Prevalence of Hypertrophic Cardiomyopathy in Neonates of Diabetic Mothers: A Six-month Follow-up Study

Document Type : Original Article

Authors

1 Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Department of Surgery, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

4 Laboratory Hematology and Blood Banking Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Hypertrophic cardiomyopathy (HCM) is known to be the most common cardiac disorder in fetuses of diabetic mothers, especially when diabetes is not controlled in pregnancy. This study aimed as to estimate the prevalence of HCM in neonates born to diabetic mothers and to evaluate therapeutic interventions with follow-up after six months. We also focused on the possible association of neonatal HCM with the maternal type of diabetes.
Methods: A cross-sectional study was conducted between October 2016, and September 2017, in the Cardiac Clinic of Yazd, a city in the center of Iran. The subjects were 150 neonates of mothers with diabetes. We determined HCM through fetal echocardiography before treatment and assessed the maternal and fetal factors. Finally, after a 6-month follow-up period, the data were analyzed statistically.
Results: According to the results, the prevalence of HCM in neonates of diabetic mothers was 14% (P < 0.0001). The results showed that there is a relationship between maternal uncontrolled diabetes and the incidence of HCM in the infant (P < 0.0001), but there is no relationship between the type of diabetes and the incidence of HCM. Our results also showed that propranolol was effective in improving HCM, and spontaneous recovery of HCM was low in infants.
Conclusion: We concluded that controlling maternal diabetes has the greatest effect on the prevention of HCM in neonates. Also, neonates of diabetic mothers need more heart tests and follow-ups. Therefore, more studies on the effects of maternal diabetes-induced HCM in neonates are needed.

Keywords


  1. Wolf CM. Hypertrophic cardiomyopathy: Genetics and clinical perspectives. Cardiovasc Diagn Ther 2019; 9(Suppl 2): S388-415.
  2. Marian AJ, Braunwald E. Hypertrophic cardiomyopathy: Genetics, pathogenesis, clinical manifestations, diagnosis, and therapy. Circ Res 2017; 121(7): 749-70.
  3. Stuart A, Amer-wåhlin I, Gudmundsson S, Marsál K, Thuring A, Källen K. Ductus venosus blood flow velocity waveform in diabetic pregnancies. Ultrasound Obstet Gynecol 2010; 36(3): 344-9.
  4. Colan SD. Hypertrophic cardiomyopathy in childhood. Heart Fail Clin 2010; 6(4): 433-44, vii-iii.
  5. 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. J Compr Pediatr 2013; 4(2): 119-23.
  6. Care D, Suppl SS. Management of diabetes in pregnancy: Standards of medical care in diabetes-2020. Diabetes Care 2020; 43 (Suppl 1): S183-92.
  7. World Health Organization. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. Geneva, Switzerland: WHO; 2013. p. 1-63.
  8. Mohebi S, Parham M, Sharifirad G, Gharlipour Z, Mohammadbeigi A, Rajati F. Relationship between perceived social support and self-care behavior in type 2 diabetics: A cross-sectional study. J Educ Health Promot 2018; 7: 48.
  9. Lookzadeh MH, Alipour MR, Vakili-Zarch A, Ekraminasab S. Prevalence of congenital heart diseases in neonates of diabetic mothers: A cross sectional study in Yazd. World J Peri & Neonatol 2022; 5(1): 24-9.
  10. Wren C, Birrell G, Hawthorne G, Wren C. Cardiovascular malformations in infants of diabetic mothers. Heart 2003; 89(10): 1217-20.
  11. Huang T, Kelly A, Becker SA, Cohen MS, Stanley CA. Hypertrophic cardiomyopathy in neonates with congenital hyperinsulinism. Arch Dis Child Fetal Neonatal Ed 2013; 98(4): F351-4.
  12. Palmieri CR, Simões MA, Silva JC, Dos Santos AD, Silva MR, Ferreira B. Prevalence of hypertrophic cardiomyopathy in fetuses of mothers with gestational diabetes before initiating treatment. Rev Bras Ginecol Obstet 2017; 39(1): 9-13.
  13. Akbariasbagh P, Shariat M, Akbariasbagh N, Ebrahim B. Cardiovascular malformations in infants of diabetic mothers : A retrospective case-control study. Acta Med Iran 2017; 55(2): 103-8
  14. Aman J, Hansson U, Ostlund I, Wall K, Persson B. Increased fat mass and cardiac septal hypertrophy in newborn infants of mothers with well-controlled diabetes during pregnancy. Neonatology 2011; 100(2): 147-54.
  15. Yeh J, Berger S. Cardiac findings in infants of diabetic mothers. Neoreviews 2015; 16(11): e624-30.
  16. Motamadinasab M, Dastgheib SA, Golshan-Tafti M, Bahrami R, Javaheri A, Tabatabaie RS, et al. Association of TCF7L2 polymorphisms with susceptibility to gestational diabetes mellitus: A systematic review and meta-analysis. World J Peri & Neonatol 2021; 4(2): 88-103.
  17. Miri S, Sheikhha MH, Dastgheib SA, Shaker SA, Neamatzadeh H. Association of ACE I/D and PAI-1 4G/5G polymorphisms with susceptibility to type 2 diabetes mellitus. J Diabetes Metab Disord 2021; 20(2): 1191-7.
  18. Pantazi K, Karlafti E, Bekiaridou A, Didagelos M, Ziakas A, Didangelos T. Insulin receptors and insulin action in the heart: The effects of left ventricular assist devices. Biomolecules 2022; 12(4): 578.
  19. Paauw ND, Stegeman R, de Vroede MAMJ, Termote JUM, Freund MW, Breur JMPJ. Neonatal cardiac hypertrophy: the role of hyperinsulinism-a review of literature. Eur J Pediatr 2020; 179(1): 39-50.
  20. Wang X, Lian Y, Wang X, Tian M. Study of regional left ventricular longitudinal function
    in fetuses with gestational diabetes mellitus by velocity vector imaging. Echocardiography 2016; 33(8): 1228-33.
  21. Nandi D, Hayes EA, Wang Y, Jerrell JM. Epidemiology of pediatric hypertrophic cardiomyopathy in a 10-year medicaid cohort. Pediatr Cardiol 2021; 42(1): 210-4.
  22. Muhammad A, Khan M, Khan I, Anwar T. Frequency of congenital heart diseases in infants of diabetic mothers referred to pediatrics department. J Postgrad Med Inst 2014; 28(1): 37-41.
  23. Ostman-Smith I. Beta-blockers in pediatric hypertrophic cardiomyopathies. Rev Recent Clin Trials 2014; 9(2): 82-5.