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Is the child at risk? Cardiovascular remodelling in children born to diabetic mothers

Published online by Cambridge University Press:  03 April 2019

Zahra Hoodbhoy ,
Nuruddin Mohammed ,
Nadeem Aslam ,
Urooj Fatima ,
Salima Ashiqali ,
Arjumand Rizvi ,
Christine Pascua ,
Devyani Chowdhury  and
Babar S. Hasan
Zahra Hoodbhoy
Affiliation:
Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
Nuruddin Mohammed
Affiliation:
Department of Obstetrics and Gynaecology, The Aga Khan University, Karachi, Pakistan
Nadeem Aslam
Affiliation:
Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
Urooj Fatima
Affiliation:
Cardiopulmonary Services, The Aga Khan University, Karachi, Pakistan
Salima Ashiqali
Affiliation:
Cardiopulmonary Services, The Aga Khan University, Karachi, Pakistan
Arjumand Rizvi
Affiliation:
Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
Christine Pascua
Affiliation:
Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Devyani Chowdhury
Affiliation:
Cardiology Care for Children and Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Babar S. Hasan*
Affiliation:
Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
*
Author for correspondence: Babar S. Hasan, Department of Paediatrics and Child Health, The Aga Khan University, PO Box 3500, Stadium Road, Karachi, Pakistan. Tel: 92-21-34930051 Ext 4364; Fax: 92-21-34932095; E-mail: babar.hasan@aku.edu
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Abstract

Objective:

The objective of this study was to assess differences in myocardial systolic and diastolic function and vascular function in children 2−5 years of age born to diabetic as compared to non-diabetic mothers.

Methods:

This study was a retrospective cohort conducted in 2016 at The Aga Khan University Hospital, Karachi, Pakistan. It included children between 2 and 5 years of age born to mothers with and without exposure to diabetes in utero (n = 68 in each group) and who were appropriate for gestational age. Myocardial morphology and function using echocardiogram and carotid intima media thickness (cIMT) and pulse wave velocity was performed to evaluate cardiac function as well as macrovascular remodelling in these children. Multiple linear regression was used to compare the groups.

Results:

There was no significant difference in cardiac morphology, myocardial systolic and diastolic function, and macrovascular assessment between the exposed and unexposed groups of AGA children. Subgroup analysis demonstrated a significantly decreased mitral E/A ratio in children whose mothers were on medications as compared to those on dietary control (median [IQR] = 1.7 [1.6–1.9] and 1.56 [1.4–1.7], respectively, p = 0.02), and a higher cIMT in children whose mothers were on medication as compared to controls (0.48 [0.44–0.52] and 0.46 [0.44–0.50], respectively, p = 0.03).

Conclusion:

In utero exposure to uncontrolled maternal diabetes has an effect on the cardiovascular structure and function in children aged 2−5 years. However, future work requires long-term follow-up from fetal to adult life to assess these changes over the life course.

Keywords

Hyperglycaemia in pregnancypreschool childrencardiovascular diseaserisk assessment
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 4 , April 2019 , pp. 467 - 474
Copyright
© Cambridge University Press 2019 

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References

Guariguata, L, Linnenkamp, U, Beagley, J, et al. Global estimates of the prevalence of hyperglycaemia in pregnancy for 2013 for the IDF Diabetes Atlas. Diabetes Res Clin Pract 2014; 103: 176−185. doi: 10.1016/j.diabres.2013.11.003.CrossRefGoogle Scholar
Wild, S, Roglic, G, Green, A, et al. Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27: 1047−1053.CrossRefGoogle ScholarPubMed
Maric-Bilkan, C, Symonds, M, Ozanne, S, et al. Impact of maternal obesity and diabetes on long-term health of the offspring. Exp Diabetes Res 2011; 2011: 1−2. doi: 10.1155/2011/163438.CrossRefGoogle ScholarPubMed
Freinkel, N. Banting lecture 1980: of pregnancy and progeny. Diabetes 1980; 29(12): 1023−1035.CrossRefGoogle ScholarPubMed
Simeoni, U, Barker, DJ (ed.). Offspring of diabetic pregnancy: long-term outcomes. Semin Fetal Neonatal Med 2009; 14(2): 119−124. CrossRefGoogle Scholar
Boney, CM, Verma, A, Tucker, R, et al. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 2005; 115:e290−e296.CrossRefGoogle ScholarPubMed
Philipps, LH, Santhakumaran, S, Gale, C, et al. The diabetic pregnancy and offspring BMI in childhood: a systematic review and meta-analysis. Diabetologia 2011; 54: 1957−1966.CrossRefGoogle ScholarPubMed
Manderson, J, Mullan, B, Patterson, C, et al. Cardiovascular and metabolic abnormalities in the offspring of diabetic pregnancy. Diabetologia 2002; 45: 991−996.CrossRefGoogle ScholarPubMed
Kozak-Barany, A, Jokinen, E, Kero, P, et al. Impaired left ventricular diastolic function in newborn infants of mothers with pregestational or gestational diabetes with good glycemic control. Early Hum Dev 2004; 77: 13−22.CrossRefGoogle ScholarPubMed
Al-Biltagi, M, Tolba, OARE, Rowisha, MA, et al. Speckle tracking and myocardial tissue imaging in infant of diabetic mother with gestational and pregestational diabetes. Pediatr Cardiol 2015; 36: 445−453.CrossRefGoogle ScholarPubMed
Mitanchez, D, Yzydorczyk, C, Siddeek, B, et al. The offspring of the diabetic mother−short-and long-term implications. Best Pract Res Clin Obstet Gynaecol 2015; 29: 256−269.CrossRefGoogle ScholarPubMed
Gordis, L. Epidemiology. 5th edn. Philadelphia, PA, USA: Saunders, 2013.Google Scholar
Ucar, T, Tutar, E, Yalccinkaya, F, et al. Global left-ventricular function by tissue Doppler imaging in pediatric dialysis patients. Pediatr Nephrol 2008; 23: 779−785.CrossRefGoogle ScholarPubMed
Crispi, F, Bijnens, B, Figueras, F, et al. Fetal growth restriction results in remodeled and less efficient hearts in children. Circulation 2010; 121(22): 2427−2436.CrossRefGoogle ScholarPubMed
Atabek, ME, Çağan, HH, Eklioğlu, BS, et al. Absence of increase in carotid artery intima-media thickness in infants of diabetic mothers. J Clin Res Pediatr Endocrinol 2011; 3: 144−148.CrossRefGoogle ScholarPubMed
Van Bortel, LM, Laurent, S, Boutouyrie, P, et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens 2012; 30: 445−448.CrossRefGoogle ScholarPubMed
Boston Children’s Hospital Z score calculator 2015 [cited 2016 20 December 2016]. http://zscore.chboston.org/Google Scholar
El-Ganzoury, MM, El-Masry, SA, El-Farrash, RA, et al. Infants of diabetic mothers: echocardiographic measurements and cord blood IGF-I and IGFBP-1. Pediatr Diabetes 2012; 13: 189−196.CrossRefGoogle ScholarPubMed
Goosby, BJ, Cheadle, JE, McDade, T. Birth weight, early life course BMI, and body size change: chains of risk to adult inflammation? Social Sci Med 2016; 148: 102−109.CrossRefGoogle ScholarPubMed
Dawid, G, Horodnicka-Jozwa, A, Czeszynska, M, et al. 78 A prospective echocardiography evaluation in infants of diabetic mothers during the first year of life. Pediatr Res 2005; 58: 367.CrossRefGoogle Scholar
Mehta, A, Hussain, K. Transient hyperinsulinism associated with macrosomia, hypertrophic obstructive cardiomyopathy, hepatomegaly, and nephromegaly. Arch Dis Childhood 2003; 88: 822−824.CrossRefGoogle ScholarPubMed
Mehta, S, Nuamah, I, Kalhan, S. Altered diastolic function in asymptomatic infants of mothers with gestational diabetes. Diabetes 1991; 40 (Suppl 2): 56−60.CrossRefGoogle ScholarPubMed
Zablah, JE, Gruber, D, Stoffels, G, et al. Subclinical decrease in myocardial function in asymptomatic infants of diabetic mothers: a tissue doppler study. Pediatr Cardiol 2017; 38: 801−806.CrossRefGoogle ScholarPubMed
Levy, PT, Machefsky, A, Sanchez, AA, et al. Reference ranges of left ventricular strain measures by two-dimensional speckle-tracking echocardiography in children: a systematic review and meta-analysis. J Am Soc Echocardiography 2016; 29: 209−225.e6.CrossRefGoogle ScholarPubMed
Pislaru, C, Abraham, TP, Belohlavek, M. Strain and strain rate echocardiography. Curr Opin Cardiol 2002; 17: 443−454.CrossRefGoogle ScholarPubMed
Wang, H, Xu, Y, Fu, J, et al. Evaluation of the regional ventricular systolic function by two-dimensional strain echocardiography in gestational diabetes mellitus (GDM) fetuses with good glycemic control. J Maternal-Fetal Neonatal Med 2015; 28(18): 2150−2154.CrossRefGoogle ScholarPubMed
Miranda, JO, Cerqueira, RJ, Ramalho, C, et al. Fetal cardiac function in maternal diabetes: a conventional and speckle-tracking echocardiographic study. J Am Soc Echocardiography 2018; 31: 333−341.CrossRefGoogle ScholarPubMed
Bunt, JC, Tataranni, PA, Salbe, AD. Intrauterine exposure to diabetes is a determinant of hemoglobin A1c and systolic blood pressure in Pima Indian children. J Clin Endocrinol Metab 2005; 90: 3225−3229.CrossRefGoogle ScholarPubMed
Cho, NH, Silverman, BL, Rizzo, TA, et al. Correlations between the intrauterine metabolic environment and blood pressure in adolescent offspring of diabetic mothers. J Pediatr 2000; 136: 587−592.CrossRefGoogle ScholarPubMed
Beyerlein, A, Nehring, I, Rosario, AS, et al. Gestational diabetes and cardiovascular risk factors in the offspring: Results from a cross-sectional study. Diabetic Med 2012; 29: 378−384.CrossRefGoogle ScholarPubMed
van den Oord, SCH, Sijbrands, EJG, ten Kate, GL, et al. Carotid intima-media thickness for cardiovascular risk assessment: systematic review and meta-analysis. Atherosclerosis 2013; 228: 1−11.CrossRefGoogle ScholarPubMed
Hidvagi, EV, Illyas, M, Benczar, B, et al. Reference values of aortic pulse wave velocity in a large healthy population aged between 3 and 18 years. J Hypertens 2012; 30(12): 2314−2321.CrossRefGoogle Scholar
Guérin, AP, London, GM, Marchais, SJ, et al. Arterial stiffening and vascular calcifications in end-stage renal disease. Nephrol Dial Transplant 2000; 15: 1014−1021.CrossRefGoogle ScholarPubMed
Ramos, E, Perez-Quintero, J, Encinas, S, et al. B035: carotid-femoral pulse-wave velocity in children and adolescents from 2-18 years. Am J Hypertension 2000; 13(S2): 199A.Google Scholar
Chen, S, Chetty, S, Lowenthal, A, et al. Feasibility of neonatal pulse wave velocity and association with maternal hemoglobin A1c. Neonatology 2015; 107: 20−26.CrossRefGoogle ScholarPubMed
Ruotolo, G, Bavenholm, P, Brismar, K, et al. Serum insulin-like growth factor-I level is independently associated with coronary artery disease progression in young male survivors of myocardial infarction: beneficial effects of bezafibrate treatment. J Am Coll Cardiol 2000; 35: 647−654.CrossRefGoogle ScholarPubMed
Rijpert, M, Breur, JM, Evers, IM, et al. Cardiac function in 7-8-year-old offspring of women with type 1 diabetes. Exp Diabetes Res 2011; 2011: 1−7.CrossRefGoogle ScholarPubMed