We report an interesting case of a diabetic pregnancy with fetal hypertrophic cardiomyopathy. The diagnosis was made following an emergency caesarean delivery at 37 weeks for fetal distress and was associated with severe metabolic acidosis and poor apgar scores. The baby was transferred to a tertiary unit at Liverpool Women’s Hospital and required ventilation support as the hypertrophy and severity dramatically increased.
The patient’s anomaly scan was normal and a fetal echocardiography did not show any signs of congenital, valvular, or structural abnormality. Neonatal hypertrophic cardiomyopathy usually has a poor prognosis that is not secondary to a cardiac malformation with the exception of transient hypertrophic cardiomyopathy in neonates of diabetic mothers .
Myocardial ischaemia can develop following acute fetal distress and the common neonatal manifestaitions of this include cardiac failure, tricuspid or mitral insufficiency [2,3].
There is an increased risk of hypertrophic cardiomyopathy among newborns of diabetic mothers . Around 1 in 5000 people are affected in the UK, but the majority are in their teenage years or early adulthood . As a result, there is little literature regarding this condition and we aim to establish suitable antenatal care and heighten awareness with particular attention to the surveillance of neonates after acute fetal distress. We also recommend a multidisciplinary team approach with the maternal and fetal medicine departments.
Dawid G et al, A fetal dilated and hypertrophic cardiomyopathy associated with maternal gestational diabetes-a case report. Pediatr Endocrinol Diabetes Metab. 2010; 16(2):123–5.
Bucciarelli RL, et al, Transient tricuspid insufficiency of the newborn: a form of myocardial dysfunction in stressed newborn. 1997. Pediatrics 96:295– 300.
Donelly WH, Bucciarelli RL, Nelson RM (1980) Ischemic papillary muscle necrosis in stressed newborn infants. J Pediatr 59:330–337.
The Cardiomyopathy Association, www.cardiomyopathy.org 2012
M.C. Vaillant et al, Transient Hypertrophic Cardiomyopathy in Neonates after Acute Fetal Distress. Pediatr Cardiol 18:52–56, 1997.
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