Role of ultrasonographic measurement of the fetal epicardial fat pad and cardiac interventricular septal thickness in predicting the outcome and prevent various complications of gestational diabetes mellitus
Tóm tắt
Gestational diabetes mellitus (GDM) is one of the most common medical conditions affecting pregnancy and increasing the risk for maternal and perinatal complications. The present study aimed at determining the role of ultrasonographic measurement of fetal epicardial fat pad thickness (f EFT) and fetal cardiac interventricular septal thickness (f IVST) at 24–32 weeks of gestation in the prediction of GDM. A prospective observational case–control study was conducted including a total of 35 GDM patients and 35 normal pregnancies who were subjected to ultrasonographic measurement of the f EFT and f IVST at 24–32 weeks of gestation. Statistical analysis and the receiver operating characteristic curves were used to find out the cutoff value, sensitivity, specificity and diagnostic accuracy of these two parameters for the prediction of GDM. When an f EFT value of 1.3 was accepted as a cutoff value, GDM could be predicted with a sensitivity of 68.6% and specificity of 91.4%, PPV of 88.9%, NPV of 74.4% and diagnostic accuracy of 80%. When an f IVST value of 2.6 was accepted as a cutoff value, GDM could be predicted with a sensitivity of 80%, specificity of 77.14%, PPV of 77.8%, NPV of 79.4% and diagnostic accuracy of 78.5%. The ultrasonographic measurements of fetal epicardial fat pad thickness and fetal cardiac interventricular septal thickness were statistically significantly higher in GDM pregnancies (p value < 0.0001) as compared to the controls. Thus, these two parameters can serve as excellent ultrasonographic markers in the prediction of GDM.
Tài liệu tham khảo
Buchanan TA, Xiang AH, Kjos SL, Watanabe RM (2007) What is gestational diabetes? Dia Care 30:105–111
American Diabetes Association (2003) Gestational diabetes mellitus. Dia Care 26:103–105
King H (1998) Epidemiology of glucose intolerance and gestational diabetes in women of childbearing age. Dia Care 2:09–13
Sheiner E (2020) Gestational diabetes mellitus: long-term consequences for the mother and child grand challenge: how to move on towards secondary prevention? Front Clinic Diabetes Healthc. https://doi.org/10.3389/fcdhc.2020.546256
Hornberger LK (2006) Maternal diabetes and the fetal heart. Heart 92:1019–1021
Al-Biltagi M, razaky, O. E., & Amrousy, D. E. (2021) Cardiac changes in infants of diabetic mothers. World J Diabetes 12(8):1233–1247
Lacobellis G, Corradi D, Sharma AM (2005) Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med 2:536–543
Bertaso AG, Bertol D, Duncan BB, Foppa M (2013) Epicardial fat: definition, measurements and systematic review of main outcomes. Arq Bras Cardiol 101:18–28
International Association of D, Pregnancy study groups consensus P, Metzger BE, Gabbe SG, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676–82
Vannuccini S, Torricelli M, Voltolini C, Bocchi C, Severi F, Petraglia F (2014) Placental location and delivery outcome in healthy pregnancy. Ultrasound Obstet Gynecol 44:286–287
Akkurt M, Turan O, Crimmins S, Harman C, Turan S (2018) Increased fetal epicardial fat thickness: a novel ultrasound marker for altered fetal metabolism in diabetic pregnancies. J Clin Ultrasound 46:397–402
Jackson D, Deschamps D, Myers D, Fields D, Knudtson E, Gunatilake R (2015) Fetal epicardial fat thickness in diabetic and non-diabetic pregnancies: a retrospective cross-sectional study. Obesity 24:167–171
Yavuz A, Akkurt M, Yalcin S, Karakoc G, Varol E, Sezik M (2016) Second trimester fetal and maternal epicardial fat thickness in gestational diabetic pregnancies. Horm Metab Res 48:595–600
Aydin S, Fatihoglu E (2020) Fetal epicardial fat thickness: can it serve as a sonographic screening marker for gestational diabetes mellitus? J Med Ultrasound 28(4):239–244
Russell NE, Foley M, Kinsley BT, Firth RG, Coffey M, McAuliffe FM (2008) Effect of pregestational diabetes mellitus on fetal cardiac function and structure. Am J Obstet Gynecol 199:312
Ren Y, Zhou Q, Yan Y, Chu C, Gui Y, Li X (2011) Characterization of fetal cardiac structure and function detected by echocardiography in women with normal pregnancy and gestational diabetes mellitus. Prenat Diagn 31:459–465
Garg S, Sharma P, Sharma D, Behera V, Durairaj M, Dhall A (2014) Use of fetal echocardiography for characterization of fetal cardiac structure in women with normal pregnancies and gestational diabetes mellitus. J Ultrasound Med 33:1365–1369
Miranda J, Cerqueira R, Ramalho C, Areias J, Henriques-Coelho T (2018) Fetal cardiac function in maternal diabetes: a conventional and speckle-tracking echocardiographic study. J Am Soc Echocardiogr 31:333–341
Chen C, Hao GY, Yun RY, Ye SL (2012) The impacts of maternal gestational diabetes mellitus on fetal hearts. Biomed Environ Sci 25:15–22
Fouda UM, Abou ElKassem MM, Hefny SM, Fouda RM, Hashem AT (2013) Role of fetal echocardiography in evaluation of structure and function of the fetal heart in diabetic pregnancies. J Matern Fetal Neonatal Med 26(6):571–575
Balli S, Pac FA, Ece Oflaz MB, Kibar AE et al (2014) Assessment of cardiac functions in fetuses of gestational diabetic mothers. Pediatr Cardiol 35:30
Dervisoglu P, Kosecik M, Kumbasar S (2018) Effects of gestational and pregestational diabetes mellitus on the foetal heart: a cross-sectional study. J Obstet Gynaecol 38:40
Szmyd B, Biedrzycka M, Karuga FF, Rogut M, Strzelecka I, Respondek-Liberska M (2021) Interventricular septal thickness as a diagnostic marker of fetal macrosomia. J Clin Med 10(5):949