Hypertrophic cardiomyopathy in infants of diabetic mothers: an update.

Infants of diabetic mothers (IDMs) are at known risk for developing a hypertrophic type of cardiomyopathy. The severity of IDM cardiomyopathy can vary from an incidental finding on echocardiography to an infant with severe symptoms of congestive heart failure. The purpose of this article is to review the pathophysiologic mechanisms involved in the development of cardiomyopathy in IDMs and to discuss the diagnostic tests utilized in making the diagnosis (especially echocardiography) and the potential mechanisms that may result in congestive heart failure. This report will conclude with a review of a 2 1/2 year prospective study of diabetic women who had carefully maintained diabetic control during pregnancy. Although the IDMs in this study continued to have mild evidence of generalized hypertrophy when compared with control newborn infants, none developed symptoms of congestive heart failure. These data support the contention that careful diabetic management in pregnancy reduces the severity of hypertrophic cardiomyopathy in IDMs.