Evaluation of ventricular dyssynchrony in fetuses of diabetic mothers measured by the tissue Doppler indices: A prospective single-center cohort

Abstract

Background: Maternal diabetes is the most common causes of hypertrophic cardiomyopathy, which significantly increases the risk of fetal heart dysfunction. In this study, the effect of overt maternal diabetes on fetal cardiac function was performed.

Methods: In this case-control study, twenty-six pregnant women with overt diabetes (case group) and 26 women with uncomplicated pregnancies (control group) were examined using tissue Doppler echocardiography. Cardiac function was assessed twice in the fetal period (18-22 weeks and 28 weeks of gestation) and once in the neonatal period (one week of postnatal). Fetal cardiac function was assessed using early-diastolic maximum velocity index (Em), end-diastolic maximum velocity index (Am), Em / Am ratio, left ventricular myocardial function index (LVMPI) and inter-ventricular mechanical delay index (IVMDI).

Results: The case and control groups were not significantly different in terms of maternal age and gestational age at the time of fetal Doppler evaluation. Em (P = 0.007), Am (P <0.001), LVMPI (P = 0.003), and IVMDI (P = 0.026) were significantly higher in fetuses of diabetic mothers than control group, while there was no significant difference in Em / Am ratio (P = 0.264). Eight fetuses (30.8%) of diabetic mothers had dyssynchrony, while no cases of dyssynchrony were seen in fetuses of non-diabetic mothers (P = 0.004). Infants of diabetic mothers were 8.8 times more likely to develop adverse neonatal outcomes than infants of healthy mothers (RR = 8.8, 95% CI: 1.71-45.31, P = 0.009). Regarding the predictive value of cardiac indices for adverse neonatal outcome, IVMDI had the area under curve of 0.887 (P = 0.001) and LVMPI had area under the curve of 0.762 (P = 0.024).

Conclusion: The findings of the current study revealed significant cardiac dysfunction and dyssynchrony in fetuses of diabetic pregnant women. We also found that the IVMDI and the LVMPI index can be used to predict adverse neonatal outcomes in pregnancies complicated with overt diabetes.