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Altered transitional circulation in infants of diabetic mothers with strict antenatal obstetric management: a
1Division of Neonatology, UCSD Medical Center, University of California, San Diego, San Diego, CA, USA. akatheria@ucsd.edu
Insights
Infants born to diabetic mothers (IDMs) show altered blood flow and persistent fetal shunts, indicating impaired transitional hemodynamics even with good gestational control.
Area of Science:
- Neonatal physiology
- Cardiovascular adaptation
- Fetal circulation
Background:
- Infants of diabetic mothers (IDMs) experience significant neonatal morbidity.
- These complications often manifest during the critical neonatal transition period.
- Even with maternal glycemic control, IDMs remain at risk.
Purpose of the Study:
- To compare systemic and pulmonary blood flow in IDMs versus controls.
- To analyze directional blood flow changes within fetal shunts in early neonatal life.
- To investigate the impact of maternal diabetes on neonatal hemodynamics.
Main Methods:
- Prospective observational cohort study.
- Serial echocardiography used to assess cardiac output and shunts.
- Evaluated right ventricular output, left ventricular output, and vena cava flow in 32 IDMs and 18 controls.
Main Results:
- IDMs exhibited lower right ventricular output post-birth and at 48 hours.
- IDMs showed reduced left-to-right atrial shunting and increased right-to-left ductal shunting.
- 15 IDMs required neonatal intensive care unit admission, with 11 experiencing respiratory symptoms.
Conclusions:
- Persistent fetal shunts and diminished right ventricular output in IDMs suggest compromised transitional hemodynamics.
- These findings highlight the vulnerability of IDMs despite good maternal glycemic control.
- Impaired hemodynamics in IDMs necessitate closer monitoring and potential interventions.
Objective:
Infants born to diabetic mothers (IDMs) even with good glycemic control are at risk for neonatal morbidity. Many of these problems occur during neonatal transition. We assessed (i) systemic and pulmonary blood flow in IDMs compared with controls and (ii) directional blood flow changes within fetal shunts during the first few days of life.
Study Design:
In this prospective observational cohort study, we evaluated right (RVO) and left ventricular output, superior vena cava flow, atrial and ductal shunts, and tricuspid regurgitation in 32 IDMs and 18 controls using serial echocardiography after birth and 48 h of life in both groups and at 24 and 72 h in IDMs only.
Result:
IDMs had lower RVO after birth and 48 h of life. IDMs also had less left to right atrial shunt and more right to left ductal shunt after birth compared with controls. In all, 15 of the 32 IDMs were admitted to the neonatal intensive care unit and 11 had respiratory symptoms.
Conclusion:
Persistence of fetal shunts and decreased RVO in IDMs suggest that even those with good gestational control have impaired transitional hemodynamics.
