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Graupner O, Rath C, Lecker L, Ritter M, Ritgen J, Enzensberger C. Role of Ductus Venosus Doppler Sonography for the Prediction of Perinatal Outcome in Term Pregnancies Complicated by Gestational Diabetes Mellitus. Z Geburtshilfe Neonatol 2024; 228:363-369. [PMID: 38519041 DOI: 10.1055/a-2272-6743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
PURPOSE Ductus venosus (DV) Doppler velocimetry reflects fetal cardiac function. Gestational diabetes mellitus (GDM) is assumed to impair cardiac function due to fetal hyperglycemia. The purpose of this study was to assess the ability of DV Doppler to predict an adverse perinatal outcome (APO) in term pregnancies with GDM. METHODS This is a retrospective cohort study including GDM pregnancies of singleton, non-anomalous fetuses without any signs of placental dysfunction. All GDM women who primarily had a vaginal delivery attempt and in which DV Doppler was examined from 37+0 weeks on were included. Receiver operating characteristic curve (ROC) analyses were performed to assess the predictive value of DV pulsatility index (DV-PI) regarding a composite APO (CAPO). Furthermore, a subgroup analysis was performed regarding the presence of a large-for-gestational-age (LGA) newborn. RESULTS A total of n=89 cases were included. Overall, CAPO occurred in 26 out of 89 cases (29.2%). All DV Doppler examinations showed a positive A wave. DV-PI was>95th percentile in 8 out of 89 cases (9%). Overall, ROC analysis showed no significant association of DV-PI with CAPO (AUC=0.523, p=0.735). However, regarding individual APO parameters, ROC analysis showed a significant association of DV-PI with 5th-min AGPAR (AUC=0.960, p=0.027), which was not confirmed after exclusion of LGA cases. CONCLUSION In GDM pregnancies at term, DV Doppler sonography seems to have no benefit for APO prediction.
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Affiliation(s)
- Oliver Graupner
- Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany
- Department of Obstetrics and Gynecology, Technical University of Munich Hospital Rechts der Isar, München, Germany
| | - Caroline Rath
- Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany
| | - Linda Lecker
- Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany
| | - Monica Ritter
- Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany
| | - Jochen Ritgen
- Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany
- Praenatal Plus, Köln, Germany
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Peng YQ, Qiu X, Wang L, Li X, Huo XY. Left atrial shortening fraction to predict fetal cardiac abnormalities and dysfunction in gestational diabetes mellitus. Front Cardiovasc Med 2022; 9:1026587. [PMID: 36588551 PMCID: PMC9800860 DOI: 10.3389/fcvm.2022.1026587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Objective To evaluate the diagnostic efficiency of left atrial shortening fraction (LASF) in the detection of fetal cardiac abnormalities and dysfunction in patients with gestational diabetes mellitus (GDM). Methods In this study, we enrolled 256 pregnant women and divided them into GDM group (n = 156) and control group (n = 100). Fetal echocardiography was performed at 24-28 weeks of gestation to measure the LASF and interventricular septum (IVS) thickness. Based on IVS thickness, the GDM group was subdivided into the septal hypertrophy group (GDM I, n = 62) and non-septal hypertrophy group (GDM II, n = 94). LASF and IVS thickness were compared between the GDM and control groups and between GDM I and GDM II groups. Receiver operating characteristic (ROC) analysis was performed to determine the diagnostic accuracy of LASF in predicting septal hypertrophy. Results The GDM group had a larger IVS thickness (P < 0.05) but a lower LASF level (P < 0.001) than those of the control group. GDM I group had significantly lower LASF level than that in the GDM II group (P < 0.001). At 38.41% as the cutoff value, the LASF can predict septal hypertrophy with diagnostic sensitivity and specificity of 96.7% and 65.2%, respectively. Conclusion Fetal GDM are more likely to induce septal hypertrophy and ventricular dysfunction. LASF is a good indicator of septal hypertrophy or early diastolic dysfunction without septal hypertrophy.
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Affiliation(s)
- Yu-Qing Peng
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xuan Qiu
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China
| | - Li Wang
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China
| | - Xin Li
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China,*Correspondence: Xin Li,
| | - Xiao-Yan Huo
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China,Xiao-Yan Huo,
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Oncel Alanyali M, Alkan F, Artunc Ulkumen B, Coskun S. Use of the modified myocardial performance index for evaluating fetal cardiac functions in pregestational diabetic pregnancy babies. J OBSTET GYNAECOL 2020; 41:187-192. [PMID: 32148132 DOI: 10.1080/01443615.2020.1718623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this study is assessment of importance of use of the modified myocardial performance index (Mod-MPI) for the evaluation of foetal cardiac function in foetuses of women with pregestational diabetes mellitus (PDM). In this study, data of 30 pregnant patients aged 18-45 years diagnosed with PDM and 30 pregnant women aged 18-45 years with normal pregnancy and their babies were evaluated. Foetal echocardiographic and doppler measurements, foetal biometric measurements, umbilical artery and ductus venosus pulsatility indexes were measured in both PDM and control groups. The Mod-MPI was significantly higher in foetuses of PDM women. Many influences especially cardiac and postpartum complications are observed in infants of PDM women. The Mod-MPI is a simple and useful method for assessing foetal ventricular function. Our study has shown that PDM is associated with foetal ventricular dysfunction.Impact statementWhat is already known on this subject? Although MPI is frequently used in routine clinical assessment of neonates, it is not used adequately in foetuses. Many influences especially cardiac and postpartum complications are observed in infants of PDM women. However, there are few studies focussed specifically on the assessment of foetal cardiac function in PDM.What do the results of this study add? MPI, which shows both diastolic and systolic functions is independent of ventricular anatomy and foetal heart rate, was found significantly higher in diabetic mother foetuses, can be said to be a valuable parameter in evaluating foetal cardiac functions globally.What are the implications of these findings for clinical practice and/or further research? Our study has shown that foetuses PDM are associated with foetal ventricular dysfunction. For this MPI measurement can be routinely performed at foetal cardiac measurements in foetuses of PDM mothers.
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Affiliation(s)
- Merve Oncel Alanyali
- Department of Pediatrics, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Fatos Alkan
- Department of Pediatric Cardiology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Burcu Artunc Ulkumen
- Obstetrics and Gynecology Department, Perinatology Division, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Senol Coskun
- Department of Pediatric Cardiology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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Lund A, Ebbing C, Rasmussen S, Kiserud T, Kessler J. Maternal diabetes alters the development of ductus venosus shunting in the fetus. Acta Obstet Gynecol Scand 2018; 97:1032-1040. [PMID: 29752712 DOI: 10.1111/aogs.13363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/25/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Despite adequate glycemic control, the risks of fetal macrosomia and perinatal complications are increased in diabetic pregnancies. Adjustments of the umbilical venous distribution, including increased ductus venosus shunting, can be important fetal compensatory mechanisms, but the impact of pregestational diabetes on umbilical venous and ductus venosus flow is not known. MATERIAL AND METHODS In this prospective study, 49 women with pregestational diabetes mellitus underwent monthly ultrasound examinations from gestational week 20 to 36. The blood velocity and the mean diameters of the umbilical vein and ductus venosus were used for calculating blood flow volumes. The development of the umbilical venous flow, ductus venosus flow and ductus venosus shunt fraction (% of umbilical venous blood shunted through the ductus venosus) was compared with a reference population, and the effect of HbA1c on the ductus venosus flow was assessed. RESULTS The umbilical venous flow was larger in pregnancies with pregestational diabetes mellitus than in low-risk pregnancies (p < 0.001) but smaller when normalized for fetal weight (p = 0.036). The distributional pattern of the ductus venosus flow developed differently in diabetic pregnancies, particularly during the third trimester, being smaller (p = 0.007), also when normalized for fetal weight (p < 0.001). Correspondingly, the ductus venosus shunt fraction was reduced (p < 0.0001), most prominently at 36 weeks. There were negative relations between the maternal HbA1c and the ductus venosus flow velocity, flow volume and shunt fraction. CONCLUSIONS In pregnancies with pregestational diabetes mellitus, prioritized umbilical venous distribution to the fetal liver and lower ductus venosus shunt capacity reduce the compensatory capability of the fetus and may represent an augmented risk during hypoxic challenges during late pregnancy and birth.
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Affiliation(s)
- Agnethe Lund
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Research Group for Pregnancy, Fetal Development and Birth, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Cathrine Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Research Group for Pregnancy, Fetal Development and Birth, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Svein Rasmussen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Research Group for Pregnancy, Fetal Development and Birth, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Torvid Kiserud
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Research Group for Pregnancy, Fetal Development and Birth, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jörg Kessler
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Research Group for Pregnancy, Fetal Development and Birth, Department of Clinical Science, University of Bergen, Bergen, Norway
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Placental structural abnormalities have detrimental hemodynamic consequences in a rat model of maternal hyperglycemia. Placenta 2016; 44:54-60. [DOI: 10.1016/j.placenta.2016.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 12/31/2022]
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Visser GH, de Valk HW. Management of diabetes in pregnancy: Antenatal follow-up and decisions concerning timing and mode of delivery. Best Pract Res Clin Obstet Gynaecol 2015; 29:237-43. [DOI: 10.1016/j.bpobgyn.2014.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
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Ahmed B, Abushama M, Khraisheh M, Dudenhausen J. Role of ultrasound in the management of diabetes in pregnancy. J Matern Fetal Neonatal Med 2014; 28:1856-63. [PMID: 25367382 DOI: 10.3109/14767058.2014.971745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this review is to discuss the established role of ultrasound (US) in the management of pregnancy complicated by diabetes mellitus (DM), as well as new developments with regard to the use of US in this situation. We choose to explore the role of US in pregnancy complicated by DM in three areas: (1) Role of US in estimation of fetal weight. (2) Role of US in diagnosis of congenital malformation. (3) Role of US in monitoring diabetic pregnant patients.
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Affiliation(s)
- Badreldeen Ahmed
- a Weill Cornell Medical College, Fetal Medicine Centre , Doha , Qatar
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Crispi F, Gratacós E. Fetal cardiac function: technical considerations and potential research and clinical applications. Fetal Diagn Ther 2012; 32:47-64. [PMID: 22614129 DOI: 10.1159/000338003] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 03/07/2012] [Indexed: 12/12/2022]
Abstract
Fetal echocardiography was initially used to detect structural anomalies but has more recently also been proposed to assess fetal cardiac function. This review summarizes technical issues and limitations in fetal cardiac function evaluation, as well as its potential research and clinical applications. Functional echocardiography has been demonstrated to select high-risk populations and to be associated with outcome in several fetal conditions including intrauterine growth restriction, twin-to-twin transfusion syndrome, maternal diabetes, and congenital diaphragmatic hernia. Fetal heart evaluation is challenging due to the smallness and high heart rate of the fetus and restricted access to the fetus far from the transducer. Due to these limitations and differences in cardiac function which are related to fetal maturation, cardiovascular parameters should be validated in the fetus and used with caution. Despite these precautions, in expert hands and with appropriate ultrasound equipment, evaluation of cardiac function is feasible in most fetuses. Functional fetal echocardiography is a promising tool that may soon be incorporated into clinical practice. Research is warranted to further refine the contribution of fetal cardiac assessment to the diagnosis, monitoring, or prediction of outcomes in various fetal conditions.
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Affiliation(s)
- Fatima Crispi
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
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Tutschek B, Schmidt KG. Techniques for assessing cardiac output and fetal cardiac function. Semin Fetal Neonatal Med 2011; 16:13-21. [PMID: 21051302 DOI: 10.1016/j.siny.2010.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fetal echocardiography was initially used to diagnose structural heart disease, but recent interest has focused on functional assessment. Effects of extracardiac conditions on the cardiac function such as volume overload (in the recipient in twin-twin transfusion syndrome), a hyperdynamic circulation (arterio-venous malformation), cardiac compression (diaphragmatic hernia, lung tumours) and increased placental resistance (intrauterine growth restriction and placental insufficiency) can be studied by ultrasound and may guide decisions for intervention or delivery. A variety of functional tests can be used, but there is no single clinical standard. For some specific conditions, however, certain tests have shown diagnostic value.
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Affiliation(s)
- Boris Tutschek
- Department of Obstetrics, Bern University Hospital, Effingerstrasse 102, 3010 Bern, Switzerland.
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Kiserud T. Diabetes in pregnancy: scanning the wrong horizon? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:266-267. [PMID: 20812306 DOI: 10.1002/uog.7758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- T Kiserud
- Department of Obstetrics & Gynecology, Haukeland University Hospital, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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