Doppler ultrasonographic assessment of fetal middle cerebral artery peak systolic velocity in gestational diabetes mellitus

Ultrasonographic diagnosis of fetal hemodynamic parameters in pregnant women with diabetes mellitus in the third trimester of pregnancy

Objective

It was to investigate the diagnosis of fetal hemodynamics in pregnant women with diabetes mellitus in the third trimester of pregnancy by color Doppler ultrasonography.

Methods

55 women with gestational diabetes mellitus (GDM) in the third trimester of pregnancy who were clinically diagnosed and treated in Haian City People's Hospital of Jiangsu Province were selected as the observation group, and 55 pregnant women with normal prenatal examination results were selected as the controls. The hemodynamic parameters of fetal middle cerebral artery (MCA), umbilical artery (UA), and renal artery (RA) were detected, including the ratio of maximum systolic blood flow velocity to end-diastolic blood flow velocity (S/D), resistance index (RI) and arterial pulsation index (PI). Fasting serum levels of maternal patients were collected for detecting Cystain C (Cys C) and homocysteine (Hcy) to analyze the predictive value of serological indexes and target arterial hemodynamics parameters for adverse pregnancy outcome (APO).

Results

The results showed that compared with controls, in the observation group, RI, PI, and S/D of MCA and RA increased significantly, while RI, PI and S/D of UA decreased obviously (P < 0.05), the levels of serum Cys C and Hcy were clearly increased (P < 0.05). The APO rate of controls and observation group was 10.91 % and 25.45 %, respectively. It was found that the area under the curve of serum Cys C, Hcy, and the APO predicted by the hemodynamic parameters of fetal MCA, UA, and RA were all greater than 0.75 (P < 0.05). Multiple Logistic regression analysis showed that serum Cys C and Hcy, and the hemodynamic parameters of fetal MCA, UA and RA were correlated with APO (P < 0.05).

Conclusion

In summary, maternal blood glucose level can affect fetal hemodynamic parameters. In the third trimester of pregnancy, the changes of blood flow parameters of fetal MCA, UA, RA, and maternal serum Cys C and Hcy levels are helpful to understand fetal status in utero, and can be used to predict APO.

Utility of the cerebro-placental-uterine ratio in predicting composite adverse perinatal outcomes in pregestational diabetes: A prospective cohort study

PURPOSE

To examine the cerebro-placental-uterine ratio (CPUR) in pregnant women with pregestational diabetes and determine its role in predicting adverse prenatal outcomes.

METHODS

This prospective, cohort study conducted at a tertiary hospital included 65 patients with pregestational diabetes (25 with type1 diabetes, 40 with type2 diabetes) and 130 low-risk patients in the control group. The cerebroplacental (CPR) ratio and the CPUR were calculated. Composite adverse perinatal outcome (CAPO) is defined as the presence of any of the following: (1) Neonatal intensive care unit (NICU) admission, (2) Apgar at 5 min <7, and (3) umbilical cord arterial pH <7.10. The relationship of CPR and CPUR with CAPO was investigated.

RESULTS

CPR and CPUR were significantly lower in the pregestational diabetes group than in the control group. The NICU admission was higher in the case group. In receiver operating characteristic analyses, the optimal cut-off value of CPUR was 1.46 (AUC = 0.72, p = 0.003, 80% sensitivity, and 69% specificity) to predict CAPO and the optimal cut-off value of CPUR was 1.50 for NICU admission (AUC = 0.70, p = 0.013, 77% sensitivity, and 66% specificity).

CONCLUSION

Low CPUR values were found to be associated with adverse perinatal outcomes in women with pregestational diabetes. With the increasing number of studies, CPUR is expected to be utilized more widely in routine obstetric practice.

Doppler Indices of the Uterine, Umbilical and Fetal Middle Cerebral Artery in Diabetic versus Non-Diabetic Pregnancy: Systematic Review and Meta-Analysis

Background and Objectives: The aim of this study was to assess the differences in Doppler indices of the uterine (Ut), umbilical (UA), and middle cerebral artery (MCA) in diabetic versus non-diabetic pregnancies by conducting a comprehensive systematic review of the literature with a meta-analysis. Materials and Methods: PubMed, Web of Science, and SCOPUS were searched for studies that measured the pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio index (S/D ratio) of the umbilical artery, middle cerebral artery, and uterine artery in diabetic versus non-diabetic pregnancies. Two reviewers independently evaluated the eligibility of studies, abstracted data, and performed quality assessments according to standardized protocols. The standardized mean difference (SMD) was used as a measure of effect size. Heterogeneity was assessed using the I2 statistic. Publication bias was evaluated by means of funnel plots. Results: A total of 62 publications were included in the qualitative and 43 in quantitative analysis. The UA-RI, UtA-PI, and UtA-S/D ratios were increased in diabetic compared with non-diabetic pregnancies. Subgroup analysis showed that levels of UtA-PI were significantly higher during the third, but not during the first trimester of pregnancy in diabetic versus non-diabetic pregnancies. No differences were found for the UA-PI, UA-S/D ratio, MCA-PI, MCA-RI, MCA-S/D ratio, or UtA-RI between diabetic and non-diabetic pregnancies. Conclusions: This meta-analysis revealed the presence of hemodynamic changes in uterine and umbilical arteries, but not in the middle cerebral artery in pregnancies complicated by diabetes.

Altered Doppler velocimetry of fetal middle cerebral artery in singleton pregnancies complicated by mild well-controlled gestational diabetes

Introduction The aim the present study is to evaluate fetal umbilical artery (UA) and middle cerebral artery (MCA) blood flow in patients with gestational diabetes (GD), in order to determine whether minimal anomalies of glucose metabolism may influence fetal placental function. Methods UA and MCA flow were prospectively measured by transabdominal ultrasound in singleton pregnancies between 34 and 37 weeks of gestation. Results The study included 35 women with GD and 217 non-diabetic patients. Middle cerebral pusatility index (PI) was significantly higher in the GD group (mean MCA - PI =1.82±0.27 vs 1.71 ±0.26; p< 0.02). Likewise, MCA peak systolic velocity (MCA-PSV) was higher in the GD group compared to the non-GD group, though the difference was not significant (mean of MCA-PSV =47.14 ±8.45 vs 47.09 ± 11.21; p = 0.98). UA-PI resulted higher in the non-GD group without significant differences (mean of UA-PI =0.88 ±0.14 vs 0.86 ± 0.15; p = 0.32) Conclusions Our study shows that even in cases of minimal metabolic derangements, GD is characterised by a significant variation in fetal Doppler velocimetry, particularly in the brain.