Third Trimester Myocardial Performance Index in Fetuses from Women with Hyperglycemia in Pregnancy: A Systematic Review and Meta-Analysis

Abstract

Introduction The myocardial performance index (MPI) has been proposed to evaluate cardiac dysfunction in newborns from diabetic mothers. Although MPI is routinely assessed in newborns, its role in the evaluation of fetuses from women with hyperglycemia in pregnancy (HIP) is still under evaluation. We aimed to evaluate the differences in third trimester fetal MPI in pregnant women with hyperglycemia compared to healthy controls.

Materials and Methods Seven electronic databases were searched for all studies assessing women with HIP who underwent evaluation of fetal left MPI during pregnancy compared to a control group. The summary measures were reported as mean differences (MD) in the mean fetal left MPI between women with HIP and healthy controls, with a 95 % confidence interval (CI). A post hoc subgroup analysis based on the type of HIP – pregestational diabetes, GDM, or gestational impaired glucose tolerance (GIGT) – was performed as an additional analysis.

Results 14 studies assessing 1326 fetuses (580 from women with HIP and 746 from controls) were included. Women with HIP had a significantly higher mean left fetal MPI compared to controls (MD 0.08; 95 %CI: 0.05 to 0.11; p < 0.00 001). Subgroup analysis according to the type of HIP concurred with the overall analysis for women with DM (MD 0.07; 95 %CI: 0.01 to 0.13; p = 0.02) and for women with GDM (MD 0.012; 95 %CI: 0.07 to 0.17; p < 0.00 001) but not for women with GIGT (MD –0.01, 95 % CI –0.28 to 0.27; p = 0.96).

Conclusion Fetal left MPI is increased in pregnancies with HIP appearing as a potential marker of cardiac dysfunction.

Zusammenfassung

Ziel Der myokardiale Performance-Index (MPI) wurde vorgeschlagen, um die kardiale Dysfunktion bei Neugeborenen von Müttern mit Diabetes zu beurteilen. Obwohl der MPI routinemäßig bei Neugeborenen bestimmt wird, ist seine Rolle bei der Beurteilung von Föten von Schwangeren mit Hyperglykämie (HIP) noch in der Evaluierung. Unser Ziel war es, die Unterschiede im fetalen MPI im dritten Trimester bei schwangeren Frauen mit Hyperglykämie im Vergleich zu gesunden Kontrollen zu bewerten.

Material und Methoden Sieben elektronische Datenbanken wurden nach allen Studien durchsucht, in denen Frauen mit HIP untersucht wurden, bei denen während der Schwangerschaft eine Bewertung des fetalen linken MPI im Vergleich zu einer Kontrollgruppe durchgeführt wurde. Die zusammenfassenden Messungen wurden als mittlere Differenzen (MD) des mittleren fetalen linken MPI zwischen Frauen mit HIP und gesunden Kontrollen mit einem 95 %-Konfidenzintervall (KI) angegeben. Eine Post-hoc-Subgruppenanalyse basierend auf dem HIP-Typ – präkonzeptioneller Diabetes, Gestationsdiabetes mellitus (GDM) oder Gestations-bedingte Glukosetoleranzstörung (GIGT) – wurde als zusätzliche Analyse durchgeführt.

Ergebnisse 14 Studien mit 1326 Föten (580 von Frauen mit HIP und 746 von Kontrollpersonen) wurden eingeschlossen. Frauen mit HIP hatten einen signifikant höheren mittleren linken fetalen MPI im Vergleich zu den Kontrollen (MD 0,08; 95 %-KI 0,05–0,11; p < 0,00 001). Die Subgruppenanalyse nach dem HIP-Typ stimmte mit der Gesamtanalyse für Frauen mit DM (MD 0,07; 95 %-KI 0,01–0,13; p = 0,02) und für Frauen mit GDM (MD 0,012; 95 %-KI 0,07–0,17; p < 0,00 001) überein, nicht aber für Frauen mit GIGT (MD –0,01; 95 %-KI –0,28–0,27; p = 0,96).

Schlussfolgerung Der fetale linke MPI ist bei Schwangerschaften mit HIP erhöht und könnte sich somit als potenzieller Marker für die kardiale Dysfunktion erweisen.

Key words

hyperglycemia - pregnancy - fetal ultrasound - fetus - echocardiography

Publication History

Received: 22 October 2020

Accepted: 09 April 2021

Article published online:
23 August 2021

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