Role of Fetal Cardiac Screening in Fetuses of Diabetic Mothers and its Impact on Postnatal Outcome

Abstract Background Maternal diabetes mellitus (DM) is known to affect fetal growth and development. Fetuses of diabetic mothers may have functional cardiac abnormalities, which have recently gained importance and may be found despite good glycemic control. Analysis of fetal cardiac function might provide important information on the hemodynamic status and cardiovascular adaptation to different perinatal complications. Objectives To study the role of fetal echocardiography and fetal cardiac MRI in screening of fetuses of diabetic mother and to study the impact of early diagnosis on postnatal outcome. Subjects and Methods Our study included 60 pregnant diabetic females divided into two groups according to HbA1c cut off value which is related to adverse pregnancy outcomes 7% (Group a): 30 pregnant diabetic females with HbA1c level below 7% were examined by fetal echocardiography and also assessed by postnatal echocardiography (Group b): 30 pregnant diabetic females with HbA1c level more than 7% were examined with fetal echocardiography with further assessment with fetal cardiac MRIand also assessed by postnatal echocardiography Results As regard type of maternal diabetes 32.5% of our patients were diagnosed with gestational diabetes and 67.5% were diagnosed with pregestational diabetes. Maternal diabetes affects left ventricle (LV) diastolic function and global cardiac function but does not affect LV systolic function. Diastolic dysfunction was detected through assessment of myocardial performance index(MPI)which ranges form (0.42_0.64)in group (b) compared to (0.4_0.48) in group (a) with p value 0.000. Diastolic dysfunction was detected in 10% of infants of diabetic mothers (IDM) of our patients with pregestational maternal diabetes compared to 0% affection of systolic function in IDM of our patients (p-value=0.000). Interventricular septum (IVS) thickness showed significant values in IDM with 72% in pregestational maternal diabetes with range of (2.3_5 mm) compared to 45% in gestational maternal diabetes with range of (0.28_4.9mm) with (p- value=0.001). IVS showed positive correlation with myocardial performance index (MPI) and indices of DM such as HbA1c. HbA1c is the most significant predictor for IVS thickness in fetuses of diabetic mothers especially with long duration of DM with p value of 0.026. Conclusion Fetal echocardiography in diabetic mothers is highly important for evaluation of cardiac function of the fetuses. Fetal cardiac MRI can provide ad