Evaluation of Fetal Myocardial Contractility of Pre-Existing Diabetes Mellitus by Three-Dimensional Ultrasonography Using STIC and Vocal Methods.

Abstract

Objective: To evaluate global and ventricular myocardial contractility in fetuses of pregnant women with pre-existing diabetes compared with normal fetuses using three-dimensional (3D) ultrasound with the Virtual Organ Computer-aided Analysis (VOCAL) and Spatio-temporal Image Correlation (STIC) methods.

Methods: A retrospective cross-sectional study was performed on 60 normal fetuses and 20 fetuses from pregnant women with pre-existing diabetes. The STIC and VOCAL methods were used to calculate fetal cardiac volumes. Global contractility was calculated by subtracting cardiac volume in diastole from cardiac volume in systole. Ventricular contractility was calculated by subtracting diastolic ventricular volume from systolic ventricular volume. Myocardial contractility was correlated with gestational age using Spearman's coefficient (r), while the difference between normal and diabetic pregnant women was calculated using Student-t and Mann-Whitney tests.

Results: Pregnant women with pre-existing diabetes had a higher mean number of pregnancies than normal pregnant women (2.4 vs. 1.8 pregnancies, p = 0.028). There were no significant differences in global and ventricular contractility between normal fetuses and those of pregnant women with previous diabetes (p = 0.070 and 0.186, respectively). A moderate positive significant correlation was observed between gestational age and global myocardial contractility (r = 0.58, p < 0.0001). There was a strong positive significant correlation between gestational age and ventricular myocardial contractility (r = 0.62, p < 0.0001). A one-week increase in gestational age was responsible for an increase in global and ventricular myocardial contractility of 0.222 and 0.1505 cm³, respectively. Considering only pregnant women with pre-existing diabetes, there was a strong negative significant correlation between glycated hemoglobin levels and global myocardial contractility (r = -0.63, p = 0.027) and a moderate negative significant correlation and ventricular myocardial contractility (r = -0.59, p = 0.044).

Conclusions: The global and ventricular myocardial contractility of normal fetuses and fetuses of pre-existing diabetes pregnant women measured by 3D ultrasound using the STIC and VOCAL methods showed a linear and positive correlation with gestational age and no significant differences between them.