TroponinT and proBNP in fetuses of Type 1 diabetic mothers

  1. Noirin E Russell, MRCPI (noirinrussell{at}physicians.ie)1,
  2. Mary F Higgins, MRCOG1,
  3. Michael Amaruso2,
  4. Michael Foley, FRCOG1 and
  5. F M McAuliffe, MD1
  1. 1University College Dublin School of Medicine and Medical Science, Obstetrics & Gynaecology, National Maternity Hospital, Dublin 2, Ireland
  2. 2National Maternity Hospital, Holles St., Dublin 2, Ireland

    Abstract

    Objective: Cardiomyopathy is noted in up to 40% of infants of diabetic mothers, the exact mechanisms of which are unknown. The aim of this study is to determine if fetal serum markers of cardiac function differ between normal and type 1 diabetic pregnancy and to examine the relationship between these markers and fetal cardiac structure and function.

    Research Design and Methods: This is a prospective observational study of 45 type 1 diabetic pregnancies and 39 normal pregnancies. All participants had concentrations of fetal pro B-type natriuretic peptide and troponin-T measured at the time of delivery. All patients with type 1 diabetes had Doppler evaluation of the umbilical artery, middle cerebral artery and ductus venosus in the third trimester and a subset (n=21) had detailed fetal echocardiograms performed in each trimester.

    Results: Fetal proBNP and TnT concentrations were higher in the diabetic cohort than in the normal cohort(p<0.05). ProBNP correlated positively with interventricular septum thickness(p<0.05) but not with cardiac function indices in the third trimester. In patients with poor glycaemic control there was a significant positive correlation(p< 0.05) between fetal TnT and third trimester umbilical artery pulsatility index(UAPI). There were also increased levels of fetal TnT in infants with poor perinatal outcome (p<0.05).

    Conclusion: Biochemical markers of cardiac dysfunction are elevated in infants of diabetic mothers, especially those with cardiomyopathy or poor perinatal outcome. Hyperglycaemia in early pregnancy may affect myocardial and placental development, thus contributing to the susceptibility to hypoxia seen in these infants.

    Footnotes

      • Received March 30, 2009.
      • Accepted August 2, 2009.

    This Article

    1. Diabetes Care
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