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da Silva OA, Duarte GP, Lahlou S. Maternal Hyperglycemia Induces Autonomic Dysfunction and Heart Failure in Older Adult Offspring. Exp Clin Endocrinol Diabetes 2023; 131:615-623. [PMID: 37758043 DOI: 10.1055/a-2159-6468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
AIMS Offspring exposed to an adverse fetal environment, such as gestational diabetes, may manifest increased susceptibility to several chronic diseases later in life. In the present study, the cardiovascular function of three different ages of offspring from diabetic rats was evaluated. METHODS AND RESULTS Diabetes mellitus was induced in pregnant rats by a single dose of streptozotocin (50 mg/kg). The offspring from diabetic (OD) and control rats (OC) were evaluated at three different ages: 6, 12 or 18 months. In the corresponding OC groups, fasting glycemia, baseline mean arterial pressure, and sympathetic tonus increased in the OD rats at 12 (OD12) and 18 (OD18) months of age, while cardiac hypertrophy was observed in all OD groups. Cardiac function evaluation in vivo showed low left ventricular systolic pressure and+dP/dt in the OD18 rats, suggesting a systolic dysfunction. OD12 and OD18 groups showed high left ventricle end-diastolic pressure, suggesting a diastolic dysfunction. OD groups showed an age-related impairment of both baroreflex-mediated tachycardia and baroreflex-mediated bradycardia in OD12 and OD18 rats. In isolated hearts from OD18 rats, both inotropic and tachycardiac responses to increasing isoproterenol were significantly reduced compared to the corresponding OC group. CONCLUSION These results suggest that gestational diabetes triggers the onset of hyperglycemia hypertension with impaired baroreflex sensitivity and heart failure in older age of offspring, representing important risk factors for death. Therefore, ensuring optimal glycemic control in diabetic pregnancy is important and serves as a key to preventing cardiovascular disease in the offspring in their older age.
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Affiliation(s)
- Odair Alves da Silva
- Department of Physiology and Pharmacology, Federal University of Pernambuco, Recife, Brazil
| | - Glória Pinto Duarte
- Department of Physiology and Pharmacology, Federal University of Pernambuco, Recife, Brazil
| | - Saad Lahlou
- Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
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Hoodbhoy Z, Mohammed N, Nathani KR, Sattar S, Chowdhury D, Maskatia S, Tierney S, Hasan B, Das JK. The Impact of Maternal Preeclampsia and Hyperglycemia on the Cardiovascular Health of the Offspring: A Systematic Review and Meta-analysis. Am J Perinatol 2023; 40:363-374. [PMID: 33940650 DOI: 10.1055/s-0041-1728823] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The objective of this review was to assess the impact of maternal preeclampsia or hyperglycemia on the body composition and cardiovascular health in the offspring. STUDY DESIGN We conducted a systematic review utilizing PubMed, EBSCO, CINAHLPlus, Cochrane Library, and Web of Science to include all studies assessing the impact of preeclampsia/eclampsia and/or gestational/pregestational diabetes mellitus on the health of the offspring (children <10 years of age). The health measures included anthropometry, cardiac dimensions and function, and vascular function. We performed a meta-analysis using Review Manager software and computed net risk ratio (RR) with 95% confidence interval (CI) for dichotomous data and mean difference (MD) with 95% CI for continuous data. RESULTS There were 6,376 studies in total, of which 45 were included in the review and 40 in the meta-analysis. The results demonstrated higher birth weight (MD: 0.12 kg; 95% CI: 0.06-0.18) and systolic and diastolic blood pressure (BP; MD: 5.98 mm Hg; 95% CI: 5.64-6.32 and MD: 3.27 mm Hg; 95% CI: 0.65-5.89, respectively) in the offspring of mothers with gestational diabetes compared to controls. In contrast, the offspring of mothers with preeclampsia had lower birth weight (MD: -0.41 kg; 95% CI: -0.7 to -0.11); however, they had increased systolic (MD: 2.2 mm Hg; 95% CI: 1.28-3.12) and diastolic BP (MD: 1.41 mm Hg; 95% CI: 0.3-2.52) compared to controls. There is lack of data to conduct a meta-analysis of cardiac morphology, functional, and vascular imaging parameters. CONCLUSION These findings suggest that the in-utero milieu can have a permanent impact on the body composition and vascular health of the offspring. Future work warrants multicenter prospective studies to understand the mechanism and the actual effect of exposure to maternal hyperglycemia and high BP on the cardiovascular health of the offspring and long-term outcomes. KEY POINTS · Adverse in-utero exposures may have an impact on cardiovascular risk in children.. · Maternal hyperglycemia/preeclampsia lead to changes in birthweight and BP.. · Limited echocardiographic and vascular imaging data in these cohorts necessitates future work..
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Affiliation(s)
- Zahra Hoodbhoy
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Nuruddin Mohammed
- Department of Obstetrics and Gynecology, The Aga Khan University, Karachi, Pakistan
| | | | - Saima Sattar
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | | | - Shiraz Maskatia
- Department of Paediatrics, Stanford University, Stanford, California
| | - Seda Tierney
- Department of Paediatrics, Stanford University, Stanford, California
| | - Babar Hasan
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
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Braginsky L, Weiner SJ, Saade GR, Varner MW, Blackwell SC, Reddy UM, Thorp JM, Tita AT, Miller RS, McKenna DS, Chien EK, Rouse DJ, El-Sayed YY, Sorokin Y, Caritis SN. Intrapartum Fetal Electrocardiogram in Small- and Large-for-Gestational Age Fetuses. Am J Perinatol 2021; 38:1465-1471. [PMID: 34464982 PMCID: PMC8608729 DOI: 10.1055/s-0041-1735285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate whether intrapartum fetal electrocardiogram (ECG) tracings with ST-elevation or depression occur more frequently in each stage of labor in small-for-gestational age (SGA) or large-for-gestational age (LGA), as compared with appropriate-for-gestational age (AGA) fetuses. STUDY DESIGN We conducted a secondary analysis of a large, multicenter trial in which laboring patients underwent fetal ECG waveform-analysis. We excluded participants with diabetes mellitus and major fetal anomalies. Birth weight was categorized as SGA (<10th percentile), LGA (>90th percentile), or AGA (10-90th percentile) by using a gender and race/ethnicity specific nomogram. In adjusted analyses, the frequency of ECG tracings with ST-depression or ST-elevation without depression was compared according to birthweight categories and labor stage. RESULTS Our study included 4,971 laboring patients in the first stage and 4,074 in the second stage. During the first stage of labor, there were no differences in the frequency of ST-depression in SGA fetuses compared with AGA fetuses (6.7 vs. 5.5%; adjusted odds ratio [aOR]: 1.41, 95% confidence interval [CI]: 0.93-2.13), or in ST-elevation without depression (35.8 vs. 34.1%; aOR: 1.17, 95% CI: 0.94-1.46). During the second stage, there were no differences in the frequency of ST-depression in SGA fetuses compared with AGA fetuses (1.6 vs. 2.0%; aOR: 0.69, 95% CI: 0.27-1.73), or in ST-elevation without depression (16.2 vs. 18.1%; aOR: 0.90, 95% CI: 0.67-1.22). During the first stage of labor, there were no differences in the frequency of ST-depression in LGA fetuses compared with AGA fetuses (6.3 vs. 5.5%; aOR: 0.97, 95% CI: 0.60-1.57), or in ST-elevation without depression (33.1 vs. 34.1%; aOR: 0.80, 95% CI: 0.62-1.03); during the second stage of labor, the frequency of ST-depression in LGA compared with AGA fetuses (2.5 vs. 2.0%, aOR: 1.36, 95% CI: 0.61-3.03), and in ST-elevation without depression (15.5 vs. 18.1%; aOR: 0.83, 95% CI: 0.58-1.18) were similar as well. CONCLUSION The frequency of intrapartum fetal ECG tracings with ST-events is similar among SGA, AGA, and LGA fetuses. KEY POINTS · SGA and LGA neonates are at increased risk of cardiac dysfunction.. · Fetal ECG has been used to evaluate fetal response to hypoxia.. · Fetal ST-elevation and ST-depression occur during hypoxia.. · Frequency of intrapartum ST-events is similar among SGA, AGA and LGA fetuses..
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Affiliation(s)
- Lena Braginsky
- Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Steven J. Weiner
- Departments of Obstetrics and Gynecology, George Washington University Biostatistics Center, Washington, District of Columbia
| | - George R. Saade
- Departments of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Michael W. Varner
- Departments of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Sean C. Blackwell
- Departments of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas
| | - Uma M. Reddy
- Departments of Obstetrics and Gynecology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - John M. Thorp
- Departments of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alan T.N. Tita
- Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Russell S. Miller
- Departments of Obstetrics and Gynecology, Columbia University, New York City, New York
| | - David S. McKenna
- Departments of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Edward K.S. Chien
- Departments of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio
| | - Dwight J. Rouse
- Departments of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Yasser Y. El-Sayed
- Departments of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Yoram Sorokin
- Departments of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Steve N. Caritis
- Departments of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Antolic A, Richards EM, Wood CE, Keller-Wood M. A Transcriptomic Model of Postnatal Cardiac Effects of Prenatal Maternal Cortisol Excess in Sheep. Front Physiol 2019; 10:816. [PMID: 31333485 PMCID: PMC6616147 DOI: 10.3389/fphys.2019.00816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/11/2019] [Indexed: 12/25/2022] Open
Abstract
In utero treatment with glucocorticoids have been suggested to reprogram postnatal cardiovascular function and stress responsiveness. However, little is known about the effects of prenatal exposure to the natural corticosteroid, cortisol, on postnatal cardiovascular system or metabolism. We have demonstrated an increased incidence of stillbirth in sheep pregnancies in which there is mild maternal hypercortisolemia caused by infusion of 1 mg/kg/d cortisol. In order to model corticosteroid effects in the neonate, we created a second model in which cortisol was infused for 12 h per day for a daily infusion of 0.5 mg/kg/d. In this model we had previously found that neonatal plasma glucose was increased and plasma insulin was decreased compared to those in the control group, and that neonatal ponderal index and kidney weight were reduced and left ventricular wall thickness was increased in the 2 week old lamb. In this study, we have used transcriptomic modeling to better understand the programming effect of this maternal hypercortisolemia in these hearts. This is a time when both terminal differentiation and a shift in the metabolism of the heart from carbohydrates to lipid oxidation are thought to be complete. The transcriptomic model indicates suppression of genes in pathways for fatty acid and ketone production and upregulation of genes in pathways for angiogenesis in the epicardial adipose fat (EAT). The transcriptomic model indicates that RNA related pathways are overrepresented by downregulated genes, but ubiquitin-mediated proteolysis and protein targeting to the mitochondria are overrepresented by upregulated genes in the intraventricular septum (IVS) and left ventricle (LV). In IVS the AMPK pathway and adipocytokine signaling pathways were also modeled based on overrepresentation by downregulated genes. Peroxisomal activity is modeled as increased in EAT, but decreased in LV and IVS. Our results suggest that pathways for lipids as well as cell proliferation and cardiac remodeling have altered activity postnatally after the in utero cortisol exposure. Together, this model is consistent with the observed increase in cardiac wall thickness at necropsy and altered glucose metabolism observed in vivo, and predicts that in utero exposure to excess maternal cortisol will cause postnatal cardiac hypertrophy and altered responses to oxidative stress.
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Affiliation(s)
- Andrew Antolic
- Department of Pharmacodynamics, University of Florida, Gainesville, FL, United States
| | - Elaine M Richards
- Department of Pharmacodynamics, University of Florida, Gainesville, FL, United States.,Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, United States
| | - Charles E Wood
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, United States
| | - Maureen Keller-Wood
- Department of Pharmacodynamics, University of Florida, Gainesville, FL, United States
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Blais S, Patenaude J, Doyon M, Bouchard L, Perron P, Hivert MF, Dallaire F. Effect of gestational diabetes and insulin resistance on offspring's myocardial relaxation kinetics at three years of age. PLoS One 2018; 13:e0207632. [PMID: 30462720 PMCID: PMC6248989 DOI: 10.1371/journal.pone.0207632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/02/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Scientific evidence on the long-term impact of gestational diabetes mellitus (GDM) on offspring's myocardial relaxation is scarce. Studies have linked GDM with transient ventricular hypertrophy in newborns resulting in diastolic dysfunction, but long-term assessment is lacking. The main objective of this study was to evaluate myocardial relaxation in 3-year-old children in relation to the degree of insulin resistance of their mother during pregnancy. METHODS We prospectively assessed myocardial relaxation by echocardiography imaging on 106 children at 3 years of age. Subjects were divided into 3 groups [GDM, insulin resistance (IR) and normoglycemic (CTRL)], based on their mother's 75g-OGTT and HOMA-IR results at second trimester screening. We collected information on children adiposity and body size, maternal characteristics and maternal and cord blood measurement of C-peptide and insulin. RESULTS The study population comprised 29 children from GDM mothers, 36 children from IR mothers and 41 CTRL children. Compared to the CTRL group, we found that a higher proportion of children in the IR group and the GDM group met the criteria for impaired myocardial relaxation, but this did not reach statistical significance (odds ratio adjusted for heart rate and body surface area of 1.4 [0.2-9.5] and 3.5 [0.6-20.6], respectively). CONCLUSION We did not detect an increased risk of impaired myocardial relaxation at three years of age in children exposed in-utero to IR and GDM, compared to children from normoglycemic mothers.
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Affiliation(s)
- Samuel Blais
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Julie Patenaude
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Myriam Doyon
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Luigi Bouchard
- Department of Biochemistry, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- ECOGENE-21 Biocluster, Chicoutimi, Quebec, Canada
| | - Patrice Perron
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-France Hivert
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Frederic Dallaire
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
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Cardiac adaptations in SCNT newborn cloned calves during the first month of life assessed by echocardiography. Theriogenology 2017; 103:153-161. [DOI: 10.1016/j.theriogenology.2017.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 11/17/2022]
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Mert MK, Satar M, Özbarlas N, Yaman A, Özgünen FT, Asker HS, Çekinmez EK, Tetiker T. Troponin T and NT ProBNP Levels in Gestational, Type 1 and Type 2 Diabetic Mothers and Macrosomic Infants. Pediatr Cardiol 2016; 37:76-83. [PMID: 26266327 DOI: 10.1007/s00246-015-1242-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Abstract
This study compares NT proBNP and troponin T levels in umbilical cord arterial blood and postnatal echocardiographic findings for infants of gestational and pregestational diabetic mothers and macrosomic infants. Twenty-seven infants of pregestational diabetic mothers, 61 infants of gestational diabetic mothers and 37 macrosomic infants of nondiabetic mothers were prospectively enrolled in this study along with a control group of 58 healthy infants of mothers without any pregestational or gestational disorders as the control group. All enrollees were born after 34 weeks of gestation. For this study, umbilical cord blood was drawn during delivery to determine NT proBNP and troponin T levels. Echocardiography was performed 24-72 h after the delivery. Umbilical cord troponin T and NT proBNP levels were found to be higher in the diabetic and macrosomic groups than in the control group (all of them p < 0.001). NT proBNP levels were positively correlated with interventricular septum thickness in the pregestational and gestational infants of diabetic mothers groups (r = 0.564 and r = 0.560, respectively, p < 0.01). Both pregestational and gestational diabetic mothers were divided into two groups according to HbA1c levels in the third trimester as good (<6.1 %) and suboptimal (>6.1 %) metabolic control. In the good and suboptimal metabolic control diabetic groups, NT proBNP levels were also positively correlated with interventricular septum thickness (r = 0.536 and r = 0.576, respectively, p < 0.01). In the suboptimal metabolic control diabetic group, NT proBNP was only found to be positively correlated with the left ventricular mass index (r = 0.586, p < 0.01). While there was no correlation in the myocardial performance index between infants of diabetic mothers and the control group, the myocardial performance index of macrosomic infants was lower than that of the control group (p = 0.017). Cardiac biomarkers (NT proBNP and troponin T) were elevated in infants of diabetic mothers and macrosomic infants. While there was a positive correlation between NT proBNP levels and cardiac structure in infants of pregestational and gestational diabetic mothers, there was no relationship between NT proBNP levels and cardiac function.
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Affiliation(s)
- Mustafa Kurthan Mert
- Department of Neonatology, Çukurova University Faculty of Medicine, Toros Mahallesi, 78050 Sok. Havuz Apt. Kat: 9 No: 9, 01170, Çukurova, Adana, Turkey.
| | - Mehmet Satar
- Department of Neonatology, Çukurova University Faculty of Medicine, Toros Mahallesi, 78050 Sok. Havuz Apt. Kat: 9 No: 9, 01170, Çukurova, Adana, Turkey
| | - Nazan Özbarlas
- Department of Pediatric Cardiology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Akgün Yaman
- Central Laboratory, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Fatma Tuncay Özgünen
- Department of Obstetrics and Gynecology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Hüseyin Selim Asker
- Department of Neonatology, Çukurova University Faculty of Medicine, Toros Mahallesi, 78050 Sok. Havuz Apt. Kat: 9 No: 9, 01170, Çukurova, Adana, Turkey
| | - Eren Kale Çekinmez
- Department of Neonatology, Çukurova University Faculty of Medicine, Toros Mahallesi, 78050 Sok. Havuz Apt. Kat: 9 No: 9, 01170, Çukurova, Adana, Turkey
| | - Tamer Tetiker
- Department of Endocrinology and Metabolism, Çukurova University Faculty of Medicine, Adana, Turkey
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Roodpeyma S, Rafieyian S, Khosravi N, Hashemi A. Cardiovascular Complications in Infants of Diabetic Mothers: An Observational Study in a Pediatric Cardiology Clinic in Tehran. ACTA ACUST UNITED AC 2013. [DOI: 10.17795/compreped-8432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cardiovascular Complications in Infants of Diabetic Mothers: An Observational Study in a Pediatric Cardiology Clinic in Tehran. ACTA ACUST UNITED AC 2013. [DOI: 10.5812/jcp.8432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Cardiac function in 7-8-year-old offspring of women with type 1 diabetes. EXPERIMENTAL DIABETES RESEARCH 2011; 2011:564316. [PMID: 22144987 PMCID: PMC3227501 DOI: 10.1155/2011/564316] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Revised: 08/17/2011] [Accepted: 08/29/2011] [Indexed: 11/17/2022]
Abstract
Offspring of type 1 diabetic mothers (ODMs) are at risk of short-term and long-term complications, such as neonatal macrosomia (birth weight >90th percentile), hypertrophic cardiomyopathy, and cardiovascular morbidity in later life. However, no studies have been performed regarding cardiac outcome. In this study, we investigated cardiac dimensions and function in 30 ODMs at 7-8 years of age in relation to neonatal macrosomia and maternal glycemic control during pregnancy and compared these with those in a control group of 30 children of nondiabetic women. We found that cardiac dimensions and systolic and diastolic function parameters in ODMs were comparable with those in controls. Neonatal macrosomia and poorer maternal glycemic control during pregnancy were not related to worse cardiac outcome in ODM. We conclude that cardiac function at 7-8 years of age in offspring of women with type 1 diabetes is reassuring and comparable with that in controls.
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Atabek ME, Hasret Çağan H, Selver Eklioğlu B, Oran B. Absence of increase in carotid artery intima-media thickness in infants of diabetic mothers. J Clin Res Pediatr Endocrinol 2011; 3:144-8. [PMID: 21911328 PMCID: PMC3184516 DOI: 10.4274/jcrpe.v3i3.28] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Infants of diabetic mothers (IDM) are considered as a risk group for atherosclerosis. Increased aortic intima-media thickness has been reported in IDM. The purpose of this study was to assess carotid artery intima-media thickness (CA-IMT), left ventricular mass index (LVMI) and atherosclerotic risk factors in IDM. METHODS Thirty IDM and 25 healthy controls were included in the study. Of these infants, 14 were appropriate-for-gestational age (AGA) and 16 were large-for-gestational age (LGA). CA-IMT and LVMI were obtained by M-mode echocardiographic examination. The relationship between parameters of atherosclerosis and echocardiographic measurements was assessed by Pearson's correlation analysis. RESULTS LVMI was higher in LGA IDM when compared to AGA IDM and controls. CA-IMT was not significantly different between the groups and was also not related to atherosclerotic risk factors. Serum lipid and insulin levels were higher in LGA IDM when compared with AGA IDM and controls. There were no correlations between CA-IMT, LVMI and atherosclerotic risk factors. CONCLUSIONS In contrast to previous reports indicating an increase in CA-IMT in IDM, no differences were found between IDM and controls in this study. Our results indicate that macrosomic IDM are prone to hypertrophic cardiomyopathy but not to atherosclerotic changes in the blood vessels.
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Affiliation(s)
- Mehmet Emre Atabek
- Selçuk University School of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Havva Hasret Çağan
- Selçuk University, School of Medicine, Department of Pediatrics, Konya, Turkey
| | - Beray Selver Eklioğlu
- Selçuk University School of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Bülent Oran
- Selçuk University, School of Medicine, Department of Pediatric Cardiology, Konya,
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West NJ, Thorpe M. Neonatal hyperinsulinism secondary to maternal intake of high-sugar drinks. BMJ Case Rep 2011; 2011:bcr.03.2011.3990. [PMID: 22689550 DOI: 10.1136/bcr.03.2011.3990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors report a macrosomic term male infant who developed refractory hyperinsulinism requiring 20 mg/kg/min intravenous dextrose (usual range 4-6 mg/kg/min) and treatment with diazoxide 10 mg/kg/day. His blood insulin level at 6 h of age was 22.3 mU/l (reference range <5 mU/l) with corresponding laboratory blood glucose of 0.3 mmol/l. There was no detected maternal diabetes but the mother revealed she drank 2 l of 'lucozade energy' a day in the past 3 months of pregnancy. The hyperinsulinism resolved by day 7. Transient neonatal hyperinsulinism is known to be associated with maternal diabetes but has not previously been reported as secondary to high maternal sugar intake. This case highlights that significant hypoglycaemia secondary to transient hyperinsulinism can occur in infants of mothers without identified diabetes.
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Affiliation(s)
- Nicol Jon West
- Department of Paediatrics, Bristol Children's Hospital, Bristol, UK.
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Agoudemos M, Reinking BE, Koppenhafer SL, Segar JL, Scholz TD. Programming of adult cardiovascular disease following exposure to late-gestation hyperglycemia. Neonatology 2011; 100:198-205. [PMID: 21455011 PMCID: PMC3085032 DOI: 10.1159/000324863] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 02/03/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND In utero exposure to hyperglycemia is becoming increasingly prevalent as the number of women entering pregnancy with type II diabetes, or developing gestational diabetes, increases. Both animal studies and epidemiologic investigations have found cardiovascular abnormalities in adult offspring of hyperglycemic mothers (OHM). OBJECTIVE We hypothesized that adult OHM would have abnormal cardiac function in vivo and increased susceptibility to ischemia. METHODS Pregnant rats were made diabetic on day 12 of gestation. Serum glucose was monitored twice daily and insulin provided to maintain serum glucose at 200-400 mg/dl. Offspring were fostered to normal mothers after birth. Adult OHM were studied at 8-10 months of age with echocardiography to assess in vivo cardiac function and isolated hearts to determine the response to ischemia. RESULTS Echocardiography found significant diastolic dysfunction in male OHM compared to male controls. In isolated hearts, baseline cardiac function and left ventricular compliance was significantly diminished in male OHM compared to controls. Ischemia caused a significant decline in heart function in controls and female OHM, while function in male OHM remained unchanged. CONCLUSIONS Adult male OHM demonstrate programmed cardiac dysfunction. Given the growing number of pregnancies complicated by hyperglycemia, additional assessment of cardiac function of adults born to diabetic mothers may be warranted.
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Affiliation(s)
- Melissa Agoudemos
- Department of Pediatrics, University of Iowa, Iowa City, Iowa 52242-1083, USA
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Baykan A, Cansever M, Konuskan B, Nihal H, Kazim U, Nazmi N. Hypertrophic cardiomyopathy with leprechaunism. J Pediatr Endocrinol Metab 2008; 21:317-8. [PMID: 18556961 DOI: 10.1515/jpem.2008.21.4.317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ali Baykan
- Department of Pediatrics, Erciyes University, Kayseri, Turkey.
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