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OGP 6504 Prevalence of cardiac abnormalities in fetuses of diabetic mothers
Sl26
Ultrasound
in Medicine
and Biology
Volume
23, Supplement
1, 1997
OGP6356
OGP6504
CEREBRAL&JMBILICAL ARTERY RATIO AS PREDICTOR OF ADVERSE PERINATAL OUTCOME Prof Pal-0 M, Aguilar M; LusciaIdo S; Trill0 S; M&aco A; Goldman A Maternal and Child Department, Hospital “Prof. A. Poaadas’; Buenos Aires, Argentina.
PREVALENCE OF CARDIAC ABNORMALlTlES IN FETUSES OF DIABETIC MOTHERS. Paul0 Zielinslq, Rejatte F. Dillenburg. Lucia P. Zinuner, Guilherme Fesce, AM M. Aramavo, Laura L. Hagemann. Institute of Cardiology of Rio Grande do Sul. Port0 Alegre. Brazil.
Doppler can evaluate hemodiic changes and predict fetal hypoxia, showing maternal and fetal circuit. In physiologic conditions the relation between cerebral media artery and umbilical artery is more than 1. This study describes perinatal outcome when the ratio was pathologic. Four& two cases with cerebral/umbilical ratio less than 1 were analyzed out of 327 patients between january and December 1995. The items analyzed were: maternal age, maternal pathology, delivery, neonatal weight, I.U.G.R., neonatal admission to N.I.C.U., neonatal morbidity, low weight, very low weigth, low weight for gestational age, perinatal mortality, and delivery gestational age(CAPURR0 score). The most significant findings were: Low Weigtb Very low weigtb Cesarean section I.U.G.R. Perinatal mortal&y
52 1 I,9 40,s 40,3 9,4
% % % % %
(94/1000)
OGP6453 CHANGES IN THE PULSATIUTY INDEX OF THE UTERINE ARTERY PRE AND POST HORMONE REPLACEMENT THERAPY WITH TWO DIFFERENT ESTROGEN-PROGESTIN COMSlNAnON Urthiague, ME; Palermo,M: Aguilar,M; MurabJ; Lioy.G Hospilal Nacimal “P&SW Alejandro Posadas” - Buenos Aires AQpdill6?
csrdiovsscnlar pmtcction by hormone replacement therapy (HRT) have ban focused, up to now, on lipids chrngcs but other bencficisl actions are today studying regarding the effc& of the HRT on the arterial well. Our pm-pose we to evaluate changes in the uterine arterial wall pre and post HRT with hw different estrogen-pmgestin combination and to compare these changes with or without the pnscnee of the Cardiovascular Risk Factors (Cw. WC measured by Doppkr ultmsonogmphy (DU), the Pulsatilily Index (PI) and IhePourcelot Index (RI) at bnselinc and al&x 6 months of HRT in 40 mempausd WomQl asigned by Bynecdogical criteria HRT with: Croup I (GI n-19): 2 mg of 17B &radio1 + 1 mg nomthistemne/day in combine-continues s&ma GmupU (GlI n=21): 1.50 mg/daytmnscutnneous 17B cstmdiol + 5 mg mcdmxypmgcstcmne acetnte (MPA) 12 days/month. Personal data, socioeconomic status, CVRF, PI and RI were evaluolcd and analyzed by multiple correlation by Ccs Statistica program. The age media was 51.02 + 4.86 yws old, time since menopause (TSM) 4.25 f. 3.21 years. There was a diit c0mlatic.n behveen TSM and PI et baselimer = 0.26 (95% 0.05~~053). TWICEwere no differences in CVRF prewdence between groups at entry, only women who mpartcd smoke habits (SK) showed higher PI that who da not SMK. Afkx multiples variables con&tion GII vs GI showed: reduction on PI (33% vs1~/~.019)reducti~onR1(4%vslW~.031)andincMscdHDU) (13% M 1% p=O.O3 1). Significant changes in ultmmnogmphy index= were seen in women with or without CVRF but GII showed greater decrement effect on PI in hypertensive, dislipidemic and SMK women. Conclusion: we concluded that the HRT, specialy tmnscutnneous estmgen+hEA showed beneficial effect on the tierial wall cvaluatal by the changesof the PL Thesefawxabk effects were present in women with CVRF. These findings needs fmtbcr investigation in women at cardiovnswlsr high risk.
The higher ocurrence of structural heart disease in fetuses of previous diabetic mothers is well described in the literature. This study reviews the fetal echocardiograms of 1075 diabetic mothers (852 gestational diebetes and 223 previous diabetes) examined at the Fetal Cardiology Unit from January 1989 - Cktoher 1996. There were 162 cardiac abnormalities (IS%), excluding rhythm disturbances and functional disorders. The abnormalities included in the study were 120 hypertrophic cardiomyopathy and 35 structural heart diseases. In the gestational diabetes group (n= 852) there were 87 (10.2%) patients with hypertrophic cardiomyopathy and 25 (2.9%) cases of fetal cardiac melformations: ventricular septal defects-VSD (18), double outlet right ventricle-DORV (3), pulmonary atresia-PA (1), double inlet left ventricle-DILV (1). complete atrioventricular septal defe&CAVSD (2). In the previous diabetes group (n=223) there were 33 (14.7%) fetuses with hypearophic cardiomyopathy and 17 (7.6%) cases of structural heart disease: VSD (14). tetralogy of Fallot-TF (1), DORV (1), pulmonary stenosis (1), truncus (1). mitral atresia (1). transposition of the greet arteries - TGA (1), dysplastic tricuspid valve (1). Even though the prevalence of hypertrophic cardiomyopathy in both groups was predictable, there was a much higher than expected prevalence of feral structural heart disease in the group of mothers with gestational diabetes. This finding may raise the suspicion of an erroneous diegnosis of gestational diabetes or suggest that some teratogenic effect would already he present early in gestation.
OGP6505 FETAL HYPERINSULINEMIA AND WPERTROPHIC CARDIOMYOPATHY: ASSOCIATION IN PERINATAL LIFE. Laura L. Hagemann, Ana M. Marcela, Paul0 Zielinsky. Institute of Cardiology of Rio Grande do Sul, Porte Alegre, Brazil. The frequent presence of a disproportionate hypertrophic ventricular septum in fetuses of diabetic mothers has heen widely reported. The most accepwd hypothesis to explain this disorder is fetal hypzinsulinsm due to inadequate control of maternal diabetes. This prospective controlled transversal study was carried cut to test the hypothesis that fetal hypertmphic cardiomyopathy in diabetic pregnancies is related to hyperinsulinism as assessed by amniotic fluid insulin levels. Six&-five fetuses (37 of diabetic mothers and 28 of hypertensive mothers) were studied. Fetal echocardiography was performed within one week of the amniocentesis in every case. Fetal insulin levels and interventricular septum thickness were considered abnormal when their values were above 2 standard deviations, according to local nomograms. The mean gestational age at the time ofexamination VAS 32.3 * 3.5 wds (24-39 weeks) in the geatationel diabetes group, 28.5 i 2.7 weeks (23-33 w&s) in the previous diabetes group and 30.6 i 3.1 weeks (25-36 weeks) in the control group. Mean septal thickness was 3.7 (2.2 to 6.3 nun) in the group of diabetic mothers and 3.0 (2.0 to 4.3 nun) in the control group (p
Ultrasound
in Medicine
and Biology
Volume
23, Supplement
1, 1997
OGP6356
OGP6504
CEREBRAL&JMBILICAL ARTERY RATIO AS PREDICTOR OF ADVERSE PERINATAL OUTCOME Prof Pal-0 M, Aguilar M; LusciaIdo S; Trill0 S; M&aco A; Goldman A Maternal and Child Department, Hospital “Prof. A. Poaadas’; Buenos Aires, Argentina.
PREVALENCE OF CARDIAC ABNORMALlTlES IN FETUSES OF DIABETIC MOTHERS. Paul0 Zielinslq, Rejatte F. Dillenburg. Lucia P. Zinuner, Guilherme Fesce, AM M. Aramavo, Laura L. Hagemann. Institute of Cardiology of Rio Grande do Sul. Port0 Alegre. Brazil.
Doppler can evaluate hemodiic changes and predict fetal hypoxia, showing maternal and fetal circuit. In physiologic conditions the relation between cerebral media artery and umbilical artery is more than 1. This study describes perinatal outcome when the ratio was pathologic. Four& two cases with cerebral/umbilical ratio less than 1 were analyzed out of 327 patients between january and December 1995. The items analyzed were: maternal age, maternal pathology, delivery, neonatal weight, I.U.G.R., neonatal admission to N.I.C.U., neonatal morbidity, low weight, very low weigth, low weight for gestational age, perinatal mortality, and delivery gestational age(CAPURR0 score). The most significant findings were: Low Weigtb Very low weigtb Cesarean section I.U.G.R. Perinatal mortal&y
52 1 I,9 40,s 40,3 9,4
% % % % %
(94/1000)
OGP6453 CHANGES IN THE PULSATIUTY INDEX OF THE UTERINE ARTERY PRE AND POST HORMONE REPLACEMENT THERAPY WITH TWO DIFFERENT ESTROGEN-PROGESTIN COMSlNAnON Urthiague, ME; Palermo,M: Aguilar,M; MurabJ; Lioy.G Hospilal Nacimal “P&SW Alejandro Posadas” - Buenos Aires AQpdill6?
csrdiovsscnlar pmtcction by hormone replacement therapy (HRT) have ban focused, up to now, on lipids chrngcs but other bencficisl actions are today studying regarding the effc& of the HRT on the arterial well. Our pm-pose we to evaluate changes in the uterine arterial wall pre and post HRT with hw different estrogen-pmgestin combination and to compare these changes with or without the pnscnee of the Cardiovascular Risk Factors (Cw. WC measured by Doppkr ultmsonogmphy (DU), the Pulsatilily Index (PI) and IhePourcelot Index (RI) at bnselinc and al&x 6 months of HRT in 40 mempausd WomQl asigned by Bynecdogical criteria HRT with: Croup I (GI n-19): 2 mg of 17B &radio1 + 1 mg nomthistemne/day in combine-continues s&ma GmupU (GlI n=21): 1.50 mg/daytmnscutnneous 17B cstmdiol + 5 mg mcdmxypmgcstcmne acetnte (MPA) 12 days/month. Personal data, socioeconomic status, CVRF, PI and RI were evaluolcd and analyzed by multiple correlation by Ccs Statistica program. The age media was 51.02 + 4.86 yws old, time since menopause (TSM) 4.25 f. 3.21 years. There was a diit c0mlatic.n behveen TSM and PI et baselimer = 0.26 (95% 0.05~~053). TWICEwere no differences in CVRF prewdence between groups at entry, only women who mpartcd smoke habits (SK) showed higher PI that who da not SMK. Afkx multiples variables con&tion GII vs GI showed: reduction on PI (33% vs1~/~.019)reducti~onR1(4%vslW~.031)andincMscdHDU) (13% M 1% p=O.O3 1). Significant changes in ultmmnogmphy index= were seen in women with or without CVRF but GII showed greater decrement effect on PI in hypertensive, dislipidemic and SMK women. Conclusion: we concluded that the HRT, specialy tmnscutnneous estmgen+hEA showed beneficial effect on the tierial wall cvaluatal by the changesof the PL Thesefawxabk effects were present in women with CVRF. These findings needs fmtbcr investigation in women at cardiovnswlsr high risk.
The higher ocurrence of structural heart disease in fetuses of previous diabetic mothers is well described in the literature. This study reviews the fetal echocardiograms of 1075 diabetic mothers (852 gestational diebetes and 223 previous diabetes) examined at the Fetal Cardiology Unit from January 1989 - Cktoher 1996. There were 162 cardiac abnormalities (IS%), excluding rhythm disturbances and functional disorders. The abnormalities included in the study were 120 hypertrophic cardiomyopathy and 35 structural heart diseases. In the gestational diabetes group (n= 852) there were 87 (10.2%) patients with hypertrophic cardiomyopathy and 25 (2.9%) cases of fetal cardiac melformations: ventricular septal defects-VSD (18), double outlet right ventricle-DORV (3), pulmonary atresia-PA (1), double inlet left ventricle-DILV (1). complete atrioventricular septal defe&CAVSD (2). In the previous diabetes group (n=223) there were 33 (14.7%) fetuses with hypearophic cardiomyopathy and 17 (7.6%) cases of structural heart disease: VSD (14). tetralogy of Fallot-TF (1), DORV (1), pulmonary stenosis (1), truncus (1). mitral atresia (1). transposition of the greet arteries - TGA (1), dysplastic tricuspid valve (1). Even though the prevalence of hypertrophic cardiomyopathy in both groups was predictable, there was a much higher than expected prevalence of feral structural heart disease in the group of mothers with gestational diabetes. This finding may raise the suspicion of an erroneous diegnosis of gestational diabetes or suggest that some teratogenic effect would already he present early in gestation.
OGP6505 FETAL HYPERINSULINEMIA AND WPERTROPHIC CARDIOMYOPATHY: ASSOCIATION IN PERINATAL LIFE. Laura L. Hagemann, Ana M. Marcela, Paul0 Zielinsky. Institute of Cardiology of Rio Grande do Sul, Porte Alegre, Brazil. The frequent presence of a disproportionate hypertrophic ventricular septum in fetuses of diabetic mothers has heen widely reported. The most accepwd hypothesis to explain this disorder is fetal hypzinsulinsm due to inadequate control of maternal diabetes. This prospective controlled transversal study was carried cut to test the hypothesis that fetal hypertmphic cardiomyopathy in diabetic pregnancies is related to hyperinsulinism as assessed by amniotic fluid insulin levels. Six&-five fetuses (37 of diabetic mothers and 28 of hypertensive mothers) were studied. Fetal echocardiography was performed within one week of the amniocentesis in every case. Fetal insulin levels and interventricular septum thickness were considered abnormal when their values were above 2 standard deviations, according to local nomograms. The mean gestational age at the time ofexamination VAS 32.3 * 3.5 wds (24-39 weeks) in the geatationel diabetes group, 28.5 i 2.7 weeks (23-33 w&s) in the previous diabetes group and 30.6 i 3.1 weeks (25-36 weeks) in the control group. Mean septal thickness was 3.7 (2.2 to 6.3 nun) in the group of diabetic mothers and 3.0 (2.0 to 4.3 nun) in the control group (p