Cardiac Compliance in Fetuses of Diabetic Women ZEEV WEINER, MD, MOSHE ZLOCZOWER, MD, ASAF LERNER, MD, ETAN ZIMMER, MD, AND JOSEPH ITSKOVITZ-ELDOR, MD Objective: To examine possible changes in cardiac function in fetuses of pregestational diabetic mothers. Methods: We conducted a prospective longitudinal study of 31 women whose pregnancies were between 22 weeks’ gestation and term, and who had pregestational diabetes. All diabetic women included in the study had glycosylated hemoglobin lower than 6.5%. All patients included in the study had an early ultrasound confirming gestational age. Doppler studies of the blood flow through the mitral and tricuspid valves were done every 4 weeks using a pulsed- wave Doppler ultrasound device with a 3.5- or 5-MHz transducer. The following indices were calculated from the flow velocity waveforms: the peak velocity during the rapid ventricular filling (E wave) and during the atrial systole (A wave), and the ratio between these velocities (E/A ratio); and the velocity time integral of the atrioventricular blood flow (this integral correlates with volume flow). A comparison between the Doppler indices obtained in fetuses of diabetic women and of normal women was made by using the Mann-Whitney test. Results: Each patient had four to five fetal echocardio- graphic examinations at 22, 26, 30, 34, and 38 weeks’ gesta- tion. The E/A ratio of the mitral and tricuspid valves did not increase in fetuses of diabetic women during the third trimester and was significantly higher in fetuses of nondia- betic women compared with fetuses of diabetic women at 34 and 38 weeks’ gestation. The velocity time integral of the mitral and tricuspid valves multiplied by heart rate was higher, but not significantly, in fetuses of nondiabetic women compared with fetuses of diabetic women at 34 and 38 weeks’ gestation. The E-wave of the mitral and tricuspid valves increased in both groups throughout gestation. The A-wave of the mitral and tricuspid valves increased only in fetuses of diabetic women throughout the third trimester and was significantly higher at 34 and 38 weeks’ gestation compared with fetuses of nondiabetic women. Conclusion: Differences in atrioventricular blood flow pat- terns between fetuses of diabetic women and normal fetuses do not necessarily result from differences in cardiac compli- ance. (Obstet Gynecol 1999;93:948 –51. © 1999 by The Amer- ican College of Obstetricians and Gynecologists.) Cardiac hypertrophy in fetuses of diabetic women is a well-known phenomenon that might also cause changes in cardiac function. 1,2 There are changes in intracardiac blood flow in fetuses of diabetic mothers throughout gestation. 3 The main tool used to study the human fetal intracardiac blood flow and cardiac func- tion is Doppler velocimetry of atrioventricular blood flow. This important aspect of human fetal circulation also has been characterized in normal fetuses. 4–6 The purposes of the present study were to examine possible changes in cardiac function in fetuses of dia- betic mothers by comparing the atrioventricular blood flow patterns of fetuses of diabetic and nondiabetic women and to determine more specifically whether cardiac compliance is reduced in fetuses of diabetic women. Materials and Methods Between January 1995 and January 1997, we conducted a prospective longitudinal study of women with pre- gestational diabetes (class B or C) who were between 22 weeks’ gestation and term. All diabetic women with glycosylated hemoglobin level lower than 6.5% and mean blood glucose lower than 105 mg/dL were asked to participate in this study. All patients included in the study had an early ultrasound (before 16 weeks’ gesta- tion) that confirmed gestational age. When fetal anom- alies were detected or when the ultrasound showed a discrepancy in gestational age of more than 1 week from the last menstrual period, the patients were dis- qualified. The hospital research committee approved the study, and informed consent was obtained from all participants. Thirty-one of 35 pregnant diabetic women From the Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel. 948 0029-7844/99/$20.00 Obstetrics & Gynecology PII S0029-7844(99)00003-4