Functional Assessment of Fetal Heart by Echocardiography in Maternal Diabetes Mellitus

Background: Diabetes mellitus constitutes a significant risk for the fetus if present in pregnant woman. Tissue Doppler imaging (TDI) is less dependent on loading conditions, so it is more accurate for assessment of cardiac function and can detect subclinical fetal cardiac dysfunction. The aim of this work was to assess fetal heart functional abnormalities (left ventricular systolic and diastolic function, right ventricular systolic and diastolic function) and their relation to maternal glycemic control. 
Methods: This prospective case-control study was carried out on 30 diabetic mothers either with pregestational diabetes (PGDM) or gestational diabetes (GDM) and 20 healthy mothers in the third trimester. Patients were subdivided in to two groups: group I: poorly controlled diabetic pregnant mothers (17 cases) and group II: well-controlled diabetic pregnant mothers (13 cases). Patients were subjected to fetal echocardiography (left ventricular systolic and diastolic function assessment, right ventricular systolic and diastolic function assessment). 
Results: There was significantly higher values regarding fasting blood glucose level, 2 hours post-prandial blood glucose level and HbA1c in poorly controlled patients versus well controlled (P value < 0.001). It was noticed that E` and A` wave velocities of the mitral annulus, MPI and IVRT were significantly higher in fetuses of groups I, II than fetuses of group III (P <0.05). Fetuses of groups I, II showed significantly lower E/E` ratio when compared to fetuses of group III (P <0.05). 
Conclusions: By using tissue Doppler imaging at around 28 weeks of gestation, it was discovered that the systolic and diastolic function indices measures were different in foetuses of diabetic mothers than in normal foetuses. Despite having well-controlled diabetes, the echocardiographic results of uncomplicated non-diabetic women's foetuses were significantly different from those of diabetic women's foetuses.