Does strict maternal third-trimester glycemic control prevent hypertrophic cardiomyopathy in infants of diabetic mothers?
Strict maternal glycemic control during pregnancy is important as higher HbA1c levels are significantly associated with the development of hypertrophic cardiomyopathy in infants of diabetic mothers.
Background: Infants of Diabetic Mothers (IDMs) are at known risk for the development of hypertrophic cardiomyopathy (HCM). Echocardiography is essential for the diagnosis of HCM, to assess the left ventricular function, and the degree of left ventricle obstruction, and to rule out structural cardiac malformations. Objective: To study the association of maternal third-trimester glycemic level with HCM in IDMs. Study Design: Observational cross-sectional study. Participants: 108 diabetic mothers and IDMs. Intervention: Third-trimester Glycosylated hemoglobin (HbA1c) levels were measured and Echocardiography was done for IDMs in their first week of life. Data were analyzed for correlations between various parameters. Outcomes: HCM was diagnosed when the absolute value of Inter Ventricular Septum (IVS) was ≥ 2SD from the mean (5mm) and Asymmetrical Septal Hypertrophy (ASH) was diagnosed when the IVS: LVPW ratio was ≥ 1.3. Results: 85% of the study population had gestational diabetes, and 55.6% of them were on diet control only. The mean HbA1c was 6.69%. The mean birth weight was 3.1 kg. The most common complication observed was hypoglycemia (19.4%). Asymptomatic HCM was seen in 52% and ASH in 25.9% of the study population. HCM was found to be significantly associated with maternal HbA1c levels, birth weight and hypoglycemia. Conclusion: HCM is a frequent finding in IDMs when routinely screened by echocardiography. A significant positive association of HCM with maternal glycemic control was seen in our study and hence strict glycemic control during pregnancy is of paramount significance.
Kapoor et al. (Mon,) studied this question.