University of Oulu

Lehtoranta, L, Haapsamo, M, Vuolteenaho, O, Palo, P, Ekholm, E, Räsänen, J. Fetal cardiovascular hemodynamics in type 1 diabetic pregnancies at near‐term gestation. Acta Obstet Gynecol Scand. 2021; 100: 263– 271. https://doi.org/10.1111/aogs.13987

Fetal cardiovascular hemodynamics in type 1 diabetic pregnancies at near‐term gestation

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Author: Lehtoranta, Lara1,2,3; Haapsamo, Mervi2,4; Vuolteenaho, Olli2;
Organizations: 1Department of Obstetrics and Gynecology, University of Turku, and Turku University Hospital, Turku, Finland
2Institute of Biomedicine, Department of Physiology, University of Oulu, Oulu, Finland
3The Research center of Applied and Preventive Cardiovascular Medicine (CAPC), University of Turku, Turku, Finland
4Satakunta Central Hospital, Pori, Finland
5Fetal Medicine Center, Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Format: article
Version: accepted version
Access: embargoed
Persistent link: http://urn.fi/urn:nbn:fi-fe2021042211435
Language: English
Published: John Wiley & Sons, 2021
Publish Date: 2021-09-02
Description:

Abstract

Introduction: Poor glycemic control in maternal type 1 diabetes mellitus during pregnancy can affect fetal cardiac and placental function. However, studies concerning fetal central hemodynamics have revealed conflicting results. We hypothesized that in pregnancies complicated by maternal type 1 diabetes, fetal cardiovascular and placental hemodynamics are comparable to the control fetuses at near‐term gestation. In addition, we investigated the relation between newborn serum biomarkers of cardiac function and fetal cardiovascular and placental hemodynamics. Furthermore, we studied whether maternal diabetes is associated with placental inflammation.

Material and methods: In this prospective case‐control study, fetal central and peripheral hemodynamics were assessed by ultrasonography in 33 women with type 1 diabetes and in 67 controls with singleton pregnancies between 34+2 and 40+2 gestational weeks. Newborn umbilical cord serum was collected to analyze cardiac natriuretic peptides (atrial and B‐type natriuretic peptides) and troponin T concentrations. Placental tissue samples were obtained for cytokine analyses.

Results: Fetal ventricular wall thicknesses were greater and weight‐adjusted stroke volumes and cardiac outputs were lower in the type 1 diabetes group than in the control group. Pulsatility in the aortic isthmus and inferior vena cava blood flow velocity waveforms was greater in the type 1 diabetes group fetuses than in the controls. A positive correlation was found between branch pulmonary artery and aortic isthmus pulsatility index values. Umbilical artery pulsatility indices were comparable between the groups. Umbilical cord serum natriuretic peptide and troponin T concentrations were elevated in the type 1 diabetes fetuses. These cardiac biomarkers correlated significantly with cardiovascular hemodynamics. Placental cytokine levels were not different between the groups.

Conclusions: In maternal type 1 diabetes pregnancies, fetal cardiovascular hemodynamics is impaired. Maternal type 1 diabetes does not seem to alter placental vascular impedance or induce placental inflammation.

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Series: Acta obstetricia et gynecologica Scandinavica
ISSN: 0001-6349
ISSN-E: 1600-0412
ISSN-L: 0001-6349
Volume: 100
Issue: 2
Pages: 263 - 271
DOI: 10.1111/aogs.13987
OADOI: https://oadoi.org/10.1111/aogs.13987
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
3123 Gynaecology and paediatrics
Subjects:
Funding: This study was supported by grants from The Diabetes Research Foundation of The Finnish Diabetes Association, The Turku University Hospital Research Foundation, and The National Graduate School of Clinical Investigation.
Copyright information: © 2020 Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Published by John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Lehtoranta, L, Haapsamo, M, Vuolteenaho, O, Palo, P, Ekholm, E, Räsänen, J. Fetal cardiovascular hemodynamics in type 1 diabetic pregnancies at near‐term gestation. Acta Obstet Gynecol Scand. 2021; 100: 263– 271, which has been published in final form at https://doi.org/10.1111/aogs.13987. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.