| PART I. Evaluation of Fetall Myocardial Function of Gestational Diabetes Mellitus by Tissue Doppler ImagingObjective To assess fetal myocardial systolic and diastolic function of gestational diabetes mellitus by tissue Doppler imaging. To discuss the damage period and degree of fetus' heart of mother diabetes mellitus, and the effect of different blood sugar level to fetus.Methods There are 58 fetuses of gestational diabetes mothers, including 26 cases with satisfactory control of blood glucose and 32 cases without satisfactory control. The control group consisted of 132 fetuses of normal pregnancy. Doppler spectra of mitral and tricuspid annulus were obtained by Tissue Doppler Imaging on four-chamber view. The peak velocity, including Ea, Aa and Sa of mitral and tricuspid annulus of above fetuses were measured. The difference between three groups were analyzed, and the relation between above indexes and gestation weeks were analyzed too.Results The velocity of mitral and tricuspid annulus of fetuses of three groups are positively correlated to gestation weeks (P<0.05) . The velocities of mitral and tricuspid annulus of fetuses of gestational diabetes mellitus group are lower thanthat of normal group (P<0.05). Ea, Aa and Sa of group with satisfactory control of blood glucose group are higher than that of group without satisfactory control (P<0.05).Conclusions The myocardial systolic and diastolic functions of gestational diabetes mellitus are damaged. The group with satisfactory control of blood glucose is more severe than group without satisfactory control. Control of blood glucose may diminish the damage of fetal heart of gestational diabetes mellitus.PART II. Myocardial Performance Index in Evaluation of Fetal Heart of Gestational Diabetes Mellitus by Tissue Doppler ImagingObjective To study myocardial performance index (Tei index) of fetuses of gestational diabetes mellitus by tissue Doppler imaging. To discuss the damage period and degree of fetus' myocardial performance of mother diabetes mellitus, and the effect of different blood glucose level to it.Methods There are 58 fetuses of gestational diabetes mothers, including 26 cases with satisfactory control of blood glucose and 32 cases without satisfactory control. The control group consisted of 132 fetuses of normal pregnancy. Doppler spectra of mitral and tricuspid annulus were obtained by Tissue Doppler Imaging on four-chamber view. The left and right myocardial performance index was calculated according to the formula : Tei index = (ICT+IRT) /ET, where ICT is isovolumic contraction; IRT is isovolumetric relaxation periodb and ET is ejection time. The Teiindex of mitral and tricuspid annulus reflects the left and right myocardial performance respectively. The difference between normal and group with and without satisfactory control of blood glucose were analyzed, and the relation between above indexes and gestation weeks were analyzed too.Results The Tei index has no difference between left and right ventricles of three groups (P>0.05). The Tei index of normal gestation group is negatively correlated to gestation weeks (P<0.05). The Tei index of fetuses of gestational diabetes mellitus group is positively correlating to gestation weeks (P<0.05). The Tei index of fetus of gestational diabetes mellitus is higher than the normal group (P<0.05), and the Tei index of fetus witout satisfactory control of blood glucose are higher than fetus with satisfactory control (P<0.05).Conclusions The myocardial performance of gestational diabetes mellitus is damaged. The group with satisfactory control of blood glucose is more severe than group without satisfactory control. Control of blood glucose may diminish the damage of fetal myocardial performance of gestational diabetes mellitus.PART III. The Change of Infant Myocardial Function of Gestational Diabetes Mellitus by Tissue Doppler ImagingObjective To evaluate change of myocardial systolic and diastolic function and myocardial performance index of fetus to infant period of gestational diabetes mellitus by Tissue Doppler imaging.Methods There are 58 fetuses at the third-trimester and 35 infants ofgestational diabetes mothers. The control group consisted of 26 fetuses at the third-trimester and 35 infants of normal pregnancy. Doppler spectra of mitral and tricuspid annulus were obtained by Tissue Doppler Imaging on four-chamber view. The peak velocity, including Ea, Aa and Sa of mitral and tricuspid annulus of above fetuses were measured. The left and right myocardial performance index was calculated according to the formula : Tei index = (ICT+IRT) /ET, where ICT is isovolumic contraction; IRT is isovolumetric relaxation periodb and ET is ejection time. The difference between normal gestational diabetes mother group of fetuses and infants was analyzed, and the change from fetuses to infant periods was analyzed too.Results The velocity of mitral and tricuspid annulus of infants of gestational diabetes mellitus groups is lower than that of infant of normal gestation group (P<0.05). The Tei index of infant of gestational diabetes mellitus groups is higher than that of infant of normal gestation group (P<0.05). The Tei index has no difference between infant and third-trimester fetus of normal gestation group (P>0.05). The Tei index of infants is lower than fetus of gestational diabetes mellitus group (P<0.05).Conclusions The myocardial systolic and diastolic function and performance index of fetus at the third-trimester of gestational diabetes mellitus are damaged, and it persist to infant period, but the myocardial performance index have improved in infant period. Tissue Doppler imaging may measure the velocity of mitral and tricuspid annulus and cardiac cycle of fetus accurately. It is a new method to assess the fetal cardiac function, and may offer evidence intervention pregnant forclinic.
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