| ObjectiveTo analyze the influence on different blood glucose levels on maternal and fetal heart function in patients with gestational diabetes mellitus in mid trimester of pregnancy and late pregnancy.Methods1.Study subjects: The 210 cases of gestational diabetes mellitus were selected from September 2013 to December 2015.Their age of onset were from 25 to 40 years old.their average age were(33.69±8.17)years old and their gestational age were 23 to 25 weeks of pregnancy.The average gestational weeks were(23.18±1.74)years old.all of which were singleton pregnancy.The first ultrasound examination ruled out fetal congenital malformation.2.Research group: All study objects were divided into three groups.The patients with gestational diabetes mellitus were divided into the good glycemic control group which were 135 cases and the poor glycemic control group which were 72 cases,Meanwhile,the80 cases normal pregnant women were selected as the control group subjects.3.Study methods: All study objects were detected the structure and function parameters on heart by echocardiography in mid trimester of pregnancy and late pregnancy,The serum levels of high sensitivity C reactive protein in maternal serum were detected by latex enhanced immunoassay and the plasma levels of BNP were detected by immunofluorescence.4.Ultrasound indicators:? Maternal cardiac examination index: Left ventricular ejection fraction(LVEF,%),leftventricular end diastolic diameter(LVEDd,mm),left ventricular end systolic diameter(LVEDs,mm),left atrial diameter(LAD,mm),ventricular septal thickness(IVST,mm),left ventricular posterior wall thickness(LVPWT,mm);mitral diastolic filling velocity/mitral diastolic filling velocity(E/A);mitral diastolic filling velocity/early diastolic mitral annulus velocity peak ratio(E/Ea).? Fetal cardiac structure parameters: Diastolic left ventricular posterior wall thickness(lvpwd,mm),interventricular septal thickness(IVSD,mm),right ventricular anterior wall thickness(rvaw,mm,aortic diameter(AO,mm),pulmonary artery diameter(PA,mm).? Fetal heart function parameters: left and right ventricular ejection fraction(%),E/A ratio(E/ATV),E/A ratio,mitral ratio(E/AMV),mitral E/Em ratio(E/EmMV),E/A ratio(E/ATV),mitral annular displacement(MAD,mm),tricuspid annular displacement(TAD,mm).Results1.In the second trimester,the left ventricular ejection fraction,left ventricular end diastolic diameter,left ventricular end diastolic diameter,left atrial diameter,ventricular septal thickness and left ventricular posterior wall thickness were not significantly different between the poor glycemic control group,the good glycemic control group and the control group(P>0.05).Mitral diastolic filling velocity,mitral diastolic filling velocity,early filling velocity of mitral diastolic filling velocity/peak ratio of mitral annulus velocity,plasma natriuretic peptide and serum C reactive protein level were statistically significant(P<0.05).Among them,there were significant differences in hs-CRP,E/Ea,BNP and E/A between the control glycemic group and the control group,the poor glycemic control group and the control group(P<0.05).There was no significant difference between the good glycemic control group and the control group(P>0.05).2.There was no significant difference in left ventricular ejection fraction and left ventricular end systolic diameter between the poor glycemic control group,the goodglycemic control group and the control group in the third trimester of pregnancy(P>0.05).Left ventricular end diastolic diameter,left atrial diameter,ventricular septal thickness,left ventricular posterior wall thickness mitral diastolic filling velocity/mitral diastolic filling velocity,mitral diastolic filling velocity/early diastolic mitral annulus velocity peak ratio,plasma natriuretic peptide,serum C reactive protein level differences were statistically significant(P<0.05).Among them,there were significant differences.LVEDs,LAD,IVST,LVPWT,E/A,hs-CRP,BNP,E/Ea,and LVEDd between the difference control group and the control group,the difference control group and the control group.The difference of E/A,E/Ea,hs-CRP and BNP between the control group and the control group was statistically significant(P<0.05).3.In the second trimester of pregnancy,The fetal left ventricular diastolic wall thickness,diastolic interventricular septal thickness,anterior right ventricular diastolic wall thickness,aorta,pulmonary artery diameter differences have no statistical significance among the poor control,optimal control group and control group(P>0.05).4.In the third trimester of pregnancy,Fetal left ventricular diastolic wall thickness,the aortic diameter difference have no statistical significance among the poor control,optimal control group and control group(P>0.05).There was statistical significance of interventricular septum thickness,right ventricular anterior wall thickness,diastolic pulmonary artery diameter difference(P<0.05).5.There was no significant difference in the left ventricular ejection fraction,mitral E/A ratio and E/Em ratio between the left and right ventricular ejection fraction(E/AMV)and mitral valve in the poor control,optimal control group and control group.There were significant differences in the ratio of E/A in tricuspid valve,the ratio of E/Em in tricuspid valve,there was no significant difference between mitral annular displacement(MAD)and tricuspid annular displacement(TAD)(P<0.05).6.The left and right ventricular ejection fraction,E/A ratio in mitral valve,E/Em ratio in mitral valve,E/A ratio in tricuspid valve,E/Em ratio in tricuspid valve have significantdifferences in three group(P<0.05).Among them,there was no significant difference between the optimal control group and control group(P>0.05).7.Maternal plasma BNP levels were moderately correlated with fetal E/EmMVE,/EmTV,MAD and TAD,and the correlation coefficients were(r=0.482;0.578;0.420;0.519;P<0.05).Conclusion1.The high blood glucose levels can damage heart structure and diminish cardiac function in fetus and pregnant women with gestational diabetes mellitus.2.The correlation between the plasma natriuretic peptide and the maternal and fetal cardiac diastolic function is so close.Changes in plasma BNP levels during pregnancy can contribute to maternal and fetal heart function monitoring. |
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