Troponin T and pro-B-type natriuretic Peptide in fetuses of type 1 diabetic mothers.
OBJECTIVE
Cardiomyopathy is noted in up to 40% of infants of diabetic mothers, and the exact mechanisms are unknown. The aim of this study was to determine whether fetal serum markers of cardiac function differ between normal and type 1 diabetic pregnancies and to examine the relationship between these markers and fetal cardiac structure and function.


METHODS
This was a prospective observational study of 45 type 1 diabetic pregnancies and 39 normal pregnancies. All participants had concentrations of fetal pro-B-type natriuretic peptide (proBNP) and troponin-T (TnT) measured at the time of delivery. All patients with type 1 diabetes had Doppler evaluation of the umbilical artery, middle cerebral artery, and ductus venosus in the third trimester, and a subset (n = 21) had detailed fetal echocardiograms performed in each trimester.


RESULTS
Fetal proBNP and TnT concentrations were higher in the diabetic cohort than in the normal cohort (P < 0.05). ProBNP correlated positively with interventricular septum thickness (P < 0.05) but not with cardiac function indexes in the third trimester. In patients with poor glycemic control, there was a significant positive correlation (P < 0.05) between fetal TnT and the third trimester umbilical artery pulsatility index. There were also increased levels of fetal TnT in infants with poor perinatal outcome (P < 0.05).


CONCLUSIONS
Biochemical markers of cardiac dysfunction are elevated in infants of diabetic mothers, especially those with cardiomyopathy or poor perinatal outcome. Hyperglycemia in early pregnancy may affect myocardial and placental development, thus contributing to the susceptibility to hypoxia seen in these infants.
Russell
Noirin E
NE
Obstetrics and Gynaecology, National Maternity Hospital, University College Dublin School of Medicine and Medical Science, Dublin, Ireland. noirinrussell@physicians.ie
Higgins
Mary F
MF
Amaruso
Michael
M
Foley
Michael
M
McAuliffe
F M
FM
D000328:Adult; D017668:Age of Onset; D001034:Apgar Score; D001724:Birth Weight; D015992:Body Mass Index; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000196:embryology; D003925:Diabetic Angiopathies / Q000097:blood; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005320:Fetal Macrosomia / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood; D011254:Pregnancy in Diabetics / Q000097:blood*; D011446:Prospective Studies; D012016:Reference Values; D020107:Troponin T / Q000097:blood*
D006442:Glycated Hemoglobin; D020097:Natriuretic Peptide, Brain; D020107:Troponin T
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