Evaluation of ventricular dyssynchrony in fetuses of diabetic mothers measured by the tissue Doppler indices: a case-control study

Objective Maternal diabetes is the most common causes of hypertrophic cardiomyopathy, which significantly increases the risk of fetal heart dysfunction. In this study, we sought to evaluate the effect of overt maternal diabetes on fetal cardiac function.Methods This is a single-center and case-control study consisting of 26 pregnant women with overt diabetes (case group) and 26 women with uncomplicated pregnancies (control group). Cardiac function was assessed twice in the fetal period (18–22 weeks and 28 weeks of gestation) and once in the neonatal period (one week of postnatal). Fetal cardiac function was assessed using early-diastolic maximum velocity index (Em) of mitral valve, end-diastolic maximum velocity index (Am) of mitral valve, Em/Am ratio, left ventricular myocardial performance index (LVMPI) and inter-ventricular mechanical delay index (IVMDI).Results The case and control groups were not significantly different in terms of maternal age and gestational age at the time of fetal Doppler evaluation. Em (p = 0.007), Am (p < 0.001), LVMPI (p = 0.003), and IVMDI (p = 0.026) were significantly higher in fetuses of diabetic mothers, while there was no significant difference in Em/Am ratio (p = 0.264). Eight fetuses (30.8%) of diabetic mothers had dyssynchrony, while no cases of dyssynchrony were seen in fetuses of non-diabetic mothers (p = 0.004). Infants of diabetic mothers were 8.8 times more likely to develop adverse neonatal outcomes than infants of healthy mothers (RR = 8.8, 95% CI: 1.71–45.31, p = 0.009). Regarding the predictive value of cardiac indices for adverse neonatal outcome, IVMDI had the area under curve of 0.887 (p = 0.001) and LVMPI had area under the curve of 0.762 (p = 0.024).Conclusion The findings of the current study revealed significant cardiac dysfunction and dyssynchrony in fetuses of diabetic pregnant women. We also found that the IVMDI, which indicates the extent of inter-ventricular dyssynchrony, and the LVMPI index, which indicates the global dysfunction of the heart, can be used to predict adverse neonatal outcomes in pregnancies complicated with overt diabetes.