755 - Maternal glycosylated hemoglobin is weakly correlated with ventricular thickness in infants of diabetic mothers

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 755
Publication Number: 755.304

Wenyuan Xu, Arkansas Children's Hospital, Little Rock, AR, United States; Joshua Daily, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Nafisa Dajani, University of Arkansas for Medical Sciences College of Medicine, little rock, AR, United States; Peter M. Mourani, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, AR, United States; Jordan A. Noble, UAMS, Little Rock, AR, United States; Thomas Fiedorek, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Grant Hull, Arkansas Children's Hospital, Little rock, AR, United States; Dana Abulez, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Clarkson K. Mary, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Elijah H.. Bolin, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States

Presenting Author(s)

Wenyuan Xu, MD, MS

Pediatric cardiology fellow
UAMS
Little Rock, Arkansas, United States

Background: Up to 2% of women delivering live born children in the United States have pre-gestational diabetes mellitus (PGDM). Among infants of diabetic mothers (IDMs), PGDM is associated with multiple comorbidities, including left ventricular hypertrophy (LVH). While maternal hemoglobin A1c (HbA1c) has been suggested to be a predictor of LVH in IDMs, there is little data supporting this contention.

Objective:

To determine the relationship between maternal HbA1c and LVH among IDMs born to mothers with PGDM.

Design/Methods:

We retrospectively identified all IDMs at our institution who had postnatal echocardiograms in the first week of life from 2015 to 2021 and whose mothers had PGDM and at least one HbA1c during pregnancy. We excluded IDMs with congenital cardiac defects other than atrial septal defect, ventricular septal defect and/or patent ductus arteriosus. The primary predictor was HbA1c, and the primary outcomes were the interventricular septal thickness in diastole z-score (IVSd-z) and left ventricular wall mass index (LVMI, in g/m2.7). Other maternal predictors of interest were first trimester body mass index, weight gain in pregnancy, smoking, substance abuse, age at delivery, and pre-eclampsia or other systemic hypertension; infant predictors were birthweight z-score and non-cardiac congenital anomaly. Univariate and multivariate analyses were performed; variables that yielded a p-value < 0.2 in univariate analyses were included in the multivariate model.

Results: We identified 120 IDMs who met inclusion criteria (48% female and 52% male). The mean birth weight was 3515 grams (SD = 845 grams), and the mean gestational age at birth was 36.9 weeks (SD = 2.0 weeks). Mean maternal HbA1c during first, second and third trimesters were 8.1% (SD = 2.1%), 7.4% (SD = 1.5%), and 7.2% (SD = 1.4%), respectively. Third trimester A1c was weekly correlated with IVSd-z (R-squared = 0.070, p = 0.009; Figure 1A) and LVMI (R-squared = 0.132, p < 0.001; Figure 1B); first and second trimester A1c was not significantly correlated with either IVSd-z or LVMI. In multivariate analysis, third trimester A1c accounted for only 8.7% of the variation in IVSd-z, and 20.4% of that observed for LVMI.

Conclusion(s): HbA1c is weakly correlated with ventricular thickness in IDMs born to mothers with PGDM. Further studies are needed to elucidate the biochemical perturbations underpinning the relationship between maternal diabetes and neonatal LVH.