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Transitional hemodynamics in infants of diabetic mothers by targeted neonatal echocardiography, electrocardiography
Ingrid Anne Mandy Schierz1, Giuseppa Pinello1, Ettore Piro1
1a Neonatal Intensive Care Unit, A.O.U.P. "P. Giaccone", Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy.
Insights
Infants born to diabetic mothers (IDM) show impaired cardiovascular adaptation and hemodynamics, even with good maternal glycemic control. Early cardiac and cerebrovascular evaluation is crucial for IDM to prevent long-term complications.
Area of Science:
- Neonatal cardiology
- Maternal-fetal medicine
- Endocrinology
Background:
- Intrauterine metabolic alterations in diabetes mellitus (DM) can cause fetal cardiac dysfunction.
- Cardiovascular adaptation in infants of diabetic mothers (IDM) requires careful assessment.
- Neonatal care quality improvements and revised DM diagnostic guidelines impact outcomes.
Purpose of the Study:
- To evaluate cardiovascular adaptation in IDM based on maternal DM type and glycemic control.
- To assess the influence of improved neonatal care and updated DM guidelines.
- To identify risks for delayed maturation and long-term adverse outcomes in IDM.
Main Methods:
- Observational case-control study of IDM (gestational, type 1, type 2 DM).
- Analysis of maternal and neonatal clinical and laboratory data.
- Electrocardiographic and echocardiographic assessments, including structural and functional evaluations.
Main Results:
- Lower than expected incidence of negative perinatal outcomes in IDM.
- IDM exhibited larger fetal shunts, higher pulmonary pressures, and altered atrial wave velocities compared to non-IDM.
- Persistent low kinesis, heart rate variability, and elevated cerebral blood flow velocities were noted at 72 hours, with pregestational DM showing the most severe transitional impairment.
Conclusions:
- Maternal DM negatively impacts neonatal transitional hemodynamics in IDM, irrespective of glycemic control.
- Early cardiologic and cerebrovascular assessment is essential for IDM.
- Identifying IDM with delayed maturation aids in mitigating risks for adverse metabolic, cardiovascular, and neurodevelopmental outcomes.
Objective:
Metabolic alterations of intrauterine environment in diabetes mellitus (DM) lead to fetal cardiac dysfunctions that can persist after birth. The aim of the study was to assess the cardiovascular adaptation in infants born to diabetic mothers (IDM) with different degrees of glycometabolic control, in relation to revised guidelines for diagnosis of DM and quality improvements in neonatal care.
Materials And Methods:
An observational case-control study was conducted on IDM with gestational, type 1 and type 2 DM. Relevant maternal and neonatal anamnestic, clinical and laboratory data were analyzed. Electrocardiographic and echocardiographic analyses, including structural and systo-diastolic evaluation, were performed.
Results:
In 68 IDM enrolled, we observed a lower incidence of negative perinatal outcome than expected. Comparing to non-IDM, they presented larger fetal shunts, higher pulmonary pressures, early and atrial wave velocities. At 72 hours, kinesis and heart rate variability remained low. Cerebral blood flow velocities were higher. The most serious impairment of transition was in pregestational IDM.
Conclusion:
Maternal DM impaired neonatal transitional hemodynamics also in asymptomatic IDM with good glycometabolic control. These results confirm the need for an early cardiologic and cerebrovascular evaluation, to identify IDM with delayed maturation at risk of worse long-term metabolic, cardiovascular, and neurodevelopmental outcome.
