Impaired left ventricular diastolic function in newborn infants of mothers with pregestational or gestational diabetes with good glycemic control.
OBJECTIVE
We assessed by echocardiography the left ventricular systolic and diastolic function in newborn infants of mothers with well-controlled pregestational type 1 or gestational diabetes (IDM) in comparison to normal term neonates.


METHODS
Two-dimensional/M-mode and Doppler transmitral flow velocity measurements were performed in 18 IDM and 26 control infants of non-diabetic mothers (gestational ages 36-40 and 36-41 weeks, respectively) between days 2 and 5 after birth. In the IDM, there were nine mothers with pregestational (White class C or D) and nine mothers with gestational diabetes (White class A or A/B). Peak early and atrial filling velocity, early deceleration time, early acceleration time, early, atrial and total time velocity integrals were used to examine the left ventricular diastolic performance. We also calculated the early/atrial velocity ratio, early/atrial integral ratio and early/total integral ratio. The fractional shortening, fractional shortening area, midwall fractional shortening (mFS), left ventricular mass and indexed left ventricular mass for body surface area (BSA) and birth weight were used in assessment of left ventricular systolic performance.


RESULTS
The early deceleration time was longer, resulting in higher early integral and early filling fraction (EFF) in the IDM than in the control infants (p<0.01). In the IDM, the fractional shortening was somewhat greater and the left ventricular mass/body surface area ratio was higher than in the control group (p<0.05), although the measures of systolic performance were within the normal range. There were no significant differences in the systolic or diastolic function parameters between the gestational and pregestational groups.


CONCLUSIONS
In the infants of mothers with well-controlled pregestational or gestational diabetes, we found prolonged deceleration time of early left ventricular diastolic filling, probably reflecting an impaired left ventricular relaxation rather than compliance. The mechanism for the findings may be maternal hyperglycemia during the third trimester and subsequent fetal hyperinsulinaemia leading to neonatal cardiac hypertrophy.
Kozák-Bárány
Andrea
A
Department of Paediatrics, University of Turku, Vähä-Hämeenkatu 1A3, 20520 Turku, Finland. ankoba@utu.fi
Jokinen
Eero
E
Kero
Pentti
P
Tuominen
Juhani
J
Rönnemaa
Tapani
T
Välimäki
Ilkka
I
D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D002851:Chromatography, High Pressure Liquid; D048909:Diabetes Complications / Q000503:physiopathology*; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy; D016640:Diabetes, Gestational / Q000097:blood / Q000150:complications* / Q000628:therapy; D003971:Diastole; D004032:Diet; D004452:Echocardiography; D005260:Female; D005865:Gestational Age; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use; D011247:Pregnancy; D012016:Reference Values; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin