SECOND TRIMESTER FETAL ECHOCARDIOGRAPHY IN WOMEN WITH DIABETES. A TERTIARY CARE EXPERIENCE

Venkata Arunavalli.C; Imamuddin syed; Rajaram Routhu

Volume : VI, Issue : VIII, August - 2016

SECOND TRIMESTER FETAL ECHOCARDIOGRAPHY IN WOMEN WITH DIABETES. A TERTIARY CARE EXPERIENCE

Venkata Arunavalli. C, Imamuddin Syed, Rajaram Routhu

Abstract :

BACKGROUND: Incidence of Diabetes during pregnancy varies widely, from 5 to 7%.Diabetes,especially uncontrolled and poorly managed,has an adverse outcome in fetus and is associated with increased incidence of congenital heart disease. AIMS AND OBJECTIVES: The present study aims to study the profile of congenital heart disease in fetuses of women with Diabetes,both gestational and preexisting ,to examine the relation of Diabetes control as diagnosed by HbA1c level in the last 3 months with the incidence of congenital heart disease,, to follow through the pregnancies and to study the incidence of CHD in the newborns. MATERIAL AND METHODS: The study is a retrospective and observational study,with follwup 2DEcho of the newborns. From January 2014 to April 2016,a total number of 982 fetal echoes were performed by a single operator.Of these patients,106 women were diabetic.89 of them had gestational diabetes.17 patients were already diabetic at the time of pregnancy.The incidence of CHD was recorded in all pts.The Hba1c leveis in the past 3 months was recorded where they were available. Statistical analysis was performed using Statistical Package for Social Services{SSPS}CHICAGO, IL USA. Except the cases where complex CHDs were diagnosed, .all women with Diabetes were instructed to ing the newborns for 2DEcho within one day of birth. RESULTS : Overall CHD incidence at the time of fetal echo cardiogram in second trimester was 13.2%..Commonest disease was D transposition of great arteries, followed by TOF,AVSD and septal defects. Women with isolated gestational Diabetes had more incidence of CHD than women who were already diabetic at the time of conception HbA1c levels were available only in 54% women with GDM but were available in all women with established Diabetes. Complex CHD was found only in women with GDM. In the newborns, 8 (7.7%) had hypertrophic cardiomyopathy and all of them were asymptomatic. CONCLUSIONS : The second trimester fetal echocardiogram is a valuable tool for diagnosing CHD in fetuses of women with Diabetes . Commonest CHD diagnosed in diabetes was D transposition of great arteries,followed by equal incidence of TOF ,AVSD and septal defects..The commonest CVS anomaly diagnosed in the newborn period was HCM ABBREVIATIONS: CHD : Congenital heart disease FE : Fetal echo AIUM : American institute of ultra sound in medicine (AIUM ) DTGA : D Transposition of Great Arteries AVSD : atrioventriculr Septal Defect TIFFA : Targeted imaging for fetal anomalies OS ASD : Ostium secundum atrial septal defect VSD : Ventricular septal defect GDM : Gestational Diabetes Melitus HCM : hypertrophic cardiomyopathy