title: Elevated neonatal insulin-like growth factor I is associated with fetal hypertrophic cardiomyopathy in diabetic women.
abstract: OBJECTIVE
  We sought to determine if fetal hypertrophic cardiomyopathy (HCM) or cardiac dysfunction is associated with elevated maternal or neonatal insulin-like growth factor (IGF)-I levels in women with diabetes.
  
  
  METHODS
  In a prospective cohort study, fetal echocardiogram findings at 36 weeks' gestation in women with pregestational diabetes mellitus were compared to those in women without diabetes mellitus. HCM was defined as septal or free wall thickness ≥5 mm and cardiac dysfunction as a modified myocardial performance index ≥0.43. Cord serum IGF-I levels at delivery were measured with enzyme-linked immunosorbent assay. Neonates with abnormal fetal echocardiogram were followed up until resolution or 6 months of life.
  
  
  RESULTS
  In all, 75 participants completed fetal echocardiography (55 diabetics and 20 controls). In the diabetic group, 33 of 55 (60%) had abnormal fetal echocardiograms with cardiac dysfunction in 21 of 55 (38.2%) and HCM in 8 of 55 (14.5%) and both in 4 of 55 (7.3%). At 6 months of age, 1 of 12 (8%) had persistent HCM. None in the comparison group had abnormal findings. There were no significant clinical differences in those diabetic women with normal vs abnormal fetal echocardiograms. However, among diabetic women, mean neonatal IGF-I was significantly higher in fetuses with HCM (80 ± 16 ng/mL) as compared to those without HCM (61 ± 18 ng/mL), (P < .001).
  
  
  CONCLUSIONS
  Elevated neonatal IGF-I appears to be associated with fetal HCM in fetuses of diabetic women.
authors.affiliation: Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL. Electronic address: Annabee77@hotmail.com.
authors.forename: Anna B
authors.initials: AB
authors.lastname: Gonzalez
authors.affiliation: Department of Pediatric Cardiology, Ann and Robert H. Lurie Children's Hospital, Chicago, IL.
authors.forename: Luciana
authors.initials: L
authors.lastname: Young
authors.affiliation: Department of Biomedical Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Doll
authors.affiliation: Department of Internal Medicine, University of Iowa School of Medicine, Iowa City, IA.
authors.forename: Gina M
authors.initials: GM
authors.lastname: Morgan
authors.affiliation: Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Crawford
authors.affiliation: Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Plunkett
mesh_terms: D000328:Adult; D002312:Cardiomyopathy, Hypertrophic / Q000097:blood*; D004452:Echocardiography; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood*; D011446:Prospective Studies
chemical_list: D007334:Insulin-Like Growth Factor I
keywords: fetal hypertrophic cardiomyopathy; insulin-like growth factor I; maternal diabetes