Cardiovascular Abnormalities in Newborns of Gestational Diabetic Mothers

Abstract

Background: Maternal diabetes mellitus, including gestational diabetes mellitus (GDM), poses significant risks to fetal heart development. The teratogenic impact of maternal hyperglycemia during organogenesis, combined with fetal hyperinsulinemia in late gestation, leads to structural congenital heart defects (CHD) and functional myocardial alterations. Objective: To evaluate the spectrum of cardiovascular abnormalities in neonates born to gestational diabetic mothers admitted to a tertiary care neonatal intensive care unit (NICU) and analyze their correlation with maternal GDM onset and neonatal parameters. Methods: A prospective observational study was conducted at the Neonatal Intensive Care Unit (NICU), Department of Pediatrics, J. J. Medical College, Davangere. A total of 105 neonates born to mothers diagnosed with gestational diabetes mellitus were enrolled. Maternal parameters (gestational age, mode of delivery, GDM onset) and neonatal variables (birth weight, weight for gestational age, APGAR scores) were recorded. Cardiovascular evaluation was performed using clinical examination and 2D Echocardiography. Statistical analysis was carried out using Chi-square test, Fisher's exact test, and independent t-test (p < 0.05 considered significant). Results: Cardiovascular abnormalities were identified in 9.5% (n = 10) of neonates. Patent Ductus Arteriosus (PDA) associated with moderate-to-severe Pulmonary Arterial Hypertension (PAH) was the most frequent cardiovascular finding (7.6%, n = 8), followed by Asymmetric Septal Hypertrophy (1.9%, n = 2), Coarctation of the Aorta (1.0%, n = 1), and antenatal Pericardial Effusion (1.0%, n = 1). Early onset of maternal GDM was associated with a statistically significant increase in adverse neonatal mortality and severe cardiovascular compromise compared to late-onset GDM (p = 0.003). Conclusion: Maternal gestational diabetes is strongly associated with structural and functional cardiovascular abnormalities in newborns, predominantly PDA with PAH and hypertrophic cardiomyopathy. Early maternal screening, strict glycemic control, universal fetal echocardiography, and routine postnatal cardiovascular evaluation are essential to minimize neonatal cardiovascular morbidity and mortality.