الفهرس 
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Abstract
SUMMARY
D
iabetes mellitus (DM) is a systemic chronic metabolic disorder characterized by increased insulin resistance and/or β- cell defects. The foetal heart is targeted by the pre-existing and gestational maternal DM through complex multi-factorial pathogenesis that affects both the foetal heart and foetal–placental circulation in both structure and function.
Hypertrophic cardiomyopathy (HCM) is the most common cardiac malformation in up to 40% of diabetic pregnancies.
Recently, oxidative stress was suggested to play a role in maternal and fetal complications of diabetic pregnancies.
Paraxonase-1(PON-1) is a calcium-dependent hydrolytic enzyme that is produced in the liver and bound to high-density lipoprotein (HDL). PON1 is recognized as an antioxidant enzyme that inhibits LDL oxidation. It has been reported that paraxonase level is affected in infant of diabetic mothers.
The aim of our study was to measure the level of paraxonase-1 in cord blood and to detect its correlation to cardiac hypertrophy in these infants, also identify the association between the level of paraoxonase-1 and polycythemia, macrosomia and Jaundice in these infants.
It was a cross-sectional study conducted on (50) neonates with gestational age ≥ 35 weeks of diabetic mothers from the delivery room and Neonatal Observation Unit, obstetrics and gynecology hospital, Ain shams university. An informed consent was taken from all caregivers of the participants. it was approved from the Research Ethics Committee.
We included newborns with gestational age ≥ 35 weeks of mothers with pregestational diabetes mellitus (pre-GDM) either type I or type II and gestational diabetes (GDM).
We excluded cases with, chromosomal or congenital malformation, Complex congenital heart diseases, Maternal smoking habit, pre eclampsia, Chorioamnionitis, early onset sepsis and Asphyxia.
All infants had detailed history and examination. Laboratoray investigations were, HbA1c of mothers and complete blood picture, Random blood glucose, Transcutaneous bilirubin level at 24, 72 hours, measurement of paraxonase-1 levels for all infants included in the study.
ECHO within the first week of life:
The end-diastolic and end-systolic left ventricular dimensions, interventricularseptal thickness (IVSs, Ivsd), left ventricular posterior wall thickness in systole and diastole (LVPWs, Lvpwd), ejection fraction(EF), fractional shortening(FS) and the left ventricular mass were measured by two dimensionally guided M-mode echocardiography. Z-scores corrected for body surface area were calculated with a cardiac z-score calculator to assess the extent of deviation.
The results of the study were:
There were 50 mothers with mean age of 33.2±6.4 years, 20 mothers (40%) were GDM, 10 (20%) pre-GDM type 1, 20 (40%) pre-GDM type 2 and mean HbA1c was 7.3±0.9 %.
There were 18 infants (36%) had HCM. HCM was more in cases with high maternal HbA1C (8.3 ± 0.9). There was a statistically significant (p-value = 0.012) increased percentage of HCM in infants of pre-GDM mothers when compared with infants of GDM mothers. But there was no difference in pre-GDM type I from pre-GDM type II as it was 50% in both types. HCM was more common with large for gestational age (LGA) infants (10 cases 55.6% of infants with HCM were LGA).
There was statistically significant (p-value = 0.016) lower Paraxonase-1 level in infants of pre-GDM mothers when compared with infants of GDM mothers.
There was a highly statistical significant (p-value < 0.001) negative correlation (r = - 0.71) between Paraxonase-1 and HbA1C.
There was statistically significant negative correlation between Paraxonase-1 level and macrosomia, polycythemia, hypoglycemia, bilirubin level at 24 hours, bilirubin level at 72 hours and HCM in our cases.
Using roc curve, it was shown that, Paraxonase-1 can be used to discriminate HCM at a cutoff level of < 82.5, with 100% sensitivity, 100% specificity, 100% PPV and 100% NPV (AUC = 1.0 & p-value < 0.001)