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Is the child at risk? Cardiovascular remodelling in children born to diabetic mothers

Published online by Cambridge University Press:  03 April 2019

Zahra Hoodbhoy ,
Nuruddin Mohammed ,
Nadeem Aslam ,
Urooj Fatima ,
Salima Ashiqali ,
Arjumand Rizvi ,
Christine Pascua ,
Devyani Chowdhury  and
Babar S. Hasan
Zahra Hoodbhoy
Affiliation:
Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
Nuruddin Mohammed
Affiliation:
Department of Obstetrics and Gynaecology, The Aga Khan University, Karachi, Pakistan
Nadeem Aslam
Affiliation:
Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
Urooj Fatima
Affiliation:
Cardiopulmonary Services, The Aga Khan University, Karachi, Pakistan
Salima Ashiqali
Affiliation:
Cardiopulmonary Services, The Aga Khan University, Karachi, Pakistan
Arjumand Rizvi
Affiliation:
Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
Christine Pascua
Affiliation:
Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Devyani Chowdhury
Affiliation:
Cardiology Care for Children and Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Babar S. Hasan*
Affiliation:
Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
*
Author for correspondence: Babar S. Hasan, Department of Paediatrics and Child Health, The Aga Khan University, PO Box 3500, Stadium Road, Karachi, Pakistan. Tel: 92-21-34930051 Ext 4364; Fax: 92-21-34932095; E-mail: [email protected]
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Abstract

Objective:

The objective of this study was to assess differences in myocardial systolic and diastolic function and vascular function in children 2−5 years of age born to diabetic as compared to non-diabetic mothers.

Methods:

This study was a retrospective cohort conducted in 2016 at The Aga Khan University Hospital, Karachi, Pakistan. It included children between 2 and 5 years of age born to mothers with and without exposure to diabetes in utero (n = 68 in each group) and who were appropriate for gestational age. Myocardial morphology and function using echocardiogram and carotid intima media thickness (cIMT) and pulse wave velocity was performed to evaluate cardiac function as well as macrovascular remodelling in these children. Multiple linear regression was used to compare the groups.

Results:

There was no significant difference in cardiac morphology, myocardial systolic and diastolic function, and macrovascular assessment between the exposed and unexposed groups of AGA children. Subgroup analysis demonstrated a significantly decreased mitral E/A ratio in children whose mothers were on medications as compared to those on dietary control (median [IQR] = 1.7 [1.6–1.9] and 1.56 [1.4–1.7], respectively, p = 0.02), and a higher cIMT in children whose mothers were on medication as compared to controls (0.48 [0.44–0.52] and 0.46 [0.44–0.50], respectively, p = 0.03).

Conclusion:

In utero exposure to uncontrolled maternal diabetes has an effect on the cardiovascular structure and function in children aged 2−5 years. However, future work requires long-term follow-up from fetal to adult life to assess these changes over the life course.

Keywords

Hyperglycaemia in pregnancypreschool childrencardiovascular diseaserisk assessment
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 4 , April 2019 , pp. 467 - 474
Copyright
© Cambridge University Press 2019 

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