الفهرس 
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Abstract
Diabetes mellitus either pregestational or gestational complicates 1–2% of all pregnancies, maternal DM increases perinatal mortality and morbidity five-fold compared with normal pregnancies. The risk of fetal cardiac malformations in IDM is significant high. The most common anomalies are atrial septal defect (ASD), ventricular septal defect (VSD), transposition of the great vessels, truncus arteriosus, coarctation of aorta and hypertrophic cardiomyopathy. Many reported literature claims spontaneous resolution of hypertrophic cardiomyopathy in survivors within 4-6 months.
Impaired maternal glucose tolerance has been associated with several morbidities, including maternal toxemia and fetal macrosomia, congenital heart disease, growth restriction, neonatal hypoglycemia, hypocalcaemia, hypomagnesaemia, polycythemia, hyperbilirubinemia and respiratory distress syndrome.
This study aimed to assess and evaluate the use of echocardiography in the assessment of hemodynamic stability in newborns, also to determine the prevalence of congenital heart diseases or any cardiac abnormalities in IDM in relation to the glycemic control of their mothers.
The present study was held in the Neonatal Intensive Care Unit (NICU) of The Alexandria University Maternity Hospital on Seventy two newborns. The included infants were divided into 35 neonates born to diabetic mothers (cases) and 37 neonates born to non-diabetic mothers as a control group.
Conventional and Doppler echocardiographic parameters were done for the included newborns. Glycemic control of diabetic mothers (GDM and pregestational diabetic) was tested by measuring (HbA1c) level. Cases with significant findings were planned for follow up after 1 to 2 months.
Infant of diabetic mothers had significantly higher hemoglobin level and hematocrit; they were at higher risk for Polycythemia than INDM. The incidence of hypocalcaemia and hypoglycemia were significantly higher among infant of diabetic mothers.
The studied IDMs were classified according to HbA1c to controlled and uncontrolled maternal DM. The mean of HbA1c among pre-gestational diabetic mothers was significantly higher than in mothers with gestational diabetic. Interventricular septal diameter in diastole (IVSd) was significantly higher in infants of uncontrolled group. There was positive correlation between IVSd/LVPWd and HbA1c in IDMs group. This confirms that septal hypertrophy in IDM affected by glycemic control of the mother.
There were significant increase in interventricular septal dimensions (IVSd) and posterior wall diameter (LVPWs, LVPWd) in infants of diabetic mothers in comparison to the controls, there were significant reduction in septal diameter IVSd and posterior wall diameter (LVPWs, LVPWd) in infants of diabetic mothers after a period of one to two months .In IDM, the hypertrophy may be asymptomatic and regress over months, confirming the earlier reports of the transient nature of the problem.
It was found that pulmonary arterial pressure was significantly higher in infants of diabetic mothers than those of non- diabetic mothers .As regard TAPSE, no statistically significant difference between the IDM and INDM.
In the current work, congenital heart diseases were significantly higher in IDMs (pregestational and gestational) than INDMs .The incidence of ASD, VSD and complex heart diseases were significantly higher in the IDMs group. Patent ductus ateriosus was the most common finding (51.4%) followed by ventricular septal defect (22.9%) and atrial septal defect (14.4%).
Finally, the mortality is statistically significant higher among IDM of uncontrolled diabetes than controlled DM. Major infant morbidity or mortality occurred more frequently in infants born to pre- GDM mothers compared with GDM mothers.