Assistant Professor Children's National Hospital Children's National Hospital Washington, District of Columbia, United States
Background: Diabetes is the most common metabolic disturbance in pregnancy. Maternal diabetic status during pregnancy increases the risk of perinatal complications like congenital malformations, macrosomia, stillbirth and cognitive impairment in children. Despite the prevalence of diabetes in pregnancy, little is understood about its effect on the biochemical profile in the developing fetal brain.
Objective: The objective of this study is to compare the brain biochemical profiles in fetuses of pregnant women with diabetes versus fetuses from healthy pregnancies using magnetic resonance spectroscopy (MRS).
Design/Methods: We acquired 56 MRS datasets from 43 fetuses of pregnant diabetic women and 117 dataset from 105 fetuses from healthy pregnancies during the second and third trimester of pregnancy (22-38 weeks gestational age). All the data were acquired using 1.5 Tesla GE MR scanners. Spectroscopy voxel was placed in the center of the fetal brain using SSFSE anatomical images as a guide. Spectra were acquire using PRESS sequence: TE/TR: 144/128, NSA: 128 and quantified using LCModel. Linear regressions controlling for GA were performed using R to assess any difference between the two cohorts.
Results: The success rate of good quality spectral data acquisition in this study were: 80% and 90% for fetuses from pregnancies of healthy and diabetic women, respectively. The average GAs for diabetic and non-diabetic cohorts were 29.8 and 29.6 weeks (p=0.76). Our cohort consisted of 22 women with gestational diabetes, 7 with Type 1, and 14 with Type 2 diabetes. Lactate trended higher in the overall diabetic cohort (p=0.061) compared to controls. There were no differences in any other brain metabolite levels (choline, creatine, and N-acetylaspartate) between fetuses of pregnant women with and without diabetes. When analyzing the biochemical profiles by stratifying different diabetic groups, we observed significantly higher lactate in fetuses from women with Type 2 diabetes compared to non-diabetic women (p<0.001). This difference was not observed in fetuses from gestational or Type 1 diabetic pregnancies. Conclusion(s): We were able to successfully acquire biochemical information from the fetal brain in healthy pregnant women and those with diabetes. We observed significantly higher lactate in fetuses of women with Type 2 diabetes only, suggesting anaerobic metabolism. Ongoing studies are underway to increase our sample size to allow for patient stratification based on the type of diabetes and HbA1c levels and long-term neurodevelopmental follow-up of infants.
Figure 1. Voxel location and LCModel output of a typical spectrum acquired from the fetal brain
Authors/Institutions: Subechhya Pradhan, Children's National Hospital, Washington, District of Columbia, United States; Kushal J. Kapse, Children's National Hospital, Washington, District of Columbia, United States; Nickie Andescavage, Children's National Hospital, Washington, District of Columbia, United States; Jessica Quistorff, Children's National Hospital, Washington, District of Columbia, United States; Catherine A. Lopez, Children's National Hospital, Washington, District of Columbia, United States; Catherine Limperopoulos, Children's National Hospital, Washington, District of Columbia, United States