IMPACT OF MATERNAL DIABETES ON THE PREVALENCE AND PATTERN OF CONGENITAL HEART DISEASES IN INFANTS

Main Article Content

Zartash Sial
Anam Raheel
Muqaddas Jamshaid
Sundus Noor
Muhammad Waqar Aslam
Zainab Nawaz
Muhammad Usman

Keywords

Congenital Heart Diseases, Infants, Gestational Diabetes, Pregnancy

Abstract

Background: Gestational diabetes mellitus (GDM) has already been recognized as an important risk factor for congenital heart disease (CHD). However, local studies have reported variable frequency for CHD among GDM. Learning the burden of diseases will be crucial in reducing preventable neonatal mortality by devising screening strategies for neonates born to diabetic mothers.   


Objective: To assess the frequency of congenital heart diseases (CHD) in infants of diabetic mothers.


 Methods: This cross-sectional study was conducted in the Department of Pediatrics at Fatima Memorial Hospital, Lahore, from January to December 2021. A total of 100 mothers who met the inclusion criteria were enrolled. In our study, the exposure of interest was mothers diagnosed with Gestational diabetes mellitus by a qualified physician, and the outcome of the interest was the Pattern of Congenital Heart Diseases in Infants, such as Ventricular Septal Defect, Patent Ductus Arteriosus, Atrial Septal Defect, etc. The neonates were enrolled using non-probability Consecutive sampling. Neonates were evaluated using a stethoscope to detect heart murmurs, and those with murmurs underwent echocardiography for CHD confirmation. Data were recorded on a standard questionnaire adopted from a previous study. Data was entered and analyzed using SPSS version 25.


 Results: Congenital heart disease was diagnosed in 71% of neonates. The most frequent types were Ventricular Septal Defect (32.39%), Patent Ductus Arteriosus (35.21%), and Atrial Septal Defect (19.72%). The frequency of CHD was higher among older mothers and those with gestational ages of 37-40 weeks. Male infants had a higher frequency of CHD (Male: 62%, Female: 38%, p-value=0.344). Neonates with weights <2.75 kg also had a higher frequency of CHD. These findings are consistent with national and international studies.


 Conclusion: A high frequency of congenital heart disease was observed in infants of diabetic mothers. Effective screening for GDM mothers is crucial for early CHD diagnosis through echocardiography, which may help us with proper counseling and early intervention.

Abstract 81 | PDF Downloads 28

References

1. Helle E, Priest JR. Maternal Obesity and Diabetes Mellitus as Risk Factors for Congenital Heart Disease in the Offspring. J Am Heart Assoc. 2020 Apr 21;9(8):e011541. doi: https://doi.org/10.1161/jaha.119.011541.
2. Vela-Huerta MM, Amador-Licona N, Villagomez HVO, Ruiz AH, Guizar-Mendoza JM. Asymmetric Septal Hypertrophy in Appropriate for Gestational Age Infants Born to Diabetic Mothers. Indian Pediatr. 2019 Apr 15;56(4):314-316. doi: https://doi.org/10.1007/s13312-019-1522-6
3. Cucerea M, Fagarasan A, David CT, Marginean C, Suciu LM. Optimally Controlled Diabetes and Its Influence on Neonatal Outcomes at a Level II Center: A Study on Infants Born to Diabetic Mothers. Medicina (Kaunas). 2023 Oct 4;59(10):1768. doi:10.3390/medicina59101768
4. Schena F, Cappelleri A, Picciolli I, Mayer A, Francescato G, Galli MA, Arcidiacono C, Mosca F. A case report of aorto-pulmonary window in an infant born to a diabetic mother. J Cardiol Cases. 2015 Aug 14;12(6):173-175. doi: 10.1016/j.jccase.2015.07.008
5. Lopez KN, Marengo LK, Canfield MA, Belmont JW, Dickerson HA. Racial disparities in heterotaxy syndrome. Birth Defects Res A Clin Mol Teratol. 2015 Nov;103(11):941-50. doi: 10.1002/bdra.23416
6. Morton SU, Pereira AC, Quiat D, Richter F, Kitaygorodsky A, Hagen J, Bernstein D, Brueckner M, Goldmuntz E, Kim RW, Lifton RP, Porter GA Jr, Tristani-Firouzi M, Chung WK, Roberts A, Gelb BD, Shen Y, Newburger JW, Seidman JG, Seidman CE. Genome-Wide De Novo Variants in Congenital Heart Disease Are Not Associated With Maternal Diabetes or Obesity. Circ Genom Precis Med. 2022 Apr;15(2):e003500. doi: 10.1161/CIRCGEN.121.003500
7. Agha MM, Glazier RH, Moineddin R, Booth G. Congenital abnormalities in newborns of women with pregestational diabetes: A time-trend analysis, 1994 to 2009. Birth Defects Res A Clin Mol Teratol. 2016 Oct;106(10):831-839. doi: 10.1002/bdra.23548
8. Persson M, Razaz N, Edstedt Bonamy AK, Villamor E, Cnattingius S. Maternal Overweight and Obesity and Risk of Congenital Heart Defects. J Am Coll Cardiol. 2019 Jan 8;73(1):44-53. doi: 10.1016/j.jacc.2018.10.050
9. Sanapo L, Donofrio MT, Ahmadzia HK, Gimovsky AC, Mohamed MA. The association of maternal hypertensive disorders with neonatal congenital heart disease: analysis of a United States cohort. J Perinatol. 2020 Nov;40(11):1617-1624. doi: 10.1038/s41372-020-00795-9
10. Mert MK, Satar M, Özbarlas N, Yaman A, Özgünen FT, Asker HS, Çekinmez EK, Tetiker T. Troponin T and NT ProBNP Levels in Gestational, Type 1 and Type 2 Diabetic Mothers and Macrosomic Infants. Pediatr Cardiol. 2016 Jan;37(1):76-83. doi: 10.1007/s00246-015-1242-1
11. Arendt LH, Pedersen LH, Pedersen L, Ovesen PG, Henriksen TB, Lindhard MS, Olsen J, Sørensen HT, Ramlau-Hansen CH. Glycemic Control in Pregnancies Complicated by Pre-Existing Diabetes Mellitus and Congenital Malformations: A Danish Population-Based Study. Clin Epidemiol. 2021 Jul 26;13:615-626. doi: 10.2147/CLEP.S298748
12. Ji H, Liang H, Yu Y, Wang Z, Yuan W, Qian X, Mikkelsen EM, Laursen ASD, Fang G, Huang G, Miao M, Li J. Association of Maternal History of Spontaneous Abortion and Stillbirth With Risk of Congenital Heart Disease in Offspring of Women With vs Without Type 2 Diabetes. JAMA Netw Open. 2021 Nov 1;4(11):e2133805. doi: 10.1001/jamanetworkopen.2021.33805
13. Islam MN, Hossain MA, Khaleque MA, Das MK, Khan MR, Bari MS, Bhuiyan MK. Prevalence of congenital heart disease in neonate in a tertiary level hospital. Nepal Journal of Medical sciences. 2013 Oct 14;2(2):91-5. doi: https://doi.org/10.3126/njms.v2i2.8942
14. Kovalenko AA, Anda EE, Odland JØ, Nieboer E, Brenn T, Krettek A. Risk Factors for Ventricular Septal Defects in Murmansk County, Russia: A Registry-Based Study. Int J Environ Res Public Health. 2018 Jun 24;15(7):1320. doi: 10.3390/ijerph15071320
15. Brodwall K, Leirgul E, Greve G, Vollset SE, Holmstrøm H, Tell GS, Øyen N. Possible Common Aetiology behind Maternal Preeclampsia and Congenital Heart Defects in the Child: a Cardiovascular Diseases in Norway Project Study. Paediatr Perinat Epidemiol. 2016 Jan;30(1):76-85. doi: 10.1111/ppe.12252
16. Hăşmăşanu MG, Bolboacă SD, Matyas M, Zaharie GC. CLINICAL AND ECHOCARDIOGRAPHIC FINDINGS IN NEWBORNS OF DIABETIC MOTHERS. Acta Clin Croat. 2015 Dec;54(4):458-66.
17. Zaqout M, Aslem E, Abuqamar M, Abughazza O, Panzer J, De Wolf D. The Impact of Oral Intake of Dydrogesterone on Fetal Heart Development During Early Pregnancy. Pediatr Cardiol. 2015 Oct;36(7):1483-8. doi: 10.1007/s00246-015-1190-9
18. Huang C, Li J, Qin G, Liew Z, Hu J, László KD, Tao F, Obel C, Olsen J, Yu Y. Maternal hypertensive disorder of pregnancy and offspring early-onset cardiovascular disease in childhood, adolescence, and young adulthood: A national population-based cohort study. PLoS Med. 2021 Sep 28;18(9):e1003805. doi: 10.1371/journal.pmed.1003805
19. Radin M, Schreiber K, Cuadrado MJ, Cecchi I, Andreoli L, Franceschini F, Caleiro T, Andrade D, Gibbone E, Khamashta M, Buyon J, Izmirly P, Aguirre MA, Benedetto C, Roccatello D, Marozio L, Sciascia S. Pregnancy outcomes in mixed connective tissue disease: a multicentre study. Rheumatology (Oxford). 2019 Nov 1;58(11):2000-2008. doi: 10.1093/rheumatology/kez141
20. Castilla-Peon MF, Medina Bravo PG, Sánchez-Urbina R, Gallardo-Montoya JM, Soriano-López LC, Coronel Cruz FM. Diabetes and obesity during pregnancy are associated with oxidative stress genotoxicity in newborns. J Perinat Med. 2019 Apr 24;47(3):347-353. doi: 10.1515/jpm-2018-0201
21. Papazoglou AS, Moysidis DV, Panagopoulos P, Kaklamanos EG, Tsagkaris C, Vouloagkas I, Karagiannidis E, Tagarakis GI, Papamitsou T, Papanikolaou IG, Christodoulaki C. Maternal diabetes mellitus and its impact on the risk of delivering a child with congenital heart disease: a systematic review and meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine. 2022 Dec 12;35(25):7685-94. doi: https://doi.org/10.1080/14767058.2021.1960968

Most read articles by the same author(s)