Fetal cardiovascular hemodynamics in type 1 diabetic pregnancies at near‐term gestation
Lehtoranta, Lara; Haapsamo, Mervi; Vuolteenaho, Olli; Palo, Pertti; Ekholm, Eeva; Räsänen, Juha (2020-09-02)
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
© 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.
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https://urn.fi/URN:NBN:fi-fe2021042211435
Tiivistelmä
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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