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      Heart disease in infants of diabetic mothers

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          Abstract

          Congenital anomalies occur more commonly in infants born to diabetic mothers, and cardiac defects predominate. Although respiratory problems are also frequently found in those infants, they need to be differentiated from cardiovascular problems that such patients may also have, which include cardiovascular maladaptation to extra-uterine life, congenital heart defects and hypertrophic septal cardiomyopathy. A high index of suspicion is required as the specific management may vary and digoxin, or inotropic agents which may be used in heart failure associated with structural heart defects are contraindicated if hypertrophic cardiomyopathy is present. This article reviews the epidemiology, pathophysiology, clinical presentation, prognosis and available diagnostic and therapeutic modalities. The need for antenatal fetal echocardiography in pregnant diabetic mothers is also reviewed, as well as the controversial role of maternal glycemic control in the prevention of these anomalies.

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          Risk factors for conotruncal cardiac defects in Atlanta.

          M. Adams, R Dooley, J Mulinare (1989)
          Because the causes of conotruncal cardiac defects are poorly understood, a case-control study was conducted to investigate maternal risk factors for conotruncal cardiac defects. Eligible cases included all infants who were born from 1976 through 1980 to residents of the five county metropolitan Atlanta area and diagnosed with truncus arteriosus, transposition of the great arteries or tetralogy of Fallot. Eligible control infants were a sample of comparable infants without birth defects. Maternal interviews were conducted for 73% (83 of 114) of eligible cases and 72% (1,303 of 1,804) of eligible control infants. The results showed increased risks associated with maternal diabetes (odds ratio 5.6; 90% confidence interval 2.5 to 15.6), maternal stress related to job loss, divorce, separation or death of a close friend or relative (odds ratio 2.4; 90% confidence interval 1.4 to 4.2) and a history of a sibling with a cardiac defect (odds ratio 4.8; 90% confidence interval 2.2 to 10.5). The statistical power of the data was adequate to rule out threefold or greater increases in risk for a wide variety of other exposures, including maternal illnesses other than diabetes, contraceptive use, nonmedicinal drugs (for example, coffee, tea, alcohol, cigarettes, street drugs), employment and education. This population-based study offers no clues that could explain either the high rate of transposition of the great arteries or the temporal trend of an increasing rate of tetralogy of Fallot in Atlanta.
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            Maternal diabetes and cardiovascular malformations: predominance of double outlet right ventricle and truncus arteriosus.

            R McCarter, Rachael D. Rubin, Geoffrey W B Clark … (1990)
            Most studies on the relationship of maternal diabetes to cardiovascular malformations (CVM) have been prospective investigations of pregnancy outcome and therefore could not identify associations with rare cardiac lesions. The results of a retrospective study shed new light on the risks of specific cardiac defects in diabetic pregnancies. The Baltimore-Washington Infant Study, a population-based case-control investigation of CVM, provides information on maternal diabetes reported in personal interviews. Among 2259 mothers of cases, 35 (1.5%) reported diabetes present before pregnancy (called "overt") and 95 (4.2%) reported diabetes only during pregnancy (called "gestational"). Among 2,801 mothers of controls, 14 (0.5%) had overt diabetes and 83 (3.0%) had gestational diabetes. Malformation-specific risks were expressed as odds ratios (OR) with 99.5% confidence intervals (CI). The strongest associations with overt maternal diabetes were found with double outlet right ventricle (OR 21.33; 99.5% CI 3.34, 136.26), and truncus arteriosus (OR 12.81; 99.5% CI 1.43, 114.64). No significant diagnosis-specific associations were found with gestational diabetes. Non-cardiac malformations were present in 23% of infants with CVM whose mothers had overt diabetes and in 26% of infants with CVM whose mother had gestational diabetes, in 32% of infants with CVM whose mothers did not have diabetes, and in 4% of controls. Double outlet right ventricle and truncus arteriosus are malformations dependent upon neural-crest-cell-derived ectomesenchymal tissues; these are precisely the conotruncal abnormalities that result from experimental ablation of the neural crest in chick embryos. The association with diabetes suggests a further etiologic link between these two lesions.
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              The natural history of hypertrophic cardiomyopathy in infants of diabetic mothers.

              Gerald Way, Robert R Wolfe, E Eshaghpour … (1979)
              Eleven infants of diabetic mothers with hypertrophic cardiomyopathy have been followed for 30 to 40 months. All infants presented with cardiorespiratory distress and were found to have disproportionate septal hypertrophy on echocardiogram. Cardiac catheterization was done in four infants; three had significant subaortic obstruction. One infant had remarkable improvement after treatment with propranolol. Two infants who received digoxin did poorly and responded favorably to cessation of therapy. The natural history of HCM-IDM appears to be benign, with a resolution of symptoms within two to four weeks and a resolution of septal hypertrophy within two to 12 months. Most of the infants need only supportive care; if pharmacologic intervention is deemed necessary, propranolol appears to be the drug of choice. The natural history of this entity is that of spontaneous regression of symptoms and septal hypertrophy irrespective of therapy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Images Paediatr Cardiol
                Journal ID (publisher-id): IPC
                Title: Images in Paediatric Cardiology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 1729-441X
                ISSN (Electronic): 1729-441X
                Publication date (Print): Apr-Jun 2000
                Volume: 2
                Issue: 2
                Pages: 17-23
                Affiliations
                [* ] Consultant Paediatrician, Paediatric Department, Sandwell General Hospital, Lyndon, West Bromwich, West Midlands B 71 4HJ, United Kingdom
                [** ] Consultant Paediatrician, Paediatric Unit, Saudi Aramco Al Hasa Health Center, Box 6030, Mubarraz 31311, Saudi Arabia
                Author notes
                Contact information: Dr. Hassib Narchi, Consultant Paediatrician, Paediatric Department, Sandwell General Hospital Lyndon, West Bromwich, West Midlands B71 4HJ - UK hassibnarchi@ 123456hotmail.com
                Article
                Publisher ID: IPC-2-17
                PMC ID: 3232483
                PubMed ID: 22368579
                SO-VID: 51e17e2b-6c1f-4fca-a90f-4a91ede3e56f
                Copyright © Copyright: © Images in Paediatric Cardiology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Invited Article

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: heart defects,pregnancy,newborn,diabetes mellitus,hypertrophic cardiomyopathy,congenital
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: heart defects, pregnancy, newborn, diabetes mellitus, hypertrophic cardiomyopathy, congenital

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