Poster Session 4
Rachel L. Wiley, MD, MPH (she/her/hers)
MFM Fellow
University of California, San Diego
San Diego, California, United States
Maya Pai, BA
Medical Student
UC San Diego School of Medicine
UC San Diego School of Medicine, California, United States
Tracy Anton, RDMS, RDCS
Assistant Clinical Professor, Department of Reproductive Medicine
Ultrasound Practitioner
UC San Diego
UC San Diego, California, United States
Maryam Tarsa, MD
Professor
University of California San Diego
San Diego, California, United States
Pregnancies affected by pre-gestational diabetes mellitus (PDM) are recommended to have a fetal echocardiogram (ECHO). In an institution with expanded cardiac screening on level II ultrasounds, we aimed to examine detection of congenital heart disease (CHD) in pregnancies affected by PDM with selective referrals for fetal ECHOs.
Study Design:
This was a retrospective cohort of pregnancies who received level II ultrasounds in a two-year period. Ultrasounds were performed by experienced MFM sonographers competent in image optimization techniques to visualize the fetal heart, including utilizing system settings that maximize frame rate and applying color Doppler. Standard and extended views of the heart were obtained and recorded using still frame and cine clips (Table 1). Patients were included if they had a diagnosis of prediabetes, type I, or type diabetes mellitus. Demographics were collected, and neonatal charts were reviewed for CHD. Groups were analyzed using one-way ANOVA, student’s t-test, chi-squared or fisher exact test.
Results:
306 pregnancies complicated by PDM were included; 66% with type 2 diabetes mellitus, 19% with type I diabetes mellitus and 15% with prediabetes (Table 1). Of these, 64 (21%) had a fetal ECHO, with the indications of suboptimal cardiac views on level II ultrasound (n=22, 34%), suspected anomaly (n=20, 31%), other maternal indication (n=13, 20%) and high initial A1C (n=9, 14%). In total, 28 (7.8%) neonates had confirmed postnatal diagnosis of CHD, and 16 (57%) of the defects were diagnosed prenatally. CHD detected prenatally had higher A1C (8.1% vs 6.5%, P=0.016), but no significant difference in maternal BMI (33.2 kg/m2 vs 32.5 kg/m2, p=0.74). Of the 12 CHD that were diagnosed only postnatally, there were minor defects (small septal defects, bicuspid aortic valve), but no major cardiac defects.
Conclusion:
In a tertiary center with expanded cardiac level II ultrasound protocols and selective ECHOs, all major CHD in PDM was detected prenatally. Protocols for selective fetal ECHOs in pregnancies affected by PDM may be considered in experienced tertiary centers.
