Left ventricular mass in offspring of diabetic mothers: at 5–7 years old

  • Rista Lestari
  • Noormanto Noormanto
  • Madarina Julia
Original Article

Abstract

Newborns of mothers with diabetes have increased risk for cardiac left ventricular (LV) hypertrophy. Diabetic pregnancy is also associated with in increased risk for obesity and hypertension, as well as for later cardiovascular morbidity and mortality. This study aimed to examine the connection between being the offspring from a diabetic pregnancy and having hypertension and obesity to the increased risk to have left ventricular mass (LVM) and altered LV geometry in childhood. We conducted a retrospective cohort study on 23 offspring of diabetic mothers and 23 sex- and age-matched control children at the age of 5–7 years. LVM and LV geometry were assessed using M-mode echocardiography and indexed for height2.7. Data analyses were adjusted for birth weight, current overweight/obesity status and blood pressure. Prevalence of increased LVM/height2.7 was higher in children of diabetic mothers, i.e. 43.5 vs. 8.7% in the control group (RR (95% CI) 5.0 (1.2–20.4), p = 0.007). The association between maternal diabetes and increased LVM persisted after adjustment for age, sex, birth weight, current overweight/obesity status and blood pressure, with regression coefficient of (95% CI) 5.7 (1.4–10.1), p = 0.01. Together, maternal diabetes, overweight/obesity status and blood pressure contributed 50% to the increase. Results showed that children of diabetic mothers were more likely to have altered LV geometry (RR (95% CI) 6.0 (1.5–23.9), p < 0.001). Maternal diabetes is a risk factor for increased LVM and altered LV geometry in childhood.

Keywords

Diabetic pregnancy Maternal diabetes Childhood Left ventricular mass Left ventricular geometry Left ventricular hypertrophy 

Notes

Author contributions

All the three authors’ (RL, N, MJ) contributed to the conception and the design of the study. RL and N contributed to the acquisition of the data, and RL and MJ analysed the data. All authors (RL, N, MJ) contributed to the interpretation of the data. RL drafted the article. N and MJ critically revised the draft. All (RL, N, MJ) approved the version to be published and agreed to be accountable for all aspects of the work, including ensuring integrity and accuracy.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Medical and Health Research Ethics Committee, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and national regulations and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from parents before data collection.

Prior publication in the abstract form

The abstract of this paper has been presented in The 9th Biennial Scientific Meeting of the Asia Pacific Paediatric Endocrine Society (APPES) in Tokyo, Japan, in November 19, 2016.

References

  1. 1.
    Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract. 2014;103:176–85.CrossRefPubMedGoogle Scholar
  2. 2.
    Mitanchez D, Yzydorczyk C, Siddeek B, Boubred F, Benahmed M, Simeoni U. The offspring of the diabetic mother—short- and long-term implications. Best Pract Res Clin Obstet Gynaecol. 2015;29:256–69.CrossRefPubMedGoogle Scholar
  3. 3.
    Deorari AK, Saxena A, Singh M, Shrivastava S. Echocardiographic assessment of infants born to diabetic mothers. Arch Dis Child. 1989;64:721–4.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Garcia-Flores J, Jañez M, Gonzalez MC, Martinez N, Espada M, Gonzalez A. Fetal myocardial morphological and functional changes associated with well-controlled gestational diabetes. Eur J Obstet Gynecol Reprod Biol. 2011;154:24–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Ullmo S, Vial Y, Di Bernardo S, Roth-Kleiner M, Mivelaz Y, Sekarski N, et al. Pathologic ventricular hypertrophy in the offspring of diabetic mothers: a retrospective study. Eur Heart J. 2007;28:1319–25.CrossRefPubMedGoogle Scholar
  6. 6.
    Simeoni U, Barker DJ. Seminars in Fetal & Neonatal Medicine Semin Fetal Neonatal Med 2009;14:119–124, Offspring of diabetic pregnancy: Long-term outcomes.Google Scholar
  7. 7.
    Marco LJ, McCloskey K, Vuillermin PJ, Burgner D, Said J, Ponsonby A-L. Cardiovascular disease risk in the offspring of diabetic women: the impact of the intrauterine environment. Exp Diabetes Res. 2012;2012:565160. Available from: http://europepmc.org/articles/PMC3485506.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Artham SM, Lavie CJ, Milani R, Patel D, Verma A, Ventura HO. Clinical impact of left ventricular hypertrophy and implications for regression. Prog Cardiovasc Dis. 2009;52:153–67.CrossRefPubMedGoogle Scholar
  9. 9.
    Rijpert M, Breur J, Evers I, de Valk H, Heijnen C, Meijboom F, Visser G. Cardiac function in 7-8-year-old offspring of women with type 1 diabetes. Exp Diabetes Res 2011;2011:564316, 1, 7.Google Scholar
  10. 10.
    Crume TL, Ogden LG, Mayer-Davis EJ, Hamman RF, Norris JM, Bischoff KJ, et al. The impact of neonatal breast-feeding on growth trajectories of youth exposed and unexposed to diabetes in utero: the EPOCH study. Int J Obes. 2012;36(4):529–34.CrossRefGoogle Scholar
  11. 11.
    Crume TL, Ogden L, Daniels S, Hamman RF, Norris JM, Dabelea D. The impact of in utero exposure to diabetes on childhood body mass index growth trajectories: the EPOCH study. J Pediatr. 2011;158(6):941–6.  https://doi.org/10.1016/j.jpeds.2010.12.007.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Aceti A, Santhakumaran S, Logan KM, Philipps LH, Prior E, Gale C, et al. The diabetic pregnancy and offspring blood pressure in childhood: a systematic review and meta-analysis. Diabetologia. 2012;55(11):3114–27.CrossRefPubMedGoogle Scholar
  13. 13.
    Hanevold C, Waller J, Daniels S, Portman R, Sorof J. The effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the international pediatric hypertension association. Pediatrics. 2004;113(2):328–33.CrossRefPubMedGoogle Scholar
  14. 14.
    Richey PA, Disessa TG, Somes GW, Alpert BS, Jones DP. Left ventricular geometry in children and adolescents with primary hypertension. Am J Hypertens. 2010;23(1):24–9.CrossRefPubMedGoogle Scholar
  15. 15.
    WHO. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization guideline. Diabetes Res Clin Pract. 2014;103(3):341–63.CrossRefGoogle Scholar
  16. 16.
    Mendis S, Fukino K, Cameron A, Laing R, Filipe A, Leowski J, et al. A systematic review of inequalities in the use of maternal health care in developing countries. Bull World Health Org. 2007;85(10):812–9.CrossRefGoogle Scholar
  17. 17.
    Falkner B, Daniels SR. Summary of the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Hypertension. 2004;44(4):387–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450–458.Google Scholar
  19. 19.
    Khoury PR, Mitsnefes M, Daniels SR, Kimball TR. Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr Elsevier Inc. 2009;22(6):709–14.CrossRefGoogle Scholar
  20. 20.
    Zielinsky P, Piccoli A. Myocardial hypertrophy and dysfunction in maternal diabetes. Early Human Dev. 2012;88:273–8.CrossRefGoogle Scholar
  21. 21.
    Elmekkawi SF, Mansour GM, Elsafty MSE, Hassanin AS, Laban M, Elsayed HM. Prediction of fetal hypertrophic cardiomyopathy in diabetic pregnancies compared with postnatal outcome. Clin Med Insights: Women’s Health. 2015;8:39–43.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Ma RCW, Tutino GE, Lillycrop KA, Hanson MA, Tam WH. Maternal diabetes, gestational diabetes and the role of epigenetics in their long term effects on offspring. Prog Biophys Mol Biol. 2015;118(1–2):55–68.CrossRefPubMedGoogle Scholar
  23. 23.
    Di Bernardo S, Mivelaz Y, Epure AM, Vial Y, Simeoni U, Bovet P, et al. Assessing the consequences of gestational diabetes mellitus on offspring’s cardiovascular health: MySweetHeart Cohort study protocol, Switzerland. BMJ Open. 2017;0:e016972.  https://doi.org/10.1136/bmjopen-2017-016972.Google Scholar

Copyright information

© Research Society for Study of Diabetes in India 2018

Authors and Affiliations

  1. 1.Department of Child Health, Faculty of MedicineUniversitas Gadjah Mada/Dr. Sardjito HospitalYogyakartaIndonesia
  2. 2.Division of Paediatric Cardiology, Department of Child Health, Faculty of MedicineUniversitas Gadjah Mada/Dr. Sardjito HospitalYogyakartaIndonesia
  3. 3.Division of Paediatric Endocrinology, Department of Child Health, Faculty of MedicineUniversitas Gadjah Mada/Dr. Sardjito HospitalYogyakartaIndonesia

Personalised recommendations