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Echocardiography should be also performed during the third trimester in fetuses of pregestational diabetic mothers
Author(s) -
Puerto B.,
Martínez J. M.,
Gomez O.,
Moyano D.,
Palacio M.,
Martínez S.,
Borrell A.,
Cararach V.
Publication year - 2001
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.2001.abs28-28.x
Subject(s) - medicine , coarctation of the aorta , gestation , tetralogy of fallot , population , heart disease , cardiology , pregnancy , pulmonic stenosis , stenosis , fetal echocardiography , fetus , prenatal diagnosis , aorta , environmental health , biology , genetics
Objective: To assess the risk and types of congenital heart disease in our population of insulin‐dependent pregestational diabetic mothers. Methodology: Over a 3‐year period, a transabdominal echocardiography at 20–22 weeks of gestation and a second one at 32–34 weeks of gestation was performed in 142 insulin‐dependent diabetic pregnancies. In the last 30 cases, an early examination combining either the transvaginal or the transabdominal route at 13–16 weeks was also carried out. A complete heart evaluation and measurement of the interventricular septum thickness was performed, with color and pulsed Doppler assessment. An accurate postnatal cardiac examination was always performed. Results: Twelve significant cardiac defects (8.45%) were detected, but only two of them before 22 weeks of gestation (one tetralogy of Fallot, and another one critical aortic stenosis). Both followed early termination of pregnancy, and postmortem evaluation confirmed the diagnosis. The other 10 cases were diagnosed during the third trimester: two coarctation of the aorta (one neonatal death because hemodynamic disturbance), three pulmonic stenosis, five significant hypertrophic cardiomiopathy with subaortic stenosis, and a case of supraventricular tachycardia (>240 bpm needing postnatal cardioversion). All the babies, but one are alive and well, although most of them have needed catheterization or pharmacological treatment. One case of a ventricular septal defect (2.5 mm, muscular) was overlooked during gestation, but closed by the sixth month of life. Conclusion: Our results confirm that diabetic women are at increased risk of having a child with congenital heart disease, and therefore we recommend conventional fetal echocardiography in all pre‐gestational diabetic pregnancies at 20–22 weeks of gestation. In view of the pattern of defects we have found, we strongly suggest that a further scan during the late trimester should always be performed.