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Cardiac function in gestational diabetes mellitus: A longitudinal study from fetal life to infancy
  • +3
  • Marietta Charakida,
  • Kypros Nicolaides,
  • Janina Semmler,
  • Jesica Aguilera,
  • Huijing Zhang,
  • Santiago Anzoatgui
Marietta Charakida
King's College London Faculty of Life Sciences and Medicine
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Kypros Nicolaides
Fetal Medicine Institute
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Janina Semmler
King’s College Hospital
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Jesica Aguilera
Fetal Medicine Institute
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Huijing Zhang
King's College London Faculty of Life Sciences and Medicine
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Santiago Anzoatgui
King's College London Faculty of Life Sciences and Medicine
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Peer review status:ACCEPTED

10 Jun 2020Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
12 Jun 2020Submission Checks Completed
12 Jun 2020Assigned to Editor
15 Jun 2020Reviewer(s) Assigned
22 Jun 2020Review(s) Completed, Editorial Evaluation Pending
25 Jun 2020Editorial Decision: Revise Major
08 Jul 20201st Revision Received
10 Jul 2020Submission Checks Completed
10 Jul 2020Assigned to Editor
10 Jul 2020Review(s) Completed, Editorial Evaluation Pending
14 Jul 2020Editorial Decision: Accept

Abstract

Objective: To determine whether cardiac functional and structural changes in fetuses of mothers with gestational diabetes mellitus (GDM) persist in the offspring beyond the neonatal period. Design: Longitudinal study Setting: Fetal Medicine Unit in a UK teaching hospital Population: 73 women with GDM and 73 women with uncomplicated pregnancy were recruited and fetal cardiac scans were performed at 35-36 weeks’ gestation. Repeat echocardiogram was performed in their offspring during infancy. Main outcome measures: Fetal and infant cardiac functional and structural changes Results: Fetuses of mothers with GDM, compared to controls, had more globular right ventricles (sphericity index 0.7, IQR 0.6/0.7 vs 0.6, IQR 0.5/ 0.6, p<0.001) and reduced right global longitudinal systolic strain (-16.4, IQR -18.9/-15.3 vs -18.5, IQR -20.6/-16.8, p=0.001) and left global longitudinal systolic strain (-20.1, IQR -22.5/-16.9 vs -21.3, IQR -23.5/-19.5), p=0.021). In the GDM group, compared to controls, in infancy there was higher left ventricular E/e’ (8.7, IQR 7.3/9.7 vs 7.9 IQR, 6.8/8.9 p=0.011) and lower left ventricular global longitudinal systolic strain (-21.0, IQR -22.5/-19.4 vs -22.3, IQR -23.5/-20.7, p=0.001) and tricuspid annular plane systolic excursion (13.8, IQR 12.7/16.1 vs 15.2, IQR 13.8/16.8, p=0.003). These differences remained following multivariable analysis. Conclusion: GDM is associated with alterations in fetal cardiac function and structure compared to controls and persistent cardiac changes in infancy.