Why the study?
To establish whether pregnancies complicated by gestational diabetes mellitus are associated with a fetal cardiac phenotype that predisposes to arrhythmia, using non-invasive abdominal fetal ECG measurements.
Does gestational diabetes mellitus alter fetal heart rate variability and cardiac time intervals compared to uncomplicated pregnancies?
Does gestational diabetes mellitus alter fetal heart rate variability and cardiac time intervals compared to uncomplicated pregnancies?
Gestational diabetes mellitus is associated with altered fetal heart rate variability, suggesting potential changes in fetal autonomic function in utero.
GDM-linked fetal HRV changes may signal arrhythmia risk; leaves open whether this phenotype predicts outcomes or warrants intervention.
OBJECTIVE: Establish whether pregnancies complicated by gestational diabetes mellitus (GDM) are associated with a fetal cardiac phenotype that predisposes to arrhythmia; utilising measurements derived from non-invasive abdominal fetal ECG. DESIGN: Prospective observational study. SETTING: Three tertiary obstetric units, United Kingdom. POPULATION: Women aged ≥ 16 years with either GDM or uncomplicated pregnancy (control) who were > 20 weeks gestational age. METHODS: The MonicaAN24 non-invasive abdominal fetal ECG monitor was fitted for overnight recording. MAIN OUTCOME MEASURE: Calculation of the fetal heart rate (FHR) and fetal heart rate variability (HRV) time domain metrics standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD) and the PR, QRS, QT intervals was performed. Groups were compared using linear regression models (stratified by sleep state) and adjusted for fetal sex and ethnicity. RESULTS: Ninety-six participants were included. For HRV in sleep state 1F, SDNN was higher for GDM than control participants 12.56 (10.45-16.62)ms versus 8.58 (5.83-9.73)ms [p = 0.01] [median (IQR)]. There were no differences in SDNN in sleep state 2F. No differences were identified in RMSSD in either sleep states or in the cardiac time intervals. We observed a negative correlation between HRV and body mass index/HbA1c and a positive correlation between FHR and body mass index/HbA1c in sleep states 1F/2F. CONCLUSIONS: Alterations of HRV and FHR rate may be associated with a diagnosis of GDM, likely secondary to altered autonomic function in utero.
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Chivers et al. (2024) studied this question.
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