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Diabetes in pregnancy and offspring cardiac function: a systematic review and meta-analysis
Camilla Bjørn Skovsgaard1, Anna Møller1, Jesper Vandborg Bjerre1
1Department of Paediatrics, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Insights
Pregnancy diabetes impacts infant heart function, causing hypertrophy and reduced global function in the first six months. Long-term effects in older children remain unclear, necessitating further research.
Area of Science:
- Cardiology
- Maternal-Fetal Medicine
- Pediatric Cardiology
Background:
- Diabetes in pregnancy is a growing concern with potential long-term health implications for offspring.
- Previous research suggests a link between maternal diabetes and altered fetal development, including cardiovascular aspects.
- Understanding these effects is crucial for early intervention and improved long-term health outcomes.
Purpose of the Study:
- To systematically review and synthesize existing evidence on the impact of diabetes in pregnancy on offspring cardiac function.
- To assess cardiac parameters in neonates, infants, and young children exposed to maternal diabetes during gestation.
- To identify specific echocardiographic findings associated with maternal diabetes exposure.
Main Methods:
- A comprehensive systematic review of four major databases (PubMed, Embase, Cochrane CENTRAL, Web of Science) was conducted.
- Studies published between 1992 and June 2023, focusing on offspring (age < 18 years) cardiac function via echocardiography, were included.
- Thirty-one observational studies involving 1,679 cases and 2,694 controls were analyzed, with meta-analyses performed where feasible.
Main Results:
- Neonates exposed to maternal diabetes exhibited cardiac hypertrophy (increased intraventricular septum diastolic diameter) and impaired global cardiac function (decreased myocardial performance index) within the first week of life.
- Diastolic function (LV E/A-ratio) was also reduced in neonates, while systolic function (left ventricular ejection fraction) showed no significant difference.
- Similar findings of hypertrophy and impaired global function persisted at 1-6 months, but no significant differences were observed in older children (1-8 years).
Conclusions:
- Diabetes in pregnancy is associated with cardiac hypertrophy and impaired global cardiac function in infants up to six months of age.
- The cardiac effects observed in early infancy appear to resolve or are not detectable by standard echocardiography in older children.
- Further longitudinal studies using advanced imaging techniques like cardiac MRI are recommended to fully elucidate the long-term cardiovascular consequences for offspring.
Introduction:
Diabetes in pregnancy is associated with impaired offspring cardiac function. The objective of this systematic review was to determine the effect of diabetes in pregnancy on cardiac function in the offspring measured by echocardiography.
Methods:
PubMed, Embase, Cochrane CENTRAL and Web of Science databases were searched from 1992 to June 27, 2023. Studies reporting offspring (age < 18 years) cardiac function by echocardiography compared between any type of diabetes in pregnancy and healthy control pregnancies were included. Study selection, quality assessment and risk of bias was independently performed by two reviewers. Meta-analyses was performed where possible.
Results:
Thirty-one observational studies were included 1,679 cases and 2,694 controls. In the first week of life (23 studies, n = 2,663), intraventricular septum diastolic diameter (hypertrophy) was increased, while myocardial performance index (global function) and LV E/A-ratio (diastolic function) were decreased. No difference was found for left ventricular ejection fraction (systolic function). At 1-6 months (4 studies, n = 454) studies found hypertrophy, and decreased global function, but no difference in systolic or diastolic function. At 1-8 years (7 studies, n = 1,609) no difference was found. The available data did not allow for sub-analysis based on the type of diabetes, treatment, or glycemic control.
Conclusions:
Diabetes in pregnancy is associated with cardiac hypertrophy and impaired global cardiac function in infants up to six months old. The few studies reporting on older children found no difference in the parameters investigated. Longitudinal studies employing more advanced echocardiographic measures or MRI are needed to evaluate consequences for long-term cardiac health.
Systematic Review Registration:
https://www.crd.york.ac.uk/, identifier (CRD42022312471).
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