Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Altered transitional circulation in infants of diabetic mothers with strict antenatal obstetric management: a functional echocardiography study

Journal of Perinatology volume 32, pages 508–513 (2012)Cite this article

Abstract

Objective:

Infants born to diabetic mothers (IDMs) even with good glycemic control are at risk for neonatal morbidity. Many of these problems occur during neonatal transition. We assessed (i) systemic and pulmonary blood flow in IDMs compared with controls and (ii) directional blood flow changes within fetal shunts during the first few days of life.

Study Design:

In this prospective observational cohort study, we evaluated right (RVO) and left ventricular output, superior vena cava flow, atrial and ductal shunts, and tricuspid regurgitation in 32 IDMs and 18 controls using serial echocardiography after birth and 48 h of life in both groups and at 24 and 72 h in IDMs only.

Result:

IDMs had lower RVO after birth and 48 h of life. IDMs also had less left to right atrial shunt and more right to left ductal shunt after birth compared with controls. In all, 15 of the 32 IDMs were admitted to the neonatal intensive care unit and 11 had respiratory symptoms.

Conclusion:

Persistence of fetal shunts and decreased RVO in IDMs suggest that even those with good gestational control have impaired transitional hemodynamics.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML . Births: final data for 2002. Natl Vital Stat Rep 2003; 52: 1–113.

    PubMed  Google Scholar 

  2. Tyden O, Berne C, Eriksson UJ, Hansson U, Stangenberg M, Persson B . Fetal maturation in strictly controlled diabetic pregnancy. Diabetes Res 1984; 1: 131–134.

    CAS  PubMed  Google Scholar 

  3. Seppanen MP, Ojanpera OS, Kaapa PO, Kero PO . Delayed postnatal adaptation of pulmonary hemodynamics in infants of diabetic mothers. J Pediatr 1997; 131: 545–548.

    Article  CAS  Google Scholar 

  4. Vela-Huerta M, Aguilera-Lopez A, Alarcon-Santos S, Amador N, Aldana-Valenzuela C, Heredia A . Cardiopulmonary adaptation in large for gestational age infants of diabetic and nondiabetic mothers. Acta Paediatr 2007; 96: 1303–1307.

    Article  CAS  Google Scholar 

  5. Sarkar S, Watman J, Seigel WM, Schaeffer HA . A prospective controlled study of neonatal morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-class Al). J Perinatol 2003; 23: 223–228.

    Article  Google Scholar 

  6. Cordero L, Treuer SH, Landon MB, Gabbe SG . Management of infants of diabetic mothers. Arch Pediatr Adolesc Med 1998; 152: 249–254.

    Article  CAS  Google Scholar 

  7. Kluckow M, Evans N . Superior vena cava flow in newborn infants: a novel marker of systemic blood flow. Arch Dis Child Fetal Neonatal Ed 2000; 82: F182–F187.

    Article  CAS  Google Scholar 

  8. Hunt RW, Evans N, Rieger I, Kluckow M . Low superior vena cava flow and neurodevelopment at 3 years in very preterm infants. J Pediatr 2004; 145: 588–592.

    Article  Google Scholar 

  9. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists. Number 60, March 2005. Pregestational diabetes mellitus. Obstet Gynecol 2005; 105: 675–685.

    Article  Google Scholar 

  10. Morera J, Hoadley SD, Roland JM, Pasipoularides A, Darragh R, Gaitan G et al. Estimation of the ratio of pulmonary to systemic pressures by pulsed-wave Doppler echocardiography for assessment of pulmonary arterial pressures. Am J Cardiol 1989; 63: 862–866.

    Article  CAS  Google Scholar 

  11. Skinner JR, Boys RJ, Hunter S, Hey EN . Non-invasive assessment of pulmonary arterial pressure in healthy neonates. Arch Dis Child 1991; 66: 386–390.

    Article  CAS  Google Scholar 

  12. Walther FJ, Siassi B, King J, Wu PY . Cardiac output in infants of insulin-dependent diabetic mothers. J Pediatr 1985; 107: 109–114.

    Article  CAS  Google Scholar 

  13. Evans N, Kluckow M . Early determinants of right and left ventricular output in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed 1996; 74: F88–F94.

    Article  CAS  Google Scholar 

  14. Kluckow M, Evans N . Low superior vena cava flow and intraventricular haemorrhage in preterm infants. Arch Dis Child Fetal Neonatal Ed 2000; 82: F188–F194.

    Article  CAS  Google Scholar 

  15. Makihara K, Hata T, Hata K, Kitao M . Echocardiographic assessment of systolic time intervals in vaginal and cesarean delivered neonates. Am J Perinatol 1993; 10: 53–57.

    Article  CAS  Google Scholar 

  16. Evans N, Iyer P . Assessment of ductus arteriosus shunt in preterm infants supported by mechanical ventilation: effect of interatrial shunting. J Pediatr 1994; 125: 778–785.

    Article  CAS  Google Scholar 

  17. Evans N, Iyer P . Incompetence of the foramen ovale in preterm infants supported by mechanical ventilation. J Pediatr 1994; 125: 786–792.

    Article  CAS  Google Scholar 

  18. Stevenson JG . Comparison of several noninvasive methods for estimation of pulmonary artery pressure. J Am Soc Echocardiogr 1989; 2: 157–171.

    Article  CAS  Google Scholar 

  19. Persson B, Hanson U . Neonatal morbidities in gestational diabetes mellitus. Diabetes Care 1998; 21 (Suppl 2): B79–B84.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neonatology, UCSD Medical Center, University of California, San Diego, San Diego, CA, USA

    A Katheria & T Leone

Authors
  1. A Katheria
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T Leone
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A Katheria.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Katheria, A., Leone, T. Altered transitional circulation in infants of diabetic mothers with strict antenatal obstetric management: a functional echocardiography study. J Perinatol 32, 508–513 (2012). https://doi.org/10.1038/jp.2011.135

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2011.135

Keywords

This article is cited by

Search

Advanced search

Quick links