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Although it is known that children of diabetic mothers have a five-fold higher incidence of serious congenital heart malformations and HCM than children of healthy mothers, it had been thought until now that such complications were limited to the offspring of mothers with type I diabetes (insulin dependent diabetes).
Professor Erik Meijboom and colleagues from the Centre Hospitalier Universitaire Vaudois (Lausanne, Switzerland) undertook a retrospective analysis of the offspring of all diabetic mothers passing through their perinatal unit between January 2003 and December 2005.
They reviewed overall data from 75 pregnancies (involving 80 babies), focusing on prenatal echocardiographic evaluation, delivery and postnatal condition, including sequential echocardiographic follow-up. The team also measured levels of HbAc1, a type of haemoglobin elevated with blood sugar that remains elevated long after blood sugar levels have normalised, and can therefore be used as an indicator for the long-term efficiency of blood sugar control.
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Results showed that from the 16 type I diabetic pregnancies, one baby had CHD (ventricular septal defect), while nine had HCM, of which one died, one required premature delivery due to HCM and seven had HCM with spontaneous regression. Of the seven babies resulting from type II diabetic pregnancies, one had CHD (atrial septal defect), and three had HCM. Of the 52 babies resulting from the gestational diabetes pregnancies, one had CHD (a double outlet right ventricle) and one had HCM with spontaneous regression.
Prof Meijboom said: “An important number of cardiac problems were found in the offspring of all types of diabetic mothers, despite close glucose control, including, unexpectedly, those with type II diabetes.” He added that since there were currently no definite predictive parameters for foetal demise or malignant outcome, this required closer monitoring of all diabetic pregnancies.
“High risk pregnancies should be monitored with echocardiograms between 12 and 16 weeks to rule out structural CHD, and at 32 weeks to rule out HCM.” He said that if septal thickening was encountered, premature induction or Caesarian section might be required to prevent foetal demise.
He suggested that preconception glycaemic control might also be improved with the placement of a subcutaneous insulin pump.