Subclinical Changes in Cardiovascular Function During the Neonatal Period in Infants Born to Mothers With Diabetes

The link between maternal diabetes and congenital heart defects is well-established; however, few studies have investigated subclinical cardiovascular dysfunction at birth, which may serve as an early indicator of future risk.

We analyzed cardiovascular metrics, including heart rate and blood pressure during the postnatal hospital stay, in 1927 maternal-infant dyads at Nebraska Medicine (2012-2023), including 226 with gestational diabetes mellitus (GDM), 27 with type 1 DM (T1DM), 67 with type 2 DM (T2DM), and 1607 with no DM. Relationships between maternal diabetes subtype and neonatal cardiovascular metrics were examined using treatment effects modeling. Correlations between maternal glycemic burden, as assessed by average HbA1c and 1-hour oral glucose tolerance test (OGTT) during pregnancy, and newborn cardiovascular metrics were also evaluated.

Compared with no DM, T1DM was associated with higher newborn systolic blood pressure (SBP) (+4.6 mm Hg, p = 0.002), pulse pressure (PP) (+3.1 mm Hg, p = 0.006), and SBP variability (+1.2 mm Hg, p = 0.048). T2DM was associated with higher newborn SBP (+2.9 mm Hg, p = 0.03) and PP (+2.0 mm Hg, p = 0.02) and lower SBP variability (-1.3 mm Hg, p = 0.049). There were sigsnificant positive correlations between maternal HbA1c and newborn heart rate (p = 0.009, R ² = 0.27), mean arterial pressure (p = 0.004, R ² = 0.20), SBP (p < 0.001, R ² = 0.22), diastolic BP (p = 0.03, R ² = 0.17), and PP (p = 0.001, R ² = 0.17). No correlations were observed between maternal 1-hour OGTT and newborn cardiovascular metrics.

These findings indicate early subclinical changes in cardiovascular physiology in offspring of women with DM. The differential impacts of diabetes subtypes on newborn BP and strong link to maternal glycemic burden suggest severity and timing of maternal diabetes influence neonatal cardiovascular physiology.