What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Infants of diabetic mothers (n=150). Intervention: Maternal diabetes exposure vs. Infants of non-diabetic mothers. Primary outcome: Serum cardiac Troponin-I (cTnI) levels (ng/mL) (AUC 0.89, 95% CI 0.82-0.95, p=<0.001).

What question did this study set out to answer?

This research aims to evaluate cardiac biomarkers in infants of diabetic mothers and their correlation with echocardiographic parameters.

April 23, 2026Egyptian Pediatric Association Gazette0 citationsOpen Access

Biomarkers of cardiac injury in infants of diabetic mothers and its relation to echocardiographic findings

Q: What are the key findings of this study?

Cardiac troponin-I >0.12 ng/mL accurately detected echocardiographically defined cardiac dysfunction (AUC 0.89) in infants of diabetic mothers.

SSShimaa Abd Elrheam ShakerAssiut University GEGehan Mohamed Kamal EldinAssiut University HFH Farghaly

Key Result

Cardiac troponin-I >0.12 ng/mL accurately detected echocardiographically defined cardiac dysfunction (AUC 0.89) in infants of diabetic mothers.

Key Points

This research aims to evaluate cardiac biomarkers in infants of diabetic mothers and their correlation with echocardiographic parameters.
Evaluated cardiac troponin-I, BNP, and CK-MB in 100 infants of diabetic mothers and 50 healthy controls
Conducted comprehensive echocardiography including M-mode and tissue Doppler measurements
Derived ROC-based diagnostic cut-off values for detecting cardiac dysfunction.
Infants of diabetic mothers showed significantly higher levels of troponin-I, BNP, and CK-MB compared to controls.
Echocardiography indicated increased interventricular septal thickness and left ventricular mass, with signs of diastolic dysfunction.
Correlation found between maternal HbA1c and cardiac biomarkers.

Study Design

Type

Cross-Sectional (n=150)

Blinding

Single-blind

Multicenter

Structured PICO

Do cardiac biomarkers (cTnI, BNP, CK-MB) accurately detect echocardiographically defined subclinical cardiac dysfunction in infants of diabetic mothers?

Population

150 term neonates (≥35 weeks gestation), comprising 100 infants of diabetic mothers (type 1 diabetes, type 2 diabetes, or gestational diabetes mellitus) and 50 healthy controls. Exclusions: major congenital anomalies, chromosomal abnormalities, intrauterine growth restriction unrelated to maternal diabetes, perinatal asphyxia (5-minute Apgar <7), structural congenital heart disease other than hypertrophic cardiomyopathy, and neonatal sepsis.

Intervention

Maternal diabetes exposure (infants of diabetic mothers)

Comparator

Gestational age- and sex-matched healthy control infants born to non-diabetic mothers without significant medical or obstetric complications

Outcome

Diagnostic accuracy (ROC-based cut-off values) of cardiac biomarkers (cTnI, BNP, CK-MB) for detecting echocardiographically defined cardiac dysfunction (LV hypertrophy or diastolic impairment) within 24-48 hours of birthsurrogate

Elevated cardiac biomarkers, particularly troponin-I >0.12 ng/mL, can accurately screen for subclinical cardiac dysfunction in infants of diabetic mothers, potentially guiding selective echocardiography use.

Main Result

Effect estimate: AUC 0.89 (95% CI 0.82-0.95)

Absolute Event Rate: 0.42% vs 0.09%

p-value: p=<0.001

Limitations

Single-center, cross-sectional design limits generalizability and causal inference
Lack of universally standardized neonatal reference ranges for troponin
Unmeasured confounders such as maternal BMI and pre-eclampsia
Single-operator echocardiography limits assessment of inter-observer variability
Biomarker samples obtained at a single time point

Abstract

Infants of diabetic mothers (IDMs) are predisposed to transient hypertrophic cardiomyopathy and subclinical myocardial dysfunction. However, validated diagnostic cut-off values for cardiac biomarkers in this population are lacking, and the relationship between a panel of multiple biomarkers and advanced echocardiographic indices has not been systematically established. This study aimed to evaluate cardiac troponin-I (cTnI), B-type natriuretic peptide (BNP), and creatine kinase-MB (CK-MB) in IDMs, correlate them with conventional and advanced echocardiographic parameters, and derive ROC-based diagnostic cut-off values for detecting echocardiographically defined cardiac dysfunction. In this prospective cross-sectional study, 100 term IDMs and 50 healthy controls were enrolled. Maternal glycemic control was assessed using HbA1c. Neonatal serum cTnI, BNP, and CK-MB were measured within 24–48 h of birth. Comprehensive echocardiography included M-mode measurements, left ventricular mass (Devereux formula), fractional shortening, myocardial performance index (pulsed-wave tissue Doppler at the lateral mitral annulus), E/A ratio, and E/E′ ratio. ROC analysis determined optimal diagnostic cut-offs. IDMs had significantly higher cTnI (0.42 ± 0.18 vs. 0.09 ± 0.03 ng/mL), BNP (165 ± 60 vs. 60 ± 20 pg/mL), and CK-MB (85 ± 25 vs. 45 ± 18 U/L) compared to controls (all p 0.12 ng/mL; sensitivity 88%, specificity 84%). Elevated cTnI, BNP, and CK-MB in IDMs reflect cardiac stress linked to maternal hyperglycemia. Population-specific biomarker cut-offs, particularly cTnI > 0.12 ng/mL, may facilitate non-invasive screening for subclinical cardiac dysfunction, guiding selective echocardiography use. These thresholds require prospective multicenter validation.

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