Asymmetric septal hypertrophy in infants of diabetic mothers. Fetal echocardiography and the impact of maternal diabetic control
M. J. Cooper, M. A. Enderlein, H. Tarnoff and C. L. Roge
Department of Pediatrics, Kaiser Permanente Medical Centers, CA 94589.
Maternal hyperglycemia may result in fetal hyperinsulinemia and asymmetric
septal hypertrophy, macrosomia, and hypoglycemia in infants of diabetic
mothers. We monitored glycosylated hemoglobin levels in 61 pregnant
diabetic women each trimester as an index of maternal glycemic control and
did serial fetal echocardiograms starting at 18 weeks of gestation. At
delivery, cord blood C-peptide levels were obtained as an index of fetal
hyperinsulinemia. Infants were assessed for hypoglycemia, macrosomia and
septal thickening by echocardiography. Nineteen of the 61 infants (31%) had
septal hypertrophy, were heavier, and had higher cord blood C-peptide
levels and lower serum glucose levels than unaffected infants. Maternal
glycosylated hemoglobin levels were higher during the third trimester in
mothers of affected infants. Our data support a possible relationship
between third-trimester maternal hyperglycemia and neonatal asymmetric
septal hypertrophy, macrosomia, and hypoglycemia.
