MAGNITUDE, PATTERNS AND ASSOCIATED FACTORS OF CONGENITAL HEART DISEASES IN INFANTS OF DIABETIC MOTHERS: A PROSPECTIVE STUDY AT ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLAGE

Abstract

Abstract Background: Diabetes mellitus is a relatively common illness that can complicate pregnancy and result in an increased incidence of congenital malformations. Off-spring of diabetic mothers suffering from insulin dependent diabetes mellitus (IDDM) has fivefold incidence of congenital malformations compared to pregnancies in the general healthy population. Specifically, the pattern of congenital heart disease (CHD) encountered among this group, with an emphasis on abnormalities of laterality, looping and conotruncalseptation, suggesting that the maternal metabolic state affects cardiogenesis at a very early stage of the developmental period, prior to 7 weeks of gestation. So, this research is aimed to study the magnitude, patterns and associated factors of CHD among infant of diabetic mothers. Objective:Aim of this study is to identify the magnitude and the types of CHD seen in infants of mothers suffering from different types of diabetes mellitus, pre-gestational and gestational and to comment on the incidences, associated factors and any differences found in the types of CHD detected. Method: A prospective study was done in the SPHMMC neonatal ICU, Cardiac and high risk infant clinic from February 2022, over a period of 8 months. All infants born to diabetic mothers during the study period was included in the study. Result: Out of 71 infants, 36(50.7%) were males and 35(49.3%) were females. Mean of the infants’ age were 4 days. 71 diabetic mothers were included and their babies were screened for cardiac abnormalities. Among them, 27(38%) mothers had pregestational diabetes and 44(62%) mothers had gestational diabetes. The overall frequency of CHD including PDA and LV hypertrophy was found to be 31% in this study. Cardiac abnormalities were found in 22 neonates of diabetic mothers; Atrial septal defect (ASD) was found in 02(2.8.%), Patent ductus arteriosus (PDA) in 4(5.6%) cases, Left ventricular hypertrophy ( LVH) in 10(14.1%), pulmonary hypertension in 01(1.4%), mixed pathologies(ASD +PDA,PDA+LVH,LVH+ASD,PS+LVH) in 04(5.6%) and CHD with additional extracardiac congenital anomalies in 01(1.4%) cases . Out of 71 diabetic mothers, 6(8.45%) were on oral hypoglycemic agent (OHA) metformin, 41(57.7) were on insulin therapy, and 24(33.8%) were on dietary modification. Among 24 babies whose mother was on the meal plan, 6(25%) had cardiac abnormality. Among the 6 mothers on OHA, 3(50%) babies had cardiac abnormality and among the 41 babies of mothers who were on insulin, 13(31.7%) babies had cardiac abnormality. Out of the 27 mothers with pregestational diabetes, 11(40.7%) babies had cardiac abnormalities and 11(25%) babies of the 44 mothers with gestational diabetes had echocardiography studies suggesting cardiac abnormalities. Without including LVH abnormal echocardiography was found in 8(29.6%) out of 27 pregestational DM mothers but only in 4(9.1%) of GDM which has significant P value < 0.05(0.029). Out of the 71 mothers, 42(59.8%) had good glycemic control and iii 29(40.2%) had poor glycemic control. In this study 7(16.7%) babies born to mothers with good glycemic control and 15(51.7%) babies born to mothers with poor glycemic control had cardiac abnormality. The ECHO abnormality was significantly more in those babies born to mothers with poor glycemic control group (P value = 0.002) Conclusion and recommendation Maternal diabetes is a significant risk factor for heart disease in the infant. Cardiac abnormalities was found in 31% of infants of diabetic mothers. Infants of mothers with poor controlled diabetic mothers have higher incidence of cardiac complications than those in the controlled diabetic mothers. Structural heart disease was more associated with pre-gestational than GDM. So careful evaluation, early diagnosis of heart value and monitoring and controlling blood sugar levels starting before becoming pregnant, is important to minimize and possibly eliminate diabetes related malformations. Because some women have diabetes but do not know it, screening for CHD is important for early detecting and controlling CHD in offspring. Key words: Congenital heart disease, Infant of Diabetic mother