MORPHOMETRIC AND HEMODYNAMIC ENTITIES OF FETAL HEART IN DIABETIC PREGNANCIES AND THE ROLE OF THE MATERNAL METABOLIC STATE

Objective: Myocardial hypertrophy is a well-known complication in infa nts of diabetic mothers. The purpose of this study was to define wheth er it may be diagnosed in fetuses of diabetic mothers (FDM), whether t here are related hemodynamic consequences and if maternal metabolic da ta may predict it. Methods: A total of 100 pregnant diabetics were pro spectively studied every 4 to 6 weeks between 20 and 41 weeks of gesta tional age. Maternal metabolic data (White classification, insulin req uirement/day, weight, fasting blood sugar, hemoglobin A1C, insulin ant ibodies) and gestational age were documented, and fetal echocardiograp hy was performed with respect to endiastolic ventricular dimensions, l eft ventricular shortening fraction (SF) and mean blood flow velocity, valvar area, heart rate, and cardiac output at the semilunar and atri oventricular valves. These cardiac data were compared with those of 20 0 normal fetuses. Results: Right, left, and interventricular wall thic knesses were increased, whereas ventricular diameters were significant ly reduced. SF was significantly diminished, as were the valvar area a nd cardiac output measured at the aorta. Hemodynamic data assessed at the other valves did not differ from normal. There was no association between fetal and maternal data. Conclusions: Myocardial hypertrophy o f all ventricular walls may be already present in FDM. It is not accom panied by severe hemodynamic alterations, but rather by a diminished s ize of ventricular diameters and the aortic valve together with a dist urbed SF. This could represent a special entity in FDM but needs furth er investigation. The lack of maternal determinants may show that they are not sensitive enough to reflect relevant changes for FDM.