Prevalence of Hypertrophic Cardiomyopathy in Fetuses of Mothers with Gestational Diabetes before Initiating Treatment.

Objective To evaluate the prevalence of hypertrophic cardiomyopathy (HCM) in fetuses of pregnant women with gestational diabetes mellitus (GDM) in the beginning of the treatment. Methods A cross-sectional study was performed between July 1, 2013, and December 20, 2013, in a public maternity clinic in southern Brazil. The subjects were 63 fetuses of mothers with gestational diabetes, with a single pregnancy and no other associated pathologies. We diagnosed HCM through a fetal echocardiography before treatment and evaluated the maternal and fetal characteristics. Results The average age of the pregnant women was 32.32 (±6.2) years, and the average gestational age at the time of the evaluation was 30.59 (±2.27) weeks. The interventricular septum thickness showed a standard deviation of more than two in 50.8% of the fetuses (95% confidence interval [95%CI]: 38.1-63.5%). The left ventricular wall thickness showed a standard deviation of more than 2 in 13 (20.6%) fetuses (95%CI: 11.1-30.2%). The HCM was confirmed in 54% of the fetuses (95%CI: 41.3-65.1%). The fetal abdominal circumference was normal in 46 (73%) fetuses, and 50% of these fetuses had HCM. Conclusion The prevalence of hypertrophic cardiomyopathy in fetuses of pregnant women with GDM before treatment was of 54% (95%CI: 41.3-65.1%).

Prevalence of Hypertrophic Cardiomyopathy in Fetuses of Mothers with Gestational Diabetes before Initiating Treatment / Prevalência de miocardiopatia hipertrófica em fetos de mães com diabetes gestacional antes do tratamento

ABSTRACT Objective: To evaluate the prevalence of hypertrophic cardiomyopathy (HCM) in fetuses of pregnant women with gestational diabetes mellitus (GDM) in the beginning of the treatment. Methods: A cross-sectional study was performed between July 1, 2013, and Decem-ber 20, 2013, in a public maternity clinic in southern Brazil. The subjects were 63 fetuses of mothers with gestational diabetes, with a single pregnancy and no other associated pathologies. We diagnosed HCM through a fetal echocardiography before treatment and evaluated the maternal and fetal characteristics. Results: The average age of the pregnant women was 32.32 (±6.2) years, and the average gestational age at the time of the evaluation was 30.59 (±2.27) weeks. The interventricular septum thickness showed a standard deviation of more than two in 50.8% of the fetuses (95% confidence interval [95%CI]: 38.1-63.5%). The left ventricular wall thickness showed a standard deviation of more than 2 in 13 (20.6%) fetuses (95%CI: 11.1-30.2%). The HCM was confirmed in 54% of the fetuses (95%CI: 41.3-65.1%). The fetal abdominal circumference was normal in 46 (73%) fetuses, and 50% of these fetuses had HCM. Conclusion: The prevalence of hypertrophic cardiomyopathy in fetuses of pregnant women with GDM before treatment was of 54% (95%CI: 41.3-65.1%).

RESUMO Objetivo: Avaliar a prevalência de miocardiopatia hipertrófica em fetos de gestantes com diabetes mellitus gestacional antes do início do tratamento. Métodos: Foi realizado um estudo de corte transversal, no período de 1o de julho de 2013 até 20 de dezembro de 2013, em uma maternidade pública. Foram objetos do estudo 63 fetos de gestantes portadoras de diabetes mellitus gestacional (DMG), em gestação única e sem outras patologias associadas. Foi realizada ecocardiografia fetal antes do início do tratamento do diabetes. O diagnóstico de miocardiopatia hipertrófica (MH) foi realizado quando a medida do septo interventricular ou da parede ventricular estava superior a dois desvios-padrão. O desfecho primário avaliado foi presença de MH. Resultados: As gestantes apresentavam idade média de 32,32 (±6,2) anos, e a idade gestacional média no momento da avaliação foi de 30,59 (±2,27) semanas. A medida do septo interventricular estava acima de 2 desvios-padrão em 50,8% (intervalo de confiança de 95% [IC95%]: 38,1-63,5%). A parede do ventrículo esquerdo estava acima de 2 desvios-padrão em 13 fetos, totalizando 20,6% (IC95%: 11,1-30,2%). A MH estava presente em 54% dos fetos (IC95%: 41,3-65,1%). A circunferência abdominal fetal estava normal em 46 (73%) fetos, e destes, 50% apresentavam MH. Conclusão: A prevalência de MH em fetos de gestantes portadoras de DMG antes do tratamento foi de 54% (IC95% 41,3-65,1%).

Two-dimensional sonographic cine imaging improves confidence in the initial evaluation of the fetal heart.

OBJECTIVES: Initial screening sonography of the fetal heart with static images is often inadequate, resulting in repeated imaging or failure to detect abnormalities. We hypothesized that the addition of short cine clips would reduce the need for repeated imaging. METHODS: Two-dimensional (2D) static sonograms and short 2D cine clips of the 4-chamber view and left and right ventricular outflow tracts were obtained from 342 patients with gestational ages of greater than 16 weeks. A diagnostic radiologist and a perinatologist retrospectively reviewed the static and cine images independently and graded them as normal, abnormal, or suboptimal. RESULTS: A statistically significant increase in the number of structures called normal was seen when 2D cine clips were added to static imaging for both observers (P < .05); the radiologist called 86.5% normal with combined static and cine images versus 61.9% with static images alone, whereas the perinatologist recorded 68.1% as normal versus 58.8%, respectively. The radiologist called 77.8% of structures normal with cine images only versus 61.9% with static images only (P < .001), whereas the perinatologist called fewer structures normal with cine images alone (38.9%) versus static images alone (58.8%). The use of cine loops alone resulted in no significant increase in the ability to clear the heart as normal. The maternal body mass index was inversely associated with the ability to clear structures when 2D cine images were added to static images (P < .05). CONCLUSIONS: The addition of 2D cine clips to standard 2D static imaging of the fetal heart significantly improves the number of structures cleared as normal. Two-dimensional cine clips are easily obtained, add little time to a study, and require minimal archival space.