Hypertrophic Cardiomyopathy in an Infant of a Diabetic Mother

Abstract

We present a case of neonatal hypertrophic cardiomyopathy associated with maternal diabetes mellitus, which was not identified in utero with ultrasonography immediately prior to delivery, yet caused profound neonatal complications immediately following delivery. The perinatal presentation of diabetic hypertrophic cardiomyopathy has not been previously reported. The patient was initially referred to our facility for prenatal management of adult onset diabetes mellitus. Difficulties in maintaining blood sugar stability were encountered throughout gestation. Ultrasonographic examinations at 18 and 22 weeks showed no anomalies of the fetus, nor was abnormal amniotic fluid observed. Follow-up examination at 27 weeks showed an excess of amniotic fluid. At 31 and 32 weeks gestation, fetal macrosomia and a fetal cardiac arrhythmia (compatible with premature ventricular contractions) were observed. Upon echocardiographic examination at 34 and 35 weeks gestation, no atypical findings were identified. The infant was delivered 1 day after the final in utero assessment at 35 weeks and it developed complications resulting from left ventricular obstruction and hypertrophic cardiomyopathy. Previous reports have stated that the prenatal and postnatal biometric analysis of the fetus, in both normal and diabetic pregnancies, have correlated. We report a case of perinatal onset hypertrophic cardiomyopathy in an infant of a diabetic mother. This case represents an unusual scenario which may result in profound and unanticipated postnatal complications.