Abstract
This study compares NT proBNP and troponin T levels in umbilical cord arterial blood and postnatal echocardiographic findings for infants of gestational and pregestational diabetic mothers and macrosomic infants. Twenty-seven infants of pregestational diabetic mothers, 61 infants of gestational diabetic mothers and 37 macrosomic infants of nondiabetic mothers were prospectively enrolled in this study along with a control group of 58 healthy infants of mothers without any pregestational or gestational disorders as the control group. All enrollees were born after 34 weeks of gestation. For this study, umbilical cord blood was drawn during delivery to determine NT proBNP and troponin T levels. Echocardiography was performed 24–72 h after the delivery. Umbilical cord troponin T and NT proBNP levels were found to be higher in the diabetic and macrosomic groups than in the control group (all of them p < 0.001). NT proBNP levels were positively correlated with interventricular septum thickness in the pregestational and gestational infants of diabetic mothers groups (r = 0.564 and r = 0.560, respectively, p < 0.01). Both pregestational and gestational diabetic mothers were divided into two groups according to HbA1c levels in the third trimester as good (<6.1 %) and suboptimal (>6.1 %) metabolic control. In the good and suboptimal metabolic control diabetic groups, NT proBNP levels were also positively correlated with interventricular septum thickness (r = 0.536 and r = 0.576, respectively, p < 0.01). In the suboptimal metabolic control diabetic group, NT proBNP was only found to be positively correlated with the left ventricular mass index (r = 0.586, p < 0.01). While there was no correlation in the myocardial performance index between infants of diabetic mothers and the control group, the myocardial performance index of macrosomic infants was lower than that of the control group (p = 0.017). Cardiac biomarkers (NT proBNP and troponin T) were elevated in infants of diabetic mothers and macrosomic infants. While there was a positive correlation between NT proBNP levels and cardiac structure in infants of pregestational and gestational diabetic mothers, there was no relationship between NT proBNP levels and cardiac function.
Similar content being viewed by others
References
Abassi Z, Karram T, Ellaham S et al (2004) Implications of the natriuretic peptide system in the pathogenesis of heart failure: diagnostic and therapeutic importance. Pharmacol Ther 102:223–241
Buchanan TA, Kitzmiller JL (1994) Metabolic interactions of diabetes and pregnancy. Annu Rev Med 45:245–256
Cameron VA, Ellmers LJ (2003) Minireview: natriuretic peptides during development of the fetal heart and circulation. Endocrinology 144:2191–2194
Colan SD (2006) Assessment of ventricular and myocardial performance. In: Keane JF, Lock JE, Fyler DC (eds) NADAS pediatric cardiology, 2nd edn. Saunders Elsevier Inc., Philadelphia
Costa S, Zecca E, De RG, De LD, Barbato G, Pardeo M, Romagnoli C (2007) Is serum troponin T a useful marker of myocardial damage in newborn infants with perinatal asphyxia? Acta Paediatr 96:181–184
Demiroren K, Lokman Ç, Oran B, Koç H, Başpınar O, Baysal T, Karaaslan S (2005) Ecocardiographic measurements in infants of diabetic mothers and macrosomic infants of non diabetic mothers. J Perinat Med 33:232–235
Free B, Weil WM (1960) Body composition of a diabetic offspring by direct analysis. Am J Dis Child 100:718–719
Georgieff MK (1995) Therapy of infants of diabetic mothers. In: Burg FD, Ingelfinger JR, Wald ER, Polin RA (eds) Current pediatric therapy, 15th edn. WB Saunders, Philadelphia, pp 793–803
Girsen A, Ala-Kopsala M, Makikallio K, Vuolteenaho O, Rasanen J (2008) Increased fetal cardiac natriuretic peptide secretion in type 1 diabetic pregnancies. Acta Obstet Gynecol 87:307–312
Gunes T, Ozturk MA, Koklu SM, Narin N, Koklu E (2005) Troponin-T levels in perinatally asphyxiated infants during the first 15 days of life. Acta Paediatr 94:1638–1643
Gutgesell HP, Seer M, Rosenberg M (1980) Characterization of cardiomyopathy in infant of diabetic mothers. Circulation 61:441–450
Halse KG, Lindegaard MLS, Goetze JP, Damm P, Mathiesen ER, Nielsen LB (2005) Increased plasma Pro-B-type natriuretic peptide in infants of women with type 1 diabetes. Clin Chem 51(12):2296–2302
Makikallio K, Vuolteenaho O, Jouppila P, Rasanen J (2002) Ultrasonographic and biochemical markers of human fetal cardiac dysfunction in placental insufficiency. Circulation 105:2058–2063
Mueller T, Gegenhuber A, Poelz W, Haltmayer M (2005) Diagnostic accuracy of B type natriuretic peptide and aminoterminal proBNP in the emergency diagnosis of heart failure. Heart 91(5):606–612
Nold JL, Georgieff MK (2004) Infant of diabetic mothers. Pediatr Clin North Am 51(3):619–637
Russell NE, Folley M, Kinsley BT, Firth RG, Coffey M, McAuliffe FM (2008) Effect of pregestational diabetes mellitus on fetal cardiac function and structure. Am J Obstet Gynecol 199:312–317
Russell NE, Higgins MF, Amaruso M, Folley M, McAuliffe FM (2009) Troponin T and Pro-B-Type natriuretic peptide in fetuses of type 1 diabetic mothers. Diabetes Care 32:2050–2055
Sardesai MG, Gray AA, McGrath MM, Ford SE (2001) Fetal hypertrophic cardiomyopathy in fetüs of a woman with diabetes. Obste Gynecol 98:925–927
Sudoh T, Kangawa K, Minamino N, Matsuo H (1988) A new natriuretic peptide in porcine brain. Nature 332:78–81
Szymankiewicz M, Matuszczak-Wleklak M, Hodgman JE, Gadzinowski J (2005) Usefulness of cardiac troponin T and echocardiography in the diagnosis of hypoxic myocardial injury of full-term neonates. Biol Neonate 88:19–23
Tei C, Ling LH, Hodge DO (1995) New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function—a study in normals and dilated cardiomyopathy. J Cardiol 26:357–366
Ullmo S, Vial Y, Bernardo SD, Kleiner Roth-, Mivelaz Y, Sekarski A et al (2007) Patholojic ventricular hypertrophy in the offspring of diabetic mothers: a retrospective study. Eur Heart J 28:1319–1325
Vela-Huerta MM, Vargas-Origel A, Olvera-Lopez A (2000) Asimeytric septal hypertrophy in newborns of diabetic mothers. Am J Perinatol 17:89–94
Way GL, Wolfe RR, Eshaghpour E, Bender RL, Jaffe RB, Ruttenberg HD (1979) The natural history of hypertrophic cardiomyopathy in infants of diabetic mothers. J Pediatr 95:1020–1025
Wren C, Birrell G, Hawthorne G (2003) Cardiovascular malformations in infants of diabetic mothers. Heart 89(10):1217
Acknowledgments
This study was supported by the Çukurova University Research Foundation. We are grateful to Ilker Unal, PhD, Department of Biostatistics, Çukurova University, for her help in the statistical analysis.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that there are no conflicts of interest.
Rights and permissions
About this article
Cite this article
Mert, M.K., Satar, M., Özbarlas, N. et al. Troponin T and NT ProBNP Levels in Gestational, Type 1 and Type 2 Diabetic Mothers and Macrosomic Infants. Pediatr Cardiol 37, 76–83 (2016). https://doi.org/10.1007/s00246-015-1242-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-015-1242-1