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Abstract：
BACKGROUND: Maternal diabetes adversely affects fetal cardiovascular system development. Previous studies have reported that the fetuses of mothers with diabetes exhibit both structural and functional changes; nevertheless, prior studies have not examined the association between glucose control and fetal cardiac morphology and performance. Thus, the objective was to determine the association between fetal cardiac morphology and function and maternal glucose control in type 1 diabetes and to compare the differences in measured cardiac parameters between the fetuses of mothers with diabetes and healthy controls.
METHODS: In this prospective, longitudinal case-control study - including 62 pregnant women with type 1 diabetes mellitus and 30 healthy pregnant women - fetal cardiac assessment using B-mode, M-mode, and spectral pulsed-wave Doppler was performed in the second and third trimesters. In women with T1DM, glycated hemoglobin and data obtained from glucose sensors - including the percentage of time in, below, and above the range (TIR, TBR, and TAR, respectively), and coefficient of variation (CV) - were analyzed across three time periods: the last menstrual period to 13 (V1), 14-22 (V2), and 23-32 weeks (V3) of gestation. Fetal cardiac indices were compared between groups, and the correlation between glucose control and fetal cardiac indices was assessed.
RESULTS: At 28-32 weeks, the fetuses of women with T1DM exhibited increased left ventricular end-diastolic length, relative interventricular septum thickness, right ventricular cardiac output, and pulmonary valve peak systolic velocity compared with healthy controls. At 18-22 weeks, pulmonary and aortic valve diameters, left and right ventricular stroke volumes, and left cardiac output inversely correlated with the CV and glycated hemoglobin levels at V1 and V2. Furthermore, at 28-32 weeks, pulmonary and aortic valve diameters, left ventricular stroke volume, cardiac output, and right/left atrioventricular valve ratio inversely correlated with the TBR at V1, V2, and V3. Moreover, diastolic functional parameters correlated with the TAR and glycated hemoglobin levels, particularly after the first trimester.
CONCLUSIONS: In women with T1DM, maternal hyperglycemia during pregnancy correlates with fetal diastolic function, whereas glucose variability and hypoglycemia inversely correlate with fetal left ventricular systolic function in the second and third trimesters.
METHODS: In this prospective, longitudinal case-control study - including 62 pregnant women with type 1 diabetes mellitus and 30 healthy pregnant women - fetal cardiac assessment using B-mode, M-mode, and spectral pulsed-wave Doppler was performed in the second and third trimesters. In women with T1DM, glycated hemoglobin and data obtained from glucose sensors - including the percentage of time in, below, and above the range (TIR, TBR, and TAR, respectively), and coefficient of variation (CV) - were analyzed across three time periods: the last menstrual period to 13 (V1), 14-22 (V2), and 23-32 weeks (V3) of gestation. Fetal cardiac indices were compared between groups, and the correlation between glucose control and fetal cardiac indices was assessed.
RESULTS: At 28-32 weeks, the fetuses of women with T1DM exhibited increased left ventricular end-diastolic length, relative interventricular septum thickness, right ventricular cardiac output, and pulmonary valve peak systolic velocity compared with healthy controls. At 18-22 weeks, pulmonary and aortic valve diameters, left and right ventricular stroke volumes, and left cardiac output inversely correlated with the CV and glycated hemoglobin levels at V1 and V2. Furthermore, at 28-32 weeks, pulmonary and aortic valve diameters, left ventricular stroke volume, cardiac output, and right/left atrioventricular valve ratio inversely correlated with the TBR at V1, V2, and V3. Moreover, diastolic functional parameters correlated with the TAR and glycated hemoglobin levels, particularly after the first trimester.
CONCLUSIONS: In women with T1DM, maternal hyperglycemia during pregnancy correlates with fetal diastolic function, whereas glucose variability and hypoglycemia inversely correlate with fetal left ventricular systolic function in the second and third trimesters.
摘要：
背景：母体糖尿病会对胎儿心血管系统的发育产生不利影响。以前的研究报道，患有糖尿病的母亲的胎儿表现出结构和功能的变化;然而，先前的研究没有检查血糖控制与胎儿心脏形态和表现之间的关联.因此，目的是确定1型糖尿病患者胎儿心脏形态和功能与母体血糖控制之间的关系,并比较糖尿病母亲胎儿和健康对照组之间测得的心脏参数的差异.
方法：在此前瞻性中，纵向病例对照研究-包括62例1型糖尿病孕妇和30例健康孕妇-使用B模式进行胎儿心脏评估，M模式,在妊娠中期和中期进行频谱脉冲波多普勒。在患有T1DM的女性中，糖化血红蛋白和从葡萄糖传感器获得的数据-包括时间百分比，下面,并且高于该范围(TIR，TBR,还有TAR,分别)，和变异系数（CV）-分析了三个时间段：末次月经期至13（V1），14-22（V2），妊娠23-32周（V3）。组间比较胎儿心脏指数，并评估血糖控制与胎儿心脏指数之间的相关性。
结果：在28-32周时，T1DM女性胎儿左心室舒张末期长度增加,相对室间隔厚度，右心室心输出量,与健康对照组相比，肺动脉瓣收缩期峰值速度。在18-22周，肺动脉瓣和主动脉瓣直径，左右心室的心搏量,左心输出量与V1和V2时的CV和糖化血红蛋白水平呈负相关。此外，在28-32周，肺动脉瓣和主动脉瓣直径，左心室每搏输出量,心输出量,右/左房室瓣比值与V1、V2和V3处的TBR呈负相关。此外，舒张功能参数与TAR和糖化血红蛋白水平相关，特别是在怀孕的头三个月之后。
结论：在患有T1DM的女性中，孕妇妊娠期高血糖与胎儿舒张功能相关,而血糖变异性和低血糖与妊娠中期和晚期胎儿左心室收缩功能呈负相关。
方法：在此前瞻性中，纵向病例对照研究-包括62例1型糖尿病孕妇和30例健康孕妇-使用B模式进行胎儿心脏评估，M模式,在妊娠中期和中期进行频谱脉冲波多普勒。在患有T1DM的女性中，糖化血红蛋白和从葡萄糖传感器获得的数据-包括时间百分比，下面,并且高于该范围(TIR，TBR,还有TAR,分别)，和变异系数（CV）-分析了三个时间段：末次月经期至13（V1），14-22（V2），妊娠23-32周（V3）。组间比较胎儿心脏指数，并评估血糖控制与胎儿心脏指数之间的相关性。
结果：在28-32周时，T1DM女性胎儿左心室舒张末期长度增加,相对室间隔厚度，右心室心输出量,与健康对照组相比，肺动脉瓣收缩期峰值速度。在18-22周，肺动脉瓣和主动脉瓣直径，左右心室的心搏量,左心输出量与V1和V2时的CV和糖化血红蛋白水平呈负相关。此外，在28-32周，肺动脉瓣和主动脉瓣直径，左心室每搏输出量,心输出量,右/左房室瓣比值与V1、V2和V3处的TBR呈负相关。此外，舒张功能参数与TAR和糖化血红蛋白水平相关，特别是在怀孕的头三个月之后。
结论：在患有T1DM的女性中，孕妇妊娠期高血糖与胎儿舒张功能相关,而血糖变异性和低血糖与妊娠中期和晚期胎儿左心室收缩功能呈负相关。
