Use of the myocardial performance index as a prognostic indicator of adverse fetal outcome in poorly controlled gestational diabetic pregnancies
Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Biostatistics Unit, Medical Research Council, Durban, South Africa
What is known about the topic?Fetal complications in gestational diabetes without microvascular complications are related to fetal hyperinsulinism. Our present prenatal surveillance techniques in diabetic pregnancies are neither appropriate nor sufficient as a monitoring tool. Impaired cardiac function in fetuses of diabetic pregnancies has been documented, but no link to adverse outcome has been demonstrated. What this study adds to the topic?This study has established an association between fetal cardiac dysfunction and abnormal fetal outcomes in poorly controlled gestational diabetic pregnancies. There seems to be an association between severity of the myocardial performance index elevation and rates of abnormal outcomes. Myocardial performance index may be an attractive monitoring tool of the fetus in poorly controlled diabetic pregnancy. Objective: The aim of this study was to determine whether there are any changes in cardiac function in fetuses of poorly controlled gestational diabetics and whether these changes influence perinatal outcome. Methods: Twenty-nine pregnant women with severe gestational diabetes on insulin therapy in the third trimester of pregnancy were recruited and matched with 29 women with normal pregnancies (control group). Using Doppler echocardiography, the modified myocardial performance index (Mod-MPI) and E wave/A wave peak velocities (E/A) ratios were determined. Placental resistance Doppler markers were also determined in both groups. Adverse perinatal outcome was defined as perinatal death, admission to the neonatal intensive care unit, cord pH <7.15, 5-min Apgar score <7 and presence of cardiomyopathy. Results: The median Mod-MPI was increased (0.59 vs 0.38; p<0.0001) and the E/A ratio was decreased (0.65 vs 0.76; p<0.0001) in fetuses of diabetic mothers compared with controls. An MPI >0.52 had a sensitivity of 100% [95% confidence interval (CI) 85-100%] and specificity of 92% (95% CI 70-92%) for prediction of adverse perinatal outcome, including one stillbirth and one neonatal death. No abnormal outcomes occurred in the control group. Conclusions: There is significant impairment of cardiac function in fetuses of poorly controlled gestational diabetics. Mod-MPI and E/A ratio have the potential to improve fetal surveillance in diabetic pregnancies. © 2014 John Wiley & Sons, Ltd.
adult; clinical trial; cross-sectional study; female; fetus heart; heart function test; human; pathophysiology; pregnancy; pregnancy diabetes mellitus; pregnancy outcome; prospective study; Adult; Cross-Sectional Studies; Diabetes, Gestational; Female; Fetal Heart; Heart Function Tests; Humans; Pregnancy; Pregnancy Outcome; Prospective Studies