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World J Diabetes. Aug 15, 2021; 12(8): 1233-1247
Published online Aug 15, 2021. doi: 10.4239/wjd.v12.i8.1233
Cardiac changes in infants of diabetic mothers
Mohammed Al-Biltagi, Osama El razaky, Doaa El Amrousy
Mohammed Al-Biltagi, Osama El razaky, Doaa El Amrousy, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 35127, Egypt
Mohammed Al-Biltagi, Department of Pediatrics, University Medical Center, Arabian Gulf University, Manama 26671, Bahrain
Author contributions: Al-Biltagi M had the idea, searched the topic, and wrote the manuscript draft; Al-Biltagi M, El Razaky O and El Amrousy D wrote and revised the manuscript; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interests related to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Biltagi, MD, PhD, Professor, Department of Pediatrics, Faculty of Medicine, Tanta University, Albahr Street, Tanta 35127, Egypt. mbelrem@hotmail.com
Received: January 7, 2021
Peer-review started: January 7, 2021
First decision: May 3, 2021
Revised: May 11, 2021
Accepted: July 7, 2021
Article in press: July 7, 2021
Published online: August 15, 2021
Abstract

Diabetes mellitus (DM) is a systemic chronic metabolic disorder characterized by increased insulin resistance and/or β- cell defects. It affects all ages from the foetal life, neonates, childhood to late adulthood. Gestational diabetes is a critical risk factor for congenital heart diseases (CHDs). Moreover, the risk increases with low maternal education, high body mass index at conception, undiagnosed pre-gestational diabetes, inadequate antenatal care, improper diabetes control, and maternal smoking during pregnancy. Maternal DM significantly affects the foetal heart and foetal–placental circulation in both structure and function. Cardiac defects, myocardial hypertrophy are three times more prevalent in infants of diabetic mothers (IDMs). Antenatal evaluation of the cardiac function and structures can be performed with foetal electrocardiography and echocardiography. Postnatal cardiac evaluation can be performed with natal and postnatal electrocardiography and echocardiography, detection of early atherosclerotic changes by measuring aortic intima-media thickness, and retinal vascular changes by retinal photography. Ameliorating the effects of diabetes during pregnancy on the offspring depends mainly on pregestational and gestational diabetes prevention. However, other measures to reduce the risk, such as using medications, nutritional supplements, or probiotics, still need more research. This review discusses the mechanism of foetal sequels and the risk factors that increase the prevalence of CHDs in gestational DM, the various cardiac outcomes of gestational DM on the foetus and offspring, cardiac evaluation of foetuses and IDMs, and how to alleviate the consequences of gestational DM on the offspring.

Keywords: Gestational diabetes mellitus, Infants of diabetic mother, Hypertrophic cardiomyopathy, Congenital heart diseases, Echocardiography, Children

Core Tip: Gestational diabetes mellitus (DM) has a significant impact on cardiac function and structure, both antenatally and postnatally, an effect that could persist till late adulthood. Therefore, prevention, early detection, and strict management of gestational DM could help to minimize the risk of cardiac disorders in the foetus, neonates, children, and even adults.