The effect of pregestational diabetes on fetal heart function

Abstract

Pregestational diabetes affects nearly 2% of all pregnancies. Moreover, Type 2 diabetes in child-bearing women is on the rise because of the childhood obesity epidemic. Pregestational diabetes can affect the fetal heart in several ways. First, the risk of fetal congenital heart disease is markedly increased; second, fetal hypertrophic cardiomyopathy may occur even with good glycemic control; third, studies have shown impaired function of the hearts of some infants and fetuses of diabetic pregnancies, which can occur with and without septal hypertrophy. Small-for-gestational-age infants of diabetic mothers may have diminished cardiovascular health in the long term. This review mainly discusses methods to detect fetal diabetic cardiomyopathy prenatally. The focus is on the noninvasive diagnostic markers that can serve as an outcome measure for future therapeutic trials, which are still lacking. There is some experimental research on treatment strategies to prevent fetal heart disease in diabetic pregnancies but little clinical data.

Keywords:

• cardiac function
• diabetes
• Doppler
• fetal echocardiogram
• fetus
• hypertrophic cardiomyopathy
• pregnancy
• prenatal
• strain imaging
• tissue Doppler

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Pregestational diabetes is more common than in the past because of the childhood obesity epidemic.

• Pregestational diabetes is associated with fetal cardiac malformations, hypertrophic cardiomyopathy and cardiac dysfunction as early as the first trimester. It can also cause possible sequelae for long-term cardiovascular health of the child, which can be detected by echocardiography. Therefore, fetal echocardiography should be used to monitor these pregestational diabetic pregnancies for structural and functional cardiac abnormalities in the fetus.

• Assessment of fetal heart function is technically difficult, despite new function markers, including the myocardial performance index, tissue Doppler imaging velocities and strain rate imaging.

• Fetal cardiac dysfunction may occur even in the absence of structural change, such as hypertrophic cardiomyopathy.

• Echocardiographic studies on fetal compromise because of pregestational diabetes suggest that optimal glycemic control during pregnancy reduces the risk of fetal cardiac dysfunction but does not completely eliminate it. Therefore, even pregnancies with good glycemic control should be monitored with regard to fetal diabetic cardiomyopathy.