Investigation On Cardiac Function And Development In Infants Of Diabetic Mothers

ObjectivesTo analyze the major complications of IDMs and the development of cardiac function and cardiac structure with color doppler echocardiography.To discuss the influences of maternal blood glucose during pregnancy on neonatal heart development and function.MethodsInfant born to diabetic mothers admitted to neonatal ward in the First Affiliated Hospital of Kunming Medical University from January to December in 2016 were include in this study.At the same time the echocardiography was done for infant.Retrospective analysis of early heart development and other complications.The 185infants of were divided into three groups.Firstly,according to the blood glucose controlled ways,4 groups were divided.A group:diet and exercise controlled group(n=136),B group:insulin controlled group(n =42),C group:oral drug controlled group(n = 4),D group:not in the controlled group(n = 3).To compare the neonatal heart function and cardiac structural development in 4 groups.Secondly,according to the results of blood glucose controlled,2 groups were divided.A group:good blood glucose control group(n = 164),B group:poor blood glucose control group(n = 21).To analyze the prevalence of cardiac complications between 2 groups.Results1.Heart development abnormal types of IDMs include:patent ductus arteriosus 44 cases(23.78%),pulmonary hypertension 18 cases(9.73%),cardiac hypertrophy 18 cases(9.73%),ventricular septal defect 13 cases(7.03%),atrial septal defect 12 cases(6.49%),atrial septal aneurysm 2 cases(1.08%),aneurysm of the ductus arteriosus 1 case(0.54%),pulmonary stenosis 1 case(0.54%),coronary artery fistula 1 case(0.54%),pericardial effusion 1 case(0.54%),persistent left superior 1 case(0.54%).2.Among the short-term complications of IDMs include,neonatal hyperbilirubinemia 100 cases(54.05%),neonatal bacterial infection 41 cases(22.16%),22 cases of fetal distress(11.89%),neonatal hypoglycemia 22 cases(11.89%),neonatal hypoxic ischemic myocardial injury 16 cases(9.88%),neonatal pneumonia 15 cases(8.65%),neonatal asphyxia 15 cases(8.65%),hemolytic disease of newborns 11 cases(5.95%),full-term infants 11 cases(5.95%),neonatal aspiration syndrome 8 cases(4.32%),macrosomia 7 cases(3.78%),neonatal wet lung(1.84%)6 cases,other congenital malformations in 4 cases(2.16%),and so on.3.Main pulmonary artery diameter in B group(8.16 + 1.3mm)was lager compared to the other three groups,the difference was statistically significant(P<0.05),and left ventricular posterior wall thickness in B group(4.0mm)was thicker compared to the Aand C group,the difference was statistically significant(P<0.05),compared to D group was not obviously different.The rest of the cardiac chamber size:aortic root diameter,left atrial diameter,left ventricular end diastolic diameter and right atrial diameter,right ventricular diameter,right ventricular outflow tract diameter,left ventricular end diastolic volume,left ventricular end systolic volume,ventricular septal thickness,in 4 groups of IDMS were not obviously different(P>0.05).Cardiac function index:stroke volume,left ventricular fractional shortening and ejection fraction of left ventricle and pulmonary artery systolic pressure,aortic peak velocity,pulmonary valve peak flow velocity,in 4 groups of IDMS were not obviously different(P>0.05).4.According to glucose controlled results,for infants in Agroup,occurrence PDA,ASD,VSD,PS,CAF were not difference from infant in B(P>0.05).Conclusions1.For the 185 IDMs,91.91%glucose could be best controlled by diet and exercise management,88.65%of diabetic mothers have a good glucose control result in pregnancy.So active management of gestational diabetes,strict supervision and guidance for treatment in our hospitalhas achieved good effects.2.The incidence of PDA was the highest in cardiac complications of IDMs,and other complications were:PH,VSD,ASD,PS,CAF,atrial septal aneurysm,aneurysm,myocardial hypertrophy,pericardial effusion,persistent left superior cavity respectively.3.Early complications of IDMs:the incidence of neonatal hyperbilirubinemia was highest,other complications included neonatal bacterial infection,Miyamauchi Sako,neonatal hypoglycemia,neonatal hypoxic ischemic myocardial injury,neonatal asphyxia,full-term infants,neonatal aspiration syndrome,fetal macrosomia,neonatal wet lung etc.4.For insulin controlled mothers with diabetic mellitus the diameter of the main pulmonary artery in IDMs was enlarged and the thickness of the posterior wall of the left ventricle in IDMs was thicker.