Fetal heart function among diabetic Vs non diabetic mothers . A novel experience.

Abstract

Background: Diabetes mellitus affects not only the structure of the fetal heart but also the function. The aim of this study was to evaluate the impact of Pregestational and gestational diabetes mellitus (DM) on fetal cardiac systolic and global function. Methods: 120 pregnant women between 28 and 36 + 6 weeks of gestation were assessed and divided into three groups: 40 Pregestational DM type II, 40 gestational DM and 40 non diabetics (controls). The right ventricle (RV), left ventricle (LV) systolic function and global function were assessed. The LV systolic function was assessed by the ejection fraction and the mitral annular plane systolic excursion (MAPSE) using M mode and the s’ wave by tissue Doppler. The RV systolic function was assessed by tricuspid annular plane systolic excursion (TAPSE) using M mode and the s’ wave by tissue Doppler. The global function was measured by Doppler using the myocardial performance index (MPI).Results: Fetuses of  Pregestational DM type II mothers showed significantly lower LV EF (67% Vs. 69 %, p =0.007), MAPSE(5.39mm Vs 7.02 mm, p<0.001) and lower both lateral and septal LV s’ (p=0.009, p = 0.038) than controls while fetuses of gestational DM mothers showed significantly lower EF (65 % Vs 69%, p<0.001), MAPSE (5.49mm Vs 7.02 mm, p<0.001) and lower septal LV s’ (5.05 mm Vs 5.70 mm ,p=0.003) than controls. Fetuses of both Pregestational and gestational DM mothers showed significantly lower RV TAPSE (p=0.033 and p<0.001). Fetuses of both Pregestational and gestational DM mothers showed significantly higher MPI than controls (p<0.001and p<0.001). Conclusion: Pregestational and gestational DM affect the fetal heart. M mode, Doppler and Tissue Doppler methods are useful to detect systolic and global cardiac dysfunction.

Keywords: Fetal cardiac systolic function, M- mode, tissue Doppler, s’ wave.