Key result
Maternal gestational diabetes is linked to ~23% higher fetal cardiac acceleration capacity.
Why the study?
Maternal gestational diabetes mellitus is known to influence fetal physiology, but its impact on fetal autonomic nervous system function using phase-rectified signal averaging was not evaluated.
Does maternal gestational diabetes mellitus alter fetal autonomic nervous system function as measured by phase-rectified signal averaging compared to healthy pregnancies?
Case-Control (n=116)
Does maternal gestational diabetes mellitus alter fetal autonomic nervous system function as measured by phase-rectified signal averaging compared to healthy pregnancies?
Absolute Event Rate: 2.42% vs 1.97%
p-value: p=<0.001
Fetuses of mothers with gestational diabetes exhibit altered autonomic nervous system activity in late gestation as detected by phase-rectified signal averaging, which may offer improved surveillance over conventional CTG.
May indicate altered fetal autonomic function in GDM; hypothesis-generating for phase-rectified signal averaging surveillance.
OBJECTIVES: Maternal gestational diabetes mellitus (GDM) is known to influence fetal physiology. Phase-rectified signal averaging (PRSA) is an innovative signal-processing technique that can be used to investigate fetal heart signals. The PRSA-calculated variables average acceleration capacity (AAC) and average deceleration capacity (ADC) are established indices of autonomic nervous system (ANS) function. The aim of this study was to evaluate the influence of GDM on the fetal cardiovascular and ANS function in human pregnancy using PRSA. METHODS: This was a prospective clinical case-control study of 58 mothers with diagnosed GDM and 58 gestational-age matched healthy controls in the third trimester of pregnancy. Fetal cardiotocography (CTG) recordings were performed in all cases at entry to the study, and a follow-up recording was performed in 19 GDM cases close to delivery. The AAC and ADC indices were calculated by the PRSA method and fetal heart rate short-term variation (STV) by CTG software according to Dawes-Redman criteria. RESULTS: Mean gestational age of both groups at study entry was 35.7 weeks. There was a significant difference in mean AAC (1.97 ± 0.33 bpm vs 2.42 ± 0.57 bpm; P < 0.001) and ADC (1.94 ± 0.32 bpm vs 2.28 ± 0.46 bpm; P < 0.001) between controls and fetuses of diabetic mothers. This difference could not be demonstrated using standard computerized fetal CTG analysis of STV (controls, 10.8 ± 3.0 ms vs GDM group, 11.3 ± 2.5 ms; P = 0.32). Longitudinal fetal heart rate measurements in a subgroup of women with diabetes were not significantly different from those at study entry. CONCLUSIONS: Our findings show increased ANS activity in fetuses of diabetic mothers in late gestation. Analysis of human fetal cardiovascular and ANS function by PRSA may offer improved surveillance over conventional techniques linking GDM pregnancy to future cardiovascular dysfunction in the offspring.
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Lobmaier et al. (2017) conducted a case-control in Gestational diabetes mellitus (n=116). Gestational diabetes mellitus vs. Healthy controls was evaluated on Average acceleration capacity (AAC) (p=<0.001). Fetuses of mothers with gestational diabetes exhibited significantly higher average acceleration capacity (2.42 vs 1.97 bpm; P<0.001) and deceleration capacity (2.28 vs 1.94 bpm; P<0.001) than controls.
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