Aspects of cardiac involvement in infants of diabetic mothers

Introduction: Cardiac involvement is one of the most important clinical manifestations of newborn of diabetic mother (IDM): insulin-dependant diabetes: 0.5% of all pregnancies and 3-5% of women with gestational diabetes. IDM: cardiac problems: *hypertrophic cardio myopathy – 30% of IDMs; *congestive heart failure: 10% of cases; congenital cardiac malformations: VSD, TGA, DSA, DORV, TA, dextrocardia Objectives: To evaluate the main aspects of cardiac involvement in newborn infants of diabetic mothers. Methods: Patients:115 newborns of diabetic mothers, followed up over a period of 10 years. Patients were investigated in the first week of life and 73 were re-evaluated at 6-12 month, by clinical exam, ECG, cardiothoracic radiography (Rx.CT) and Doppler echocardiography (echo) for congenital and/or acquired cardiac diseases. Fetal echo was performed in 48 cases after 28 weeks of gestation. Results: Fetal echo: cardiomegaly and myocardial hyper trophy of LV (19 cases). Clinical cardiac exam in newborn: heart failure (4 cases), systolic murmur (52), the other being asymptomatic with signs for other extra cardiac pathology. ECG: LV hypertrophy (24). Rx.CT: cardiomegaly (14 cases). Echo: non obstructive hypertrophic cardiomyopathy with asymmetric IVS hypertrophy (41%), arterial pulmonary hypertension (6), LV diastolic dysfunction, normal systolic function (53 % of cases), congenital cardiac anomalies: 21 cases. LV myocardial hypertrophy was correlated rather with an inadequate control of maternal diabetes. Control at 6-12 months: a normal morphological cardiac aspect, normal diastolic and systolic LV functions. Conclusions: Newborn of diabetic mother presents a high risk for cardiac involvement, either cardiac congenital malformations (17 %) or acquired cardiac pathology: hypertrophic cardiomyopathy (41% of cases) and disturbances of diastolic function of LV (53%).Th is fact justifi es early cardiologic screening for all of these newborns with or without of cardiac suff ering symptoms. Fetal echo provides useful data for diabetic pregnant women and should be made mandatory to all these patients. Echocardiography is the most sensitive and noninvasive method of investigation, useful for primary diagnostic as well as for follow up of cardiac involvement in newborn infant of diabetic mothers.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
ESC search engine
CODE: 379
CME Credits: 10 (Romanian College of Physicians)