Pre eclampsia, Maternal Diabetes, the Neonate and Echocardiography



Primary, or essential hypertension accounts for the vast majority of hypertension in adults and is associated with aging, diabetes, obesity, and hyperlipidemia and is strongly linked to genetic factors. Of increasing interest is the link to hypertension later in life and dietary factors early in life and during fetal development.


Hypertension in neonates and infants is strongly correlated with thromboembolic events in the renal vasculature resulting from indwelling venous and arterial catheters, bronchopulmonary dysplasia, other renal disorders and diseases and coarctation of the aorta. For neonates and infants, systolic blood pressures greater than 80 or 90 mmHg would be considered hypertensive. Management is typically pharmacologic using vasodilators and diuretics.


Pre-eclampsia is pregnancy related maternal hypertension occurring later than 30 weeks gestation and affects 2-8% of pregnancies. Underlying contributing factors include diabetes, obesity, and prior hypertension, but the actual cause of pre-eclampsia is not clear. Improper implantation of the placenta or an autoimmune response to the placenta is being researched. Pre-eclampsia is a serious condition and is the most common cause of pregnancy related deaths (more than 40,000 per year).


The pancreas is located behind the stomach at the solar plexus and functions as both an organ for digestion and as an endocrine gland secreting numerous hormones, most importantly insulin. Diabetes is a disease in which fasting glucose levels in the blood are greater than 100 mg/deciliter. Insulin allows plasma glucose to be absorbed by every cell in the body. There are 100 trillion cells in the average human body. That is a lot of hungry little mouths to feed!


Type I diabetes, also known as juvenile diabetes occurs when the body uses insulin properly but the pancreatic cells that produce insulin (beta cells or “islets of Langerhansâ€) cannot produce enough insulin to feed the body. This is typically the result of a genetic deficiency of beta cells or the result of an injury to the pancreas. Prophylactic insulin is the treatment of choice.


Type II diabetes occurs when the pancreas is producing adequate amounts of insulin but there are too many cells to feed as in the case of obesity and/or very poor diet. Treatment involves lifestyle and dietary modifications and pharmacologic treatment with drugs such as Metformin. Very often, just returning to normal weight can resolve diabetes.


The worst form of diabetes occurs when the cells in the body develop an autoimmune reaction to its own insulin. This is very hard to treat since even insulin therapy has little effect.


Pre-diabetes is a condition in which the body is producing just barely enough insulin to get by. Blood glucose levels should return to normal 3 hours after a meal. If they do not, then one is pre-diabetic.


If diabetes is left untreated for an extended period of time, this will lead to significant complications such as renal failure, atherosclerosis, heart disease, stroke, blindness, neuropathy and skin ulcerations.


Gestational diabetes occurs during pregnancy. The extra demand for insulin and a component of insulin resistance are the primary reasons for this malady. Babies born to mothers with gestational diabetes are typically very large and may present with jaundice and have a predisposition to diabetes later in life. Treatment is pharmacologic with a change in dietary habits.


The echocardiographer should expect to see babies with large birth weight. Look for hypertensive changes such as left ventricular hypertrophy (which usually resolves in 3-6 months) and cardiomyopathy.


Thank You

Ken Heiden