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Cardiac function in offspring of women with diabetes using fetal ECG, umbilical cord blood pro-BNP, and neonatal interventricular septal thickness

Halse, Karen G.a,b; Lindegaard, Marie L.S.c; Amer-Wahlin, Isisg; Hertel, Steend; Johansen, Mariannea,b; Nielsen, Lars B.c,f; Goetze, Jens P.c; Mathiesen, Elisabeth R.a,e,f; Damm, Petera,b,f

doi: 10.1097/XCE.0b013e328362e3f2
Original articles

Objective Increased pro-brain natriuretic peptide (BNP) concentrations in newborns of diabetic women are associated with fetal stress, and fetal ECG changes often occur in labor in diabetic women. These findings could reflect a degree of fetal cardiomyopathy. We aimed to explore possible relations between serological and morphological markers of cardiac dysfunction and abnormal changes on fetal ECGs during labor and delivery in pregnancies complicated by diabetes.

Materials and methods Pregnant women with diabetes (30 type 1, nine type 2, and 60 gestational diabetes) and their newborn offspring were included prospectively. Umbilical cord blood pro-BNP concentrations were measured immediately after delivery (n=68) and echocardiography was performed in the newborns (n=75). Fetal ECG in combination with cardiotocography, that is STAN technology was also performed during labor.

Results The concentration of umbilical cord blood pro-BNP was associated positively with the neonatal cardiac interventricular septal thickness (P=0.025) and associated negatively with umbilical cord blood pH levels (P=0.036). Fetal ECG changes (STAN events) were recorded in 22 of 53 labors where STAN was used (42%). No correlation was observed between interventricular septal thickness and STAN events.

Conclusion Increased umbilical cord blood pro-BNP is associated with echocardiographic signs of cardiomyopathy and with lower umbilical cord blood pH.

aDepartment of Obstetrics, Center for Pregnant Women with Diabetes

Departments of bObstetrics

cClinical Biochemistry


eEndocrinology, Rigshospitalet

fFaculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark

gDepartment of Women and Child Health, Karolinska Institute, Stockholm, Sweden

Correspondence to Karen G. Halse, MD, Department of Obstetrics and Gynecology, Hvidovre Hospital, Kettegård Alle 30, 2650 Hvidovre, Denmark Tel: +45 6167 9049; fax: +45 3862 6101; e-mail:

Received December 4, 2012

Accepted April 26, 2013

© 2013Wolters Kluwer Health Lippincott Williams Wilkins
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