P19.06: Gestational diabetes (GDM) and fetal myocardial function: evaluation using speckle-tracking echocardiography (STE) and traditional echocardiography

To evaluate fetal myocardial function in GDM pregnancies at the time of diagnosis of GDM (dGDM) and after metabolic control (cGDM), with STE and traditional echocardiography (TE); to verify if GDM could modify fetal myocardial function in comparison to normal fetuses from healthy women; to analyse if metabolic control could improve fetal myocardial functional indices. In a prospective observational study from January 2016 to June 2016, dGDM and cGDM fetuses from 11 to 38 wg were evaluated with TE and STE, and compared to 185 physiological fetuses (Ph Group). (Hitachi-Aloka Arietta v70). We divided fetuses into 4 groups according to gestational age: Group1 (12-13+6), 2(14-18+6), 3(19-29+6), 4(≥30)wg. Aortic and pulmonary artery diameters and time-averaged maximum velocities (TAMV) were measured to calculate absolute and weight specific right (RCO, sRCO) and left (LCO, sLCO) cardiac outputs with TE. We prospectively stored 4-chambers loops obtained with STE. The images were analysed off line with a specific software to measure ventricular ejection fraction (EF) and longitudinal strain (LS). Statistical analysis was performed with Anova, Tukey's and paired t-test between: dGDM vs Ph; cGDM vs Ph; dGDM vs cGDM. 41 exams were performed in 23 GDM fetuses: 27 evaluations in 23 dGDM and 14 evaluations in 14 cGDM. In dGDM, QUV and sQUV, were higher than Ph group. In dGDM, LCO, Left EF and Left LS were significantly lower in all groups compared to Ph Group. In cGDM, after 30 wg, LCO, Left EF and left Strain remains significantly lower than Ph Group. In dGDM fetuses after 19wg, the reduction of STE indices evidenced impaired myocardial function in uterus. Metabolic control did not improve the functional indices during fetal life, mainly in dGDM after 30 wg.