title: Fetal Cardiodynamics by Echocardiography in Insulin Dependent Maternal Diabetes and Its Correlation with Pregnancy Outcome.
abstract: BACKGROUND
  Maternal diabetes mellitus is associated with an increased risk of fetal and neonatal morbidity and mortality. Usual screening tests have not proved to be good prognostic indicators of fetal distress. Fetal cardiodynamics is potentially a useful screening tool.
  
  
  OBJECTIVE
  To determine if cardiodynamics of the fetus differ in pregnancy with diabetes requiring insulin than those without and to determine whether cardiodynamics predict fetal and neonatal outcomes.
  
  
  METHODS
  This prospective case control study was carried out in 40 pregnant women with diabetes who required insulin for blood sugar control. Twenty uncomplicated pregnant women were taken as controls. Systolic and diastolic cardiac functions along with interventricular septal thickness were assessed at 26-28 weeks and again at 34-36 weeks of gestation in fetuses by echocardiography. Fetal and neonatal adverse outcomes were evaluated in terms of major and minor morbidity.
  
  
  RESULTS
  Among all parameters, E/A ratio across both mitral and tricuspid valves, myocardial performance index and cardiac output were significantly different in fetuses of diabetic mothers at both gestations. However, pulmonary vein pulsatility index and interventricular septal thickness were similar between the two groups. At 26-28 weeks of gestation myocardial performance index correlated with abnormal biophysical profile whereas cardiac output correlated with minor morbidity. At 34-36 weeks of gestation, cardiac output correlated with abnormal biophysical profile while both MPI and cardiac output correlated with minor morbidity.
  
  
  CONCLUSIONS
  Echocardiographic parameters of fetuses of diabetic women significantly differed from those of uncomplicated non-diabetic women. However, only myocardial performance index and cardiac output correlated with adverse fetal and neonatal outcomes.
authors.affiliation: Senior resident, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences , New Delhi, India . (Was Junior Resident, Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh at time of research).
authors.forename: Rashmi
authors.initials: R
authors.lastname: Pilania
authors.affiliation: Associate Professor, Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research , Chandigarh, India .
authors.forename: Pooja
authors.initials: P
authors.lastname: Sikka
authors.affiliation: Professor, Department of Cardiology, Postgraduate Institute of Medical Education and Research , Chandigarh, India .
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Rohit
authors.affiliation: Professor, Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research , Chandigarh, India .
authors.forename: Vanita
authors.initials: V
authors.lastname: Suri
authors.affiliation: Professor, Department of Paediatrics, Postgraduate Institute of Medical Education and Research , Chandigarh, India .
authors.forename: Praveen
authors.initials: P
authors.lastname: Kumar
keywords: Cardiac output; Diabetes mellitus; Echocardiography; Myocardial performance index