Consequences of gestational diabetes mellitus on neonatal cardiovascular health: MySweetHeart Cohort study

Abstract

Background: Hyperglycaemic disorders of pregnancy are associated with offspring cardiovascular alterations.

Methods: MySweetHeart cohort study aimed to assess the effect of maternal gestational diabetes (GDM) on offsprings' cardiovascular health. Newborns underwent clinical and echocardiographic examinations between 2016 and 2020.

Results: Compared to mothers without GDM (n = 141), mothers with GDM (n = 123) were more likely to have had GDM in previous pregnancies and had higher weight, BMI, blood glucose, and HbA1c. Newborns of both groups showed similar clinical characteristics. Echocardiography was performed on the 3rd (interquartile range, IQR, 2nd-4th) day of life in 101 offsprings of mothers without and 116 offsprings of mothers with GDM. Left ventricular (LV) mass was similar. Children born to mothers with GDM had a thicker posterior LV wall (z-score +0.15, IQR -0.38/0.62, versus +0.47, IQR -0.11/+1.1, p = 0.004), a smaller end-systolic (1.3 mL, IQR 1.0-1.5 mL, versus 1.4 mL, IQR 1.2-1.8 mL, p = 0.044) but a similar end-diastolic LV volume. They also had shorter tricuspid valve flow duration and aortic valve ejection time, lower tricuspid E-wave and pulmonary valve velocities.

Conclusions: Newborns of mothers with or without GDM had similar clinical characteristics and LV mass. However, some echocardiographic differences were detected, suggesting an altered myocardial physiology among infants of mothers with GDM.

Registration: ClinicalTrials.gov (NCT02872974).

Impact: Hyperglycaemic disorders of pregnancy are known to be associated with offspring cardiovascular alterations. Clinical characteristics and estimated left ventricular (LV) mass were similar in children issued from mothers with and without gestational diabetes (GDM). Children born to mothers with GDM had a thicker posterior LV wall and a smaller end-systolic LV volume. Although LV mass is not different, myocardial physiology may be altered in these infants. Further studies should investigate the endothelial function of this population and the cardiovascular evolution of these children over time.

Fig. 1. Box plots of the estimated left ventricular mass and mass index.

Box plots of the estimated left ventricular mass (LVM, a) for children born to mothers with and without gestational diabetes, as calculated by the Devereux formula. No significant difference between the two groups was detected. Similarly (b), no significant difference was detected while comparing the left ventricular mass index (LVMI), as calculated by the de Simone formula.

Fig. 2. Box plots of posterior left ventricular wall thickness (PWd).

The posterior left ventricular wall thickness (PWd) was similar in children born to mothers with (3.2, IQR 2.9–3.7 mm) or without (3.1, IQR 2.7–3.5 mm; p = 0.093) gestational diabetes when assessed as absolute dimension (a). However, it was slightly but significantly higher in children born to mothers with gestational diabetes (+0.47, IQR –0.11 to +1.1) than without (+0.15, IQR 0.38 to +0.62; p = 0.004) when normalized and assessed as z-scores (b).

Fig. 3. Box plots of left ventricular end-diastolic (LV-Vol td) and systolic (LV-Vol ts) volumes.

The left ventricular end-diastolic volume (LV-Vol td, a) was similar in children born to mothers with (4.0, IQR 3.4–4.8 mL) or without (4.4, IQR 3.5–5.3 mL, p = 0.113) gestational diabetes. However, the systolic left ventricular volume (LV-Vol ts, b) was slightly but significantly smaller in children born to mothers with gestational diabetes (1.3, IQR 1.0–1.5 mL) than without (1.4, IQR 1.2–1.8 mL; p = 0.044).