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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2017; 39(01): 09-13
DOI: 10.1055/s-0037-1598602
Original Article
Thieme-Revinter Publicações Ltda Rio de Janeiro, Brazil

Prevalence of Hypertrophic Cardiomyopathy in Fetuses of Mothers with Gestational Diabetes before Initiating Treatment

Prevalência de miocardiopatia hipertrófica em fetos de mães com diabetes gestacional antes do tratamento
Carolina Rossi Palmieri
1   Health and Environment Master Program, Universidade da Região de Joinville (Univille), Joinville, Santa Catarina, Brazil
,
Mona Adalgisa Simões
2   Department of Neonatology, Maternidade Darcy Vargas, Joinville, Santa Catarina, Brazil
,
Jean Carl Silva
3   Department of Medicine, Universidade da Região de Joinville (Univille), Joinville, Santa Catarina, Brazil
,
Anelise Darabas dos Santos
4   Universidade da Região de Joinville (Univille), Joinville, Santa Catarina, Brazil
,
Mariana Ribeiro e Silva
4   Universidade da Região de Joinville (Univille), Joinville, Santa Catarina, Brazil
,
Bruna Ferreira
4   Universidade da Região de Joinville (Univille), Joinville, Santa Catarina, Brazil
› Author Affiliations
Further Information

Publication History

05 July 2016

15 December 2016

Publication Date:
28 February 2017 (online)

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Abstract

Objective To evaluate the prevalence of hypertrophic cardiomyopathy (HCM) in fetuses of pregnant women with gestational diabetes mellitus (GDM) in the beginning of the treatment.

Methods A cross-sectional study was performed between July 1, 2013, and December 20, 2013, in a public maternity clinic in southern Brazil. The subjects were 63 fetuses of mothers with gestational diabetes, with a single pregnancy and no other associated pathologies. We diagnosed HCM through a fetal echocardiography before treatment and evaluated the maternal and fetal characteristics.

Results The average age of the pregnant women was 32.32 (±6.2) years, and the average gestational age at the time of the evaluation was 30.59 (±2.27) weeks. The interventricular septum thickness showed a standard deviation of more than two in 50.8% of the fetuses (95% confidence interval [95%CI]: 38.1–63.5%). The left ventricular wall thickness showed a standard deviation of more than 2 in 13 (20.6%) fetuses (95%CI: 11.1–30.2%). The HCM was confirmed in 54% of the fetuses (95%CI: 41.3–65.1%). The fetal abdominal circumference was normal in 46 (73%) fetuses, and 50% of these fetuses had HCM.

Conclusion The prevalence of hypertrophic cardiomyopathy in fetuses of pregnant women with GDM before treatment was of 54% (95%CI: 41.3–65.1%).

Resumo

Objetivo Avaliar a prevalência de miocardiopatia hipertrófica em fetos de gestantes com diabetes mellitus gestacional antes do início do tratamento.

Métodos Foi realizado um estudo de corte transversal, no período de 1o de julho de 2013 até 20 de dezembro de 2013, em uma maternidade pública. Foram objetos do estudo 63 fetos de gestantes portadoras de diabetes mellitus gestacional (DMG), em gestação única e sem outras patologias associadas. Foi realizada ecocardiografia fetal antes do início do tratamento do diabetes. O diagnóstico de miocardiopatia hipertrófica (MH) foi realizado quando a medida do septo interventricular ou da parede ventricular estava superior a dois desvios-padrão. O desfecho primário avaliado foi presença de MH.

Resultados As gestantes apresentavam idade média de 32,32 (±6,2) anos, e a idade gestacional média no momento da avaliação foi de 30,59 (±2,27) semanas. A medida do septo interventricular estava acima de 2 desvios-padrão em 50,8% (intervalo de confiança de 95% [IC95%]: 38,1–63,5%). A parede do ventrículo esquerdo estava acima de 2 desvios-padrão em 13 fetos, totalizando 20,6% (IC95%: 11,1–30,2%). A MH estava presente em 54% dos fetos (IC95%: 41,3–65,1%). A circunferência abdominal fetal estava normal em 46 (73%) fetos, e destes, 50% apresentavam MH.

Conclusão A prevalência de MH em fetos de gestantes portadoras de DMG antes do tratamento foi de 54% (IC95% 41,3–65,1%).

Keywords

gestational diabetes - fetal echocardiography - fetus - heart diseases - hypertrophic cardiomyopathy

Palavras chave

diabetes gestacional - ecocardiografia fetal - feto - cardiopatias - miocardiopatia hipertrófica
 

  • References

  • 1 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2012; 35 (Suppl. 01) S64-S71
    CrossrefPubMedGoogle Scholar
  • 2 Åman J, Hansson U, Östlund I, Wall K, Persson B. Increased fat mass and cardiac septal hypertrophy in newborn infants of mothers with well-controlled diabetes during pregnancy. Neonatology 2011; 100 (02) 147-154
    CrossrefPubMedGoogle Scholar
  • 3 Jaeggi ET, Fouron JC, Proulx F. Fetal cardiac performance in uncomplicated and well-controlled maternal type I diabetes. Ultrasound Obstet Gynecol 2001; 17 (04) 311-315
    CrossrefPubMedGoogle Scholar
  • 4 Park MK. Pediatric cardiology. 4th ed. St. Louis: Mosby; 2002. . Primary myocardial disease; p. 267-392
    Google Scholar
  • 5 Demiroren K, Cam L, Oran B. , et al. Echocardiographic measurements in infants of diabetic mothers and macrosomic infants of nondiabetic mothers. J Perinat Med 2005; 33 (03) 232-235
    CrossrefPubMedGoogle Scholar
  • 6 Stuart A, Amer-Wåhlin I, Gudmundsson S, Marsál K, Thuring A, Källen K. Ductus venosus blood flow velocity waveform in diabetic pregnancies. Ultrasound Obstet Gynecol 2010; 36 (03) 344-349
    CrossrefPubMedGoogle Scholar
  • 7 Dimitriu AG, Russu G, Stamatin M, Jităreanu C, Streangă V. [Clinical and developmental aspects of cardiac involvement in infant of diabetic mother]. Rev Med Chir Soc Med Nat Iasi 2004; 108 (03) 566-569
    PubMedGoogle Scholar
  • 8 Hagemann LL, Zielinsky P. [Prenatal study of hypertrophic cardiomyopathy and its association with insulin levels in fetuses of diabetic mothers]. Arq Bras Cardiol 1996; 66 (04) 193-198
    PubMedGoogle Scholar
  • 9 Fouda UM, Abou ElKassem MM, Hefny SM, Fouda RM, Hashem AT. Role of fetal echocardiography in the evaluation of structure and function of fetal heart in diabetic pregnancies. J Matern Fetal Neonatal Med 2013; 26 (06) 571-575
    CrossrefPubMedGoogle Scholar
  • 10 García-Díaz L, Coserria F, Antiñolo G. Hypertrophic cardiomyopathy due to mitochondrial disease: prenatal diagnosis, management, and outcome. Case Rep Obstet Gynecol 2013; 2013: 472356
    PubMedGoogle Scholar
  • 11 Zielinsky P. Role of prenatal echocardiography in the study of hypertrophic cardiomyopathy in the fetus. Echocardiography 1991; 8 (06) 661-668
    CrossrefPubMedGoogle Scholar
  • 12 Hadlock FP, Deter RL, Harrist RB, Park SK. Estimating fetal age: computer-assisted analysis of multiple fetal growth parameters. Radiology 1984; 152 (02) 497-501
    CrossrefPubMedGoogle Scholar
  • 13 Allan L. Technique of fetal echocardiography. Pediatr Cardiol 2004; 25 (03) 223-233
    CrossrefPubMedGoogle Scholar
  • 14 Hendler I, Blackwell SC, Bujold E. , et al. Suboptimal second-trimester ultrasonographic visualization of the fetal heart in obese women: should we repeat the examination?. J Ultrasound Med 2005; 24 (09) 1205-1209 , quiz 1210–1211
    CrossrefPubMedGoogle Scholar
  • 15 Lopes L. Ecocardiografia fetal. São Paulo: Revinter; 2015
    Google Scholar
  • 16 Zielinsky P, Piccoli Jr AL. Myocardial hypertrophy and dysfunction in maternal diabetes. Early Hum Dev 2012; 88 (05) 273-278
    CrossrefPubMedGoogle Scholar
  • 17 Han SS, Wang G, Jin Y. , et al. Investigating the mechanism of hyperglycemia-induced fetal cardiac hypertrophy. PLoS One 2015; 10 (09) e0139141
    CrossrefPubMedGoogle Scholar
  • 18 Pedra SR, Smallhorn JF, Ryan G. , et al. Fetal cardiomyopathies: pathogenic mechanisms, hemodynamic findings, and clinical outcome. Circulation 2002; 106 (05) 585-591
    CrossrefPubMedGoogle Scholar
  • 19 Garg S, Sharma P, Sharma D, Behera V, Durairaj M, Dhall A. Use of fetal echocardiography for characterization of fetal cardiac structure in women with normal pregnancies and gestational diabetes mellitus. J Ultrasound Med 2014; 33 (08) 1365-1369
    CrossrefPubMedGoogle Scholar
  • 20 Otto CM. Fundamentos da ecocardiografia clínica. 3a ed. Rio de Janeiro: Elsevier; 2005. . Cardiopatia hipertensiva e cor pulmonale; p. 199-220
    Google Scholar
  • 21 Garcia-Flores J, Jañez M, Gonzalez MC, Martinez N, Espada M, Gonzalez A. Fetal myocardial morphological and functional changes associated with well-controlled gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2011; 154 (01) 24-26
    CrossrefPubMedGoogle Scholar
  • 22 Vela-Huerta MM, Vargas-Origel A, Olvera-López A. Asymmetrical septal hypertrophy in newborn infants of diabetic mothers. Am J Perinatol 2000; 17 (02) 89-94
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Behle I, Zielinsky P, Zimmer LP, Pontremoli M, Risch JN. [Glycosylated hemoglobin levels and cardiac abnormalities in fetuses of diabetic mothers]. Rev Bras Ginecol Obstet 1998; 20 (05) 237-243 Portuguese.
    CrossrefPubMedGoogle Scholar
  • 24 Vural M, Leke L, Mahomedaly H, Maingourd Y, Kremp O, Risbourg B. Should an echocardiographic scan be done routinely for infants of diabetic mothers?. Turk J Pediatr 1995; 37 (04) 351-356
    PubMedGoogle Scholar
  • 25 Fonarow GC. Managing the patient with diabetes mellitus and heart failure: issues and considerations. Am J Med 2004; 116 (Suppl A) 76S-88S
    CrossrefPubMedGoogle Scholar
  • 26 Figueroa H, Silva MC, Kottmann C. , et al. Fetal evaluation of the modified-myocardial performance index in pregnancies complicated by diabetes. Prenat Diagn 2012; 32 (10) 943-948
    CrossrefPubMedGoogle Scholar