EP09.30: Modified myocardial performance index and prediction of cardiac hypertrophy in infants of insulin‐dependent diabetic mothers: a pilot study

This pilot study aims to evaluate the correlation between the longitudinal trend of fetal cardiac function with the risk of neonatal cardiac impairment in a population of pregestational diabetic pregnant women. Cardiac hypertrophy (CH) is a not rare cardiac anomaly in infants of diabetic mothers. Also, congenital hyperinsulinism is strictly associated with CH. Modified myocardial performance index (Mod-MPI) is a reliable tool to assess fetal heart function and contractility. Fetuses from diabetic mothers are expected to present higher Mod-MPI values with an increasing trend during pregnancy, probably due to maternal insulin's effect. We conducted a longitudinal prospective observational study enrolling pregnant women with insulin-dependent pregestational diabetes mellitus (DM) (type 1 or type 2). Each patient underwent three ultrasound evaluations from the second trimester to delivery measuring biometry, Doppler velocimetry, amniotic fluid and left ventricular Mod-MPI. At every scan, glycated hemoglobin (HbA1c) was measured to check the glycemic control. All the newborns underwent an echocardiogram by a pediatrician expert in echocardiography on 3rd day of life. CH has been diagnosed in case of an interventricular septal thickness >2 Z-score corrected for body weight. A total of 33 DM patients were included (11 type1 vs 22 type2). No differences arose from the comparison of baseline characteristics. Eleven babies presented CH afterbirth (33%). In fetuses presenting a longitudinal Mod-MPI increase (17/33, 51,5%), we found a statistically significant difference between CH incidence and mean Delta-MPI (p 0,017). In this group, defective metabolic control (increasing HbA1c in 15/33, 45,4%) is positively related to a higher MPI (p 0,025). No differences in case of decreasing/constant trend of Mod-MPI or euglycemia. The Mod-MPI longitudinal trend seems to reflect both maternal metabolic control and fetal-neonatal cardiac function. An excessive increase in Mod-MPI is related to a higher incidence of neonatal CH.