Quantitative Evaluation Of The Fetal Cardiac Structural And Functional Changes In The Women With GDM Using Fetal HQ

Objective:Gestational diabetes mellitus(GDM)is a pathological condition of carbohydrate intolerance,which has been verified that attacking fetal heart in animal research.Consequently,the purpose of this study was using Fetal HQ software to assess how fetal cardiac shape and function change in the environment of intrauterine hyperglycemia.Furthermore,to investigate if the cardiac measurement would have prognostic value for adverse perinatal outcome.Methods:The study was a prospective cohort study.We selected women which accepted routine ultrasonic examination between the gestation of 18 to 40 weeks in Zhujiang hospital of Southern Medical University as our research subject and finally collected 66 women with GDM and 134 uncomplicated pregnancies.The study was originated from national multi-center research of fetal HQ.All the women would sign for consent before the examination.A four-chamber oblique view was analyzed offline with fetal HQ which was based on the principle of speckle-tracking and the system would automatically output a report regarding the measurement of fetal shape and function,including the figure and responding Z score of 4CV(four-chamber-view)width,4CV length,4CV global spherical index(GSI),4CV area,24 segmental end-diastolic diameter(ED),24 segmental spherical index(SI),ejection fraction(EF),cardiac output(CO),stroke volume(SV),ventricular fractional area change(FAC),longitudinal global strain(GLS)and 24 segmental fractional shortening(FS).Except for that,the myocardial performance index(MPI)were measured to reflect fetal cardiac overall systolic and diastolic function.All the data was tested for normal distribution.We compared 66 women of GDM with 66 controls of matched gestation to find out the integral changes.Additionally,64 women of GDM and 131 controls were grouped by second trimester and third trimester to find out the variation in different stage.Independent Sample t-test or Mann-Whitney U test were performed to compare the discrepancy between the GDM group and controls.Pearson correlation analysis was to evaluate the relationship between cardiac parameters and gestation or glycosylated hemoglobin.The ROC curve was applied for assess fetal cardiac functional indices’ predictive value for adverse perinatal outcome.Results:In general,compared with women in the controlled group,women with GDM were older(30 years vs 28 years;P=0.015),had higher body mass index(24.29kg/m2 vs 22.57kg/m2;P=0.001)and higher glycosylated hemoglobin(5.4%vs 5.3%,P=0.002),and increasing rate for admission of neonatal intensive care unit(35%vs 6%).In fetuses of women with GDM,there was a declining tendency in the systolic function of right ventricle including 24-segments fractional shortening(FS),longitudinal global strain(GLS,-21.20%vs 22.57%,P=0.001)as well as fractional area change(FAC,37.46%vs 42.05%,P<0.001).The overall shape of fetal heart got more rounder with decreasing global spherical index(GSI,0.09 vs 1.12,P=0.001).Myocardial performance index(MPI)and 24-segments end-diastolic diameters(ED)or sphericity index(SI)for both ventricles showed no difference.There was no variation in the functional parameters of left ventricle.When grouped by gestation,it was founded that there were parts of the biventricular 24-segements ED reduced as well as declining cardiac out of left ventricle in the second trimester.However,in the third trimester,the difference between GDM and the controlled indicated a significantly descending function only in the right ventricle.The area under the ROC curve of 4CV area,4CV GSI,biventricular FAC and GLS,EF,SV,CO were below 0.7 which illustrated no statistical discrepancy.There was no correlation between gestation and FAC,GLS,4CV GSI or 24-segement FS for the result of Pearson analysis.And glycosylated hemoglobin seemed to be inversely associated with partially functional parameters in the left ventricle and be unrelated with morphological measurement.Conclusion:The study suggests that gestational diabetes mellitus is harmful for fetal heart especially shown in the declining systolic function of the right ventricle.The function in the left ventricle is reserved essentially but may present with a transiently compensatory damage in the second trimester.The regional fetal heart function is limited to predict fetal adverse perinatal outcome.