妊娠期糖尿病孕妇妊娠中期胎儿心脏功能超声评估

Echocardiography assessment of fetal cardiac function in pregnant women with gestational diabetes mellitus during the second trimester of pregnancy

目的评估妊娠期糖尿病孕妇对妊娠中期胎儿心功能的影响以及血糖控制与心脏功能的关系。方法选择2015年3月至2017年2月西安市中心医院收治的72例胎龄在24~28周单胎妊娠的妊娠期糖尿病(GDM)孕妇为研究对象(GDM组),同时选取胎龄在24~28周单胎妊娠超声心动图正常的72例孕妇作为对照组。采用超声心动图测量两组胎儿心脏各参数。结果 GDM组在等容舒张时间[(44.7±7.1) ms vs (41.2±6.1) ms]和收缩时间[(43.1±8.1) ms vs (39.7±8.7) ms]以及心肌做功指数[(0.55±0.08) vs (0.51±0.07)]和二尖瓣E/A比值(0.61±0.05 vs 0.64±0.08)与对照组比较差异均具有统计学意义(P<0.05)。GDM组二尖瓣环平面收缩期位移明显降低[(4.5±1.2) mm vs(4.9±1.0) mm,P<0.05],差异具有统计学意义。结论妊娠期糖尿病孕妇的胎儿具有较高的心脏结构及功能异常的风险,超声心动图可以检测妊娠期糖尿病孕妇妊娠中期胎儿功能性心脏异常。

Objective To assess the effect of gestational diabetes mellitus (GDM) on fetal cardiac function in the second trimester of pregnancy, and to analyze the relationship between glycemic control and cardiac function. Methods Seventy-two GDM pregnant women with singleton pregnancy of 24-28 weeks gestational age admitted to Xi'an Central Hospital from March 2015 to February 2017 were included (GDM group). Seventy-two pregnant women with singleton pregnancy and gestational age between 24 and 28 weeks with normal echocardiogram in the hospital were included as control group. The parameters of the two groups of fetal heart were measured by echocardiography. Results Functional cardiac variables in GDM group showed a statistically difference in isovolumetric relaxation, contraction times, the myocardial performance index, and mitral E/A ratios compared with normal control group (all P< 0.05):(44.7±7.1) ms vs (41.2±6.1) ms,(43.1±8.1) ms vs (39.7±8.7) ms,(0.55±0.08) vs (0.51±0.07),(0.61±0.05) mm vs (0.64±0.08) mm, respectively. Conclusion GDM puts the fetus at risk of structural and functional cardiac abnormalities. Echocardiography can be used to detect functional cardiac abnormalities during the second trimester in fetuses of GDM.