ASSESSMENT OF CARDIOVASCULAR SYSTEM STATUS IN NEWBORNS WITH DIABETIC FETOPATHY

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 129 ASSESSMENT OF CARDIOVASCULAR SYSTEM STATUS IN NEWBORNS WITH DIABETIC FETOPATHY Sh.Kh. Khodzhimetova1, Z.Т. Durmanova2 Tashkent State Medical University, Tashkent, Uzbekistan1,2 https://doi.org/10.5281/zenodo.18028112 Abstract. Objective of the study: To investigate the characteristics of the functional state of the cardiovascular system in newborns with diabetic fetopathy during the neonatal period. A total of 66 newborns were examined. The main group (Group 1) included 36 (54.5%) newborns born to mothers with pregestational diabetes mellitus (NDM). The comparison group (Group 2) included 30 (45.4%) newborns born to mothers with gestational diabetes mellitus (NGDM). Clinical and instrumental examinations were performed, including echocardiography (EchoCG). In newborns with diabetic fetopathy (DF) during the early neonatal period, structural and functional changes of the cardiovascular system were identified, including ventricular wall hypertrophy, cardiac rhythm disturbances, and left ventricular diastolic dysfunction of the impaired relaxation type. These changes were more frequently observed among newborns of mothers with pregestational diabetes, as compensatory mechanisms in this group were markedly reduced. Functional alterations in the form of hypertrophic cardiomyopathy were detected in 36.6% of newborns with DF (47.2% in the NDM group and 23.3% in the NGDM group). These changes manifested as thickening of the interventricular septum, an increase in the left ventricular end-diastolic dimension, and left ventricular diastolic dysfunction of the impaired relaxation type. Keywords: newborns, diabetic fetopathy, diabetes mellitus, gestational diabetes mellitus, cardiovascular system, cardiomyopathy. Introduction In recent decades, an increase in the incidence of cardiovascular pathology in children has been observed, including arterial hypertension, cardiomyopathy, cardiac rhythm disorders, neurocirculatory dystonia, and metabolic myocardial disturbances. The origins of these conditions lie in pathologies of the antenatal and early neonatal periods of development; therefore, the problem of early diagnosis of various cardiac alterations and the prevention of these conditions remains highly relevant. The health of a future child depends on many factors, including heredity, the health status of the parents, the course of pregnancy and delivery in the mother, and environmental influences. Without excluding the polyetiological nature of diabetic fetopathy (DF) [2], a leading role in its development is attributed to disturbances in uteroplacental blood flow, resulting in fetoplacental insufficiency. Against the background of fetal immaturity, this condition aggravates hypoxia, metabolic disorders, pathological microcirculatory reactions, and other factors whose effects damage protective and regulatory mechanisms, leading to a wide range of functional and organic disorders. These disturbances form a high-risk group for the development of cardiovascular pathology in subsequent years of life [3,4,5]. It is reasonable to assume that newborns born to mothers with disorders of carbohydrate metabolism experience impaired adaptive and reserve capacities, which contributes to the development of autonomic dysfunction, alterations in the cardiovascular system, increased SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 130 morbidity, and developmental delays. At the same time, the nature of these disorders in children with diabetic fetopathy during the early neonatal period has not been fully reflected in the available scientific literature, which served as the rationale for conducting the present study. Objective of the study: To investigate the characteristics of the functional state of the cardiovascular system in newborns with diabetic fetopathy during the neonatal period. Materials and Methods: The present study was conducted at City Children’s Hospital No. 5, City Clinical Hospital No. 1, and the Republican Perinatal Center in Tashkent. A total of 66 newborns were examined. The newborns were divided into two groups. The main group (Group 1) consisted of 36 (54.5%) newborns born to mothers with pregestational diabetes mellitus (NDM). The comparison group (Group 2) included 30 (45.4%) newborns born to mothers with gestational diabetes mellitus (GDM). The rationale for this grouping was based on the duration of pathological metabolic exposure: throughout the entire pregnancy in the case of pregestational diabetes, and from the second–third trimester in gestational diabetes. Moreover, the frequent presence of complications in women with pregestational diabetes implied a higher risk of morbidity and the development of structural and functional cardiovascular disorders in their offspring. During the study, clinical and instrumental assessments were performed, including echocardiographic examination (EchoCG). Results and Discussion: Echocardiographic examination of the newborns revealed that congenital heart defects (CHDs) were identified in 30% of cases (33.3% among newborns of mothers with pregestational diabetes and 26.6% among newborns of mothers with gestational diabetes). Both the spectrum and the number of CHDs were more prevalent in infants born to mothers with diabetes mellitus. Atrial septal defect was detected in 7.6% of cases (8.3% in the pregestational diabetes group and 3.3% in the gestational diabetes group), and in all cases the defect was located in the region of the secundum septum. Characteristics of Newborns with Congenital Heart Defects Depending on the Type of CHD in Newborns with Diabetic Fetopathy Figure № 1 SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 131 Ventricular septal defect was detected in only 5.6% of cases. However, while defects of perimembranous and muscular localization were observed in the first group, only muscular VSDs were identified in infants born to women with gestational diabetes mellitus. Developmental heart defects such as pulmonary valve stenosis (2.7%) and combined cardiac anomalies (8.3%) were found exclusively in infants born to mothers with diabetes mellitus (Figure 1). Clinical examination of the cardiovascular system in the observed newborns revealed certain differences in the frequency of individual clinical signs depending on the study groups. Figure 2. Comparative Characteristics of Clinical Signs of the Cardiovascular System in Newborns with Diabetic Fetopathy 0 5 10 15 20 25 30 35 40 45 50 8.3 5.6 8.3 22.2 2.7 47.2 5.6 2.7 3.3 0 6.7 16.6 0 23.3 0 0 I group 2 group 66.7 86 58.3 25 58.3 47.2 36.6 46.6 30 20 23.3 23.3 010 20 30 40 50 60 70 80 90 100 Systolic murmur Muffled (diminished) heart sounds Tachycardia Bradycardia Enlargement of the borders of relative cardiac dullness Displacement of the apical impulse Group II Group I SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 132 Clinically, cardiac dysfunction in newborns of mothers with pregestational diabetes (NDM) manifested as muffled heart sounds, the presence of a systolic murmur, tachycardia (p < 0.01), and enlargement of the borders of relative cardiac dullness (p < 0.001). In addition, one quarter of these infants exhibited a slowed heart rhythm, i.e., bradycardia (25%), which was observed more frequently than in newborns of mothers with gestational diabetes mellitus (NGDM) (Figure 2). To characterize functional cardiac abnormalities in newborns of mothers with pregestational and gestational diabetes, echocardiographic (EchoCG) data were also analyzed. The examinations were performed during the first–second weeks of life. The results are presented in Table 1. Table 1 Comparative Analysis of Echocardiographic Data in Newborns with Diabetic Fetopathy Parameters M±m Group I n=36 Group II n=30 LV EDD (mm) 17,8 ± 0,4* 16,6 ± 0,8 LV EDV 9,6 ± 0,8 10,4 ± 0,4 LV ESD 10,5 ± 0,3 12,3 ± 0,6* LV PW 4,3 ± 0,2* 3,6 ± 0,1 IVS 3/9 5,8 ± 0,5** 3/7 3,9 ± 0,2 EF 62,7 ± 0,2 64,3 ± 0,6* RV 13,1 ± 0,5* 12,7 ± 0,1 PV 2,3 ± 0,1 2,4 ± 0,1 BP 60/38 64/34 HR 139,1 ± 3,8** 159,5 ± 3,9 Note: * p < 0.05; ** p < 0.01 indicate statistically significant differences between the groups. Among the key hemodynamic parameters characterizing the functional state of the heart in newborns of mothers with pregestational diabetes who experienced chronic intrauterine hypoxia, changes in the end-diastolic dimension were of particular importance. In our observations, the left ventricular end-diastolic dimension (LV EDD) was significantly increased in newborns of mothers with pregestational diabetes (p < 0.05) compared with the group of newborns of mothers with gestational diabetes who had experienced hypoxia during the perinatal period. At the same time, hemodynamic disturbances in newborns who developed under unfavorable conditions manifested as alterations in the left ventricular end-diastolic volume (LV EDV). The lowest LV EDV value (9.6 ± 0.8 mm), as well as a subsequent reduction in the left ventricular end-systolic dimension (p < 0.05), was observed among newborns of mothers with pregestational diabetes. Thickening of parameters such as the left ventricular posterior wall thickness (LV PW) and interventricular septal thickness (IVS) was noted in newborns of Group I compared with Group II (p < 0.05; p < 0.01). An important indicator of myocardial contractile function is the ejection fraction (EF), which was lowest in newborns of Group I (p < 0.05). In addition, the right ventricular dimension SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 133 (RV) was significantly larger (p < 0.01) in infants of Group I. There was a tendency toward a decrease in the thickness of the anterior wall of the right ventricle (RV anterior wall) in children of Group I (2.3 mm) compared with Group II (2.4 mm); however, no statistically significant differences between the groups were observed. At the same time, lower values of arterial blood pressure and heart rate were identified in newborns of mothers with pregestational diabetes compared with those born to mothers with gestational diabetes mellitus (p < 0.01). Thus, the results of our study demonstrated that newborns with diabetic fetopathy in the early neonatal period exhibit structural and functional alterations of the cardiovascular system, including ventricular wall hypertrophy, cardiac rhythm disturbances, and left ventricular diastolic dysfunction of the impaired relaxation type. These changes were more frequently observed in newborns of mothers with pregestational diabetes, as compensatory mechanisms in this category of newborns are markedly reduced. This is evidenced by a pronounced decrease in heart rate as well as the presence of moderate bradycardia, indicating impaired physiological processes of hemodynamic adaptation during the transition to extrauterine life. Conclusion Consequently, functional abnormalities of the cardiovascular system were identified in approximately 36.6% of newborns with diabetic fetopathy (47.2% in the pregestational diabetes group and 23.3% in the gestational diabetes group). These changes manifested as hypertrophic cardiomyopathy, the diagnostic criteria of which included thickening of the interventricular septum, an increase in the left ventricular end-diastolic dimension, and left ventricular diastolic dysfunction of the impaired relaxation type. REFERENCES 1. Gulyamova M.A., Khodzhimetov Kh.A., Kuchkarova I.D.Materials of an international conference. Structure and prevalence of congenital malformations in newborns with diabetic fetopathy. Modern Technologies in the Diagnosis and Treatment of Congenital Malformations in Children, scientific and practical journal, 2022, No. 3, p. 81. 2. Gnusaev S.F., Ivanov D.A.Early detection and prevention of cardiovascular complications in children with diabetes mellitus. 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