Cardiac abnormalities including cardiomyopathy, altered diastolic function and congenital heart disease have been described in infants of diabetic mothers. It has been shown that control of maternal diabetes has a direct influence on the incidence of these complications. In order to determine whether treatment of A2 diabetic mothers with insulin will have added beneficial effect on neonatal cardiac outcome, sixty A2 diabetic subjects were randomly controlled with either diet or insulin during pregnancy. Forty-eight infants of these diabetic mothers (25 from the insulin group, 23 from the diet group) underwent echocardiographic examination during the first 48 hours of life, including M-mode, two-dimensional imaging, and pulsed Doppler interrogation using a 5 Mhz transducer. Variables included heart rate, cardiac anatomy, ventricular wall thickness, left atrial (LA) and ascending aorta (Aao) in diastole. Pulsed wave Doppler interrogation of tricuspid and mitral valve inflows were recorded to measure peak E and A velocities, E deceleration half time, and area under E and A portions of the diastolic velocity-time integral. Pulsed Doppler interrogation at aortic outflow was obtained to measure peak interventricular septal thickness/left ventricular posterior wall thickness, left ventricular ejection fraction, E/A, and cardiac index.
CONCLUSIONS: There were no cases of congenital heart disease in either group. Statistical analysis of the above measures and calculated parameters revealed no significant difference between the infants of the mothers treated with diet and of those treated with insulin. Measures and calculated parameters for both groups do not significantly differ from those of normal neonates from our own laboratory and from data previously published by others. From the neonatal cardiac standpoint, there is no benefit from insulin treatment of an A2 diabetic mothers during pregnancy.
