tolerance test.

Figure 2.

Estimation of early diastolic intraventricular pressure difference (IVPD). (A) Three-dimensional temporal and spatial profiles of IVPD. (B) Temporal profile at peak total IVPD and mid-apical IVPD. (C) IVPD spatial profile at peak IVPD, at the MV level. The basal and mid-apical IVPD segments were calculated based on the left ventricle segmentation rule of one-third for basal and two-thirds for mid-apical. AoV, aortic valve; MV, mitral valve.

Figure 3.

Correlation between maternal glycated hemoglobin (HbA1c) and infant myocardial performance. Maternal HbA1c correlated positively with (A) transmural global circumferential strain (GCS), (B) epicardial GCS, and (C) endo/epi GCS ratio at base levels but not with the endocardial GCS (r=0.182). (D) HbA1 is negatively correlated with endocardial/epicardial GCS ratio at the apex level.