Fetal Echocardiography: A Screening Tool for Congenital Heart Disease in Maternal Diabetes

Background: The imbalance of the adipoinsular axis has been shown recently to predispose to cardio renal syndromes. Epigenetics, which deals with the metabolic influences on genetic signaling, is a new concept. Diabetes during gestation can also cause an inflammatory response in placenta. The levels of leptin/adiponectin in the neonate of a mother with diabetes can affect post insulin signaling leading to fuel mediated teratogenicity. The reactive oxidative species generated at the maternal-fetal interface can alter inhibitory or permissive gene expression resulting in chromatin epigenetic remodeling of genes in multiple organs dysfunction, including the pancreas, kidney, heart, and the muscle. The fetal cardiac malformations can be mediated by these modifications of the transcriptome. Objectives: The primary objective of the study was to explore the relationship between maternal type II diabetes mellitus and gestational diabetes with congenital heart disease in new-borns. The secondary outcome of the study was to do pre-conception counseling and emphasize the importance of peri-conceptional sugar control. Materials and Methods: This prospective study involved cardiovascular system examination of 229 single pregnancies with pre-gestational and gestational diabetes (19 pregnant women were lost for follow up in control group). Two hundred twenty nine non-diabetic women of were taken as matched controls. The case and control group were comparable with no significant differences in maternal age, ethnicity and parity. Diabetic pregnant women were also offered fetal echocardiography at 24-28 weeks of gestation in second trimester. Results: In this study, 1 out of 78 gestational diabetes and 7 out 132 pregnancies with type 2 diabetes mellitus resulted in Congenital Heart Defects. Overt diabetes mellitus (p value significant) as compared to gestational diabetes was found to be a more likely risk factor associated with CHD. There were two cases of Ventral Septal Defect (VSD) in non-diabetic pregnant women diagnosed postnatally. Conclusion: Community education programmes should be initiated in high-risk population to promote better fetal surveillance in diabetic mothers for early in utero detection of cardiac defects. Maternal counseling for peri-conceptional control of blood glucose, adequate weight maintenance, intake of Insulin and exercise is needed to prevent CHD. Fetal echocardiography is a useful tool to screen high-risk fetus that require tertiary neonatal set up and emergency cardiac surgical interventions.