Prenatal Diagnosis of Fetal Hypertrophic Cardiomyopathy in Diabetic Mothers Using 5D Fetal Echocardiography

Background: Diabetes mellitus is a common condition, affecting approximately 7% of pregnant women. Appropriate management has reduced morbidity and mortality. Diabetes mellitus in pregnancy can cause many problems for the fetus as significant congenital disorders, risk of premature delivery and increased prenatal morbidity and mortality. In addition, it causes neonatal hypoglycemia, macrosomia and transient hypertrophic cardiomyopathy HCM (observed in up to 35% of fetuses). Fetal Intelligent Navigation Echocardiography (FINE) is a novel method for visualization of standard fetal echocardiography views from volume datasets obtained with spatiotemporal image correlation (STIC).This method can simplify examination of the fetal heart and reduce operator dependency.
Objectives: The aim of this study was to investigate the utility of 5D fetal echocardiography in the prenatal diagnosis of fetal hypertrophic cardiomyopathy in healthy mothers, controlled diabetic mothers and uncontrolled diabetic mothers.
Patients and Methods: Cross sectional observational study was conducted at Ain Shams University Maternity Hospital at the ultrasound fetal special care unit, Study duration: September 2017- July 2018. This study was conducted on healthy and diabetic pregnant women divided into 3 groups Sampling Method: This study included 111 pregnant women between the 28th and 36th weeks of gestation. After approval of the Local Institutional Review Board, the study was explained and an informed written consent was obtained from all participants. This study included 3 groups of pregnant women which were: Group A: Control group which consist of 37 healthy non-diabetic pregnant women, group B: Controlled group which consist of 37 diabetic pregnant women with good glycemic control, group C: Uncontrolled group which consist of 37 diabetic pregnant women with poor glycemic control.
Results: The current study showed that, as regards the thickness of the interventricular septum IVS, there were significant differences between the three groups. The mean IVS thickness in Group A was 0.38±0.05 cm; in Group B, it was 0.44±0.05cm and in Group C, it was 0.57±0.08cm. In a similar study, compared the IVS thickness between GDM, DM type 2 and DM type 1,showed that the mean fetal IVS thickness was 3.73 + 0.84 mm in the DM type1 group; 4.08 + 0.75 mm in the GDM group; and 3.99 + 0.59 mm  in the DM type 2 group and found that there was a statistically significant difference between HbA1c and IVS thickness in the DM type1 group only P=0.013.But in the GDM group (P=0.723) and the DM type2 group (P=0.380), there were no significant differences.
Conclusion: Infants of diabetic mothers are prone to have multiple problems during the neonatal period which makes them a very high risk infant. These neonates must be screened for any associated congenital anomalies and metabolic abnormalities. Hypertrophic cardiomyopathy of IDM have good prognosis and this cardiomyopathy is reversible in nature but these neonates requires close monitoring and regular follow-up and early intrauterine detection.