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Mahalinga G, Rajasekhar KV, Venkateshwar Reddy M, Kumar SS, Waheeduddin SK. Morphometric Analysis of Placenta and Fetal Doppler Indices in Normal and High-Risk Pregnancies. Cureus 2024; 16:e61663. [PMID: 38966466 PMCID: PMC11223667 DOI: 10.7759/cureus.61663] [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] [Accepted: 06/04/2024] [Indexed: 07/06/2024] Open
Abstract
Background High-risk pregnancies, encompassing pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), preeclampsia toxemia (PET), and intrauterine growth restriction (IUGR), represent intricate medical challenges with potential repercussions for maternal and fetal health. This research undertakes a comprehensive comparative investigation into the variations of Doppler indices and placental parameters within the context of these high-risk conditions when juxtaposed against pregnancies characterized as normal. Methodology Employing a rigorous cross-sectional study design, a diverse cohort of pregnant individuals with gestational diabetes, IUGR, PIH, and preeclampsia was meticulously assembled. Additionally, a group of normal pregnant women served as the comparative reference. Doppler ultrasound assessments, viz, pulsatility index (PI), were carefully performed to estimate blood flow velocities within critical maternal and fetal vessels, while placental parameters were meticulously quantified, encompassing dimensions, vascular architecture, and morphological features. Results Except in the GDM group, all high-risk groups had reduced estimated placental weight and actual birth weight than normal pregnant women. All high-risk groups showed a highly significant elevation of the PI of the umbilical artery and PI of the middle cerebral artery (MCA) than normal but the PI of MCA was significantly reduced in the PET group than in normal individuals. The cerebro-placental ratio in the GDM and IUGR groups revealed markedly greater values, whereas PET showed lower values. IUGR and PIH groups showed a substantial reduction in the fetal birth weight. All high-risk groups (GDM, IUGR, PIH, and PET) showed a highly significant reduction in luminal area umbilical artery 1 than the normal pregnant women. In IUGR, marginal placental insertion was very high, followed by GDM and PET groups. Conclusions This study reveals that Doppler indices, placental parameters, newborn weight, and their related ratios may be utilized to anticipate gestation difficulties and gain insight into the pathophysiology of problematic conceptions.
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Affiliation(s)
- G Mahalinga
- Department of Anatomy, Meenakshi Academy of Higher Education and Research, Chennai, IND
| | - K V Rajasekhar
- Department of Radiology, Meenakshi Medical College Hospital and Research Institute, Chennai, IND
| | - M Venkateshwar Reddy
- Department of Anatomy, Sri Venkata Sai (SVS) Medical College and Hospital, Mahabubnagar, IND
| | - S Saravana Kumar
- Department of Anatomy, Meenakshi Medical College Hospital and Research Institute, Chennai, IND
| | - Syed Khaja Waheeduddin
- Department of Anatomy, Sri Venkata Sai (SVS) Medical College and Hospital, Mahabubnagar, IND
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2
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Bashir M, Fagier Y, Ahmed B, C Konje J. An overview of diabetes mellitus in pregnant women with obesity. Best Pract Res Clin Obstet Gynaecol 2024; 93:102469. [PMID: 38359580 DOI: 10.1016/j.bpobgyn.2024.102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/02/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
Rates of obesity are increasing world-wide with an estimated 1billion people projected to be obese by 2030 if current trends remain unchanged. Obesity currently considered one of the most significant associated factors of non-communicable diseases poses the greatest threat to health. Diabetes mellitus is an important metabolic disorder closely associated with obesity. It is therefore expected that with the increasing rates of obesity, the rates of diabetes in pregnancy will also be rising. This disorder may pre-date pregnancy (diagnosed or undiagnosed and diagnosed for the first time in pregnancy) or may be of onset in pregnancy. Irrespective of the timing of onset, diabetes in pregnancy is associated with both fetal and maternal complications. Outcomes are much better if control is maximised. Early diagnosis, multidisciplinary care and tailored management with optimum glycaemic control is associated with a significant reduction in not only pregnancy complications but long-term consequences on both the mother and offspring. This review brings together the current understanding of the pathogenesis of the endocrine derangements that are associated with diabetes in pregnancy how screening should be offered and management including pre-pregnancy care and the role of newer agents in management.
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Affiliation(s)
- Mohammed Bashir
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar; Endocrinology, Weill Cornell Medicine, Doha, Qatar.
| | - Yassin Fagier
- Women's Clinical Management Group, Sidra Medicine, Doha, Qatar
| | - Badreldeen Ahmed
- Feto Maternal Centre, Al Markhiya Street, Doha, Qatar; Obstetrics and Gynaecology, Weill Cornell Medicine, Doha, Qatar; Obstetrics and Gynaecology, Qatar University, Doha, Qatar
| | - Justin C Konje
- Feto Maternal Centre, Al Markhiya Street, Doha, Qatar; Obstetrics and Gynaecology, Weill Cornell Medicine, Doha, Qatar; Obstetrics and Gynaecology, University of Leicester, UK
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3
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Perkovic-Kepeci S, Cirkovic A, Milic N, Dugalic S, Stanisavljevic D, Milincic M, Kostic K, Milic N, Todorovic J, Markovic K, Aleksic Grozdic N, Gojnic Dugalic M. Doppler Indices of the Uterine, Umbilical and Fetal Middle Cerebral Artery in Diabetic versus Non-Diabetic Pregnancy: Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1502. [PMID: 37629792 PMCID: PMC10456372 DOI: 10.3390/medicina59081502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/20/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023]
Abstract
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.
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Affiliation(s)
- Sonja Perkovic-Kepeci
- General Hospital Pancevo, 26000 Pancevo, Serbia;
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
| | - Andja Cirkovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.M.); (D.S.)
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.M.); (D.S.)
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Stefan Dugalic
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (S.D.); (M.M.)
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.M.); (D.S.)
| | - Milos Milincic
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (S.D.); (M.M.)
| | - Konstantin Kostic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
| | - Nikola Milic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
| | - Jovana Todorovic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Ksenija Markovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
| | - Natasa Aleksic Grozdic
- Institute for Process Engineering Environmental Engineering and Technical Life Sciences, Technical University of Vienna, 1180 Vienna, Austria;
| | - Miroslava Gojnic Dugalic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (S.D.); (M.M.)
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Aydin S, Fatihoglu E, Karavas E, Kantarci M. Gestational diabetes mellitus and early hemodynamic changes in fetus. J Med Ultrasound 2021; 29:270-276. [PMID: 35127407 PMCID: PMC8772478 DOI: 10.4103/jmu.jmu_161_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/02/2020] [Accepted: 12/29/2020] [Indexed: 11/04/2022] Open
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Dantas AMA, Palmieri ABS, Vieira MR, Souza MLR, Silva JC. Doppler ultrasonographic assessment of fetal middle cerebral artery peak systolic velocity in gestational diabetes mellitus. Int J Gynaecol Obstet 2018; 144:174-179. [PMID: 30471100 DOI: 10.1002/ijgo.12723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/08/2018] [Accepted: 11/22/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare Doppler ultrasonographic measurements of the fetal middle cerebral artery peak systolic velocity (MCA PSV) among women with or without gestational diabetes mellitus (GDM). METHODS A cross-sectional study was conducted among pregnant women who presented for prenatal care at a single hospital in Brazil between September 11, 2015, and January 6, 2017. Patients were stratified into a group with GDM and a control group without GDM. One Doppler ultrasonographic assessment was performed per participant. This measurement was made after diagnosis but before the start of treatment among women in the GDM group. Fetal ultrasonographic and biometric variables assessed included MCA PSV, MCA pulsatility index, umbilical artery pulsatility index, the MCA-to-umbilical artery ratio, abdominal circumference, and weight. RESULTS The study included 238 women: 115 in the GDM group and 123 in the control group. The median MCA PSV was 1.02 in the GDM group and 1.08 in the control group (P=0.036). No statistically significant between-group differences were found for the other fetal ultrasonographic variables or for the fetal biometric variables assessed. None of the maternal or fetal parameters assessed displayed a linear correlation with MCA PSV. CONCLUSION Doppler ultrasonographic measurements of MCA PSV were lowered among the fetuses of women diagnosed with GDM.
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Affiliation(s)
- Andrea M A Dantas
- Department of Postgraduate Studies in Health and the Environment, University of the Region of Joinville, Joinville, Brazil
| | - Andrea B S Palmieri
- Department of Postgraduate Studies in Health and the Environment, University of the Region of Joinville, Joinville, Brazil
| | - Mariana R Vieira
- Department of Medicine, University of the Region of Joinville, Joinville, Brazil
| | - Matheus L R Souza
- Department of Medicine, University of the Region of Joinville, Joinville, Brazil
| | - Jean C Silva
- Department of Postgraduate Studies in Health and the Environment, University of the Region of Joinville, Joinville, Brazil.,Department of Medicine, University of the Region of Joinville, Joinville, Brazil.,High Risk Sector, Hospital Maternidade Darcy Vargas, Joinville, Brazil
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Kutuk MS, Dolanbay M, Gokmen Karasu AF, Ozgun MT. Relationship between fetal peak systolic velocity in Middle cerebral artery and umbilical blood gas values and hemoglobin levels in diabetic pregnant women. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:391-396. [PMID: 29582442 DOI: 10.1002/jcu.22593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 01/22/2018] [Accepted: 03/11/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE To assess the relationship between peak systolic velocity in the middle cerebral artery (MCA-PSV) and fetal hypoxia in diabetic pregnant women requiring insulin therapy. METHODS The data of diabetic pregnant women using insulin who were followed in our departments were reviewed retrospectively. The relationships between MCA-PSV and umbilical cord pO2, pCO2, base deficit, hemoglobin, and birth weight were analyzed. RESULTS A total of 120 cases were included in the final analysis. The median (Q1 - Q3 ) gestational age at Doppler evaluation was 37 weeks 3 days (37-38 weeks and 2 days), and the mean ± SD gestational age at delivery was 38 weeks 4 days ± 3days. The mean ± SD hemoglobin A1c (HbA1c) level was 5.7% ± 1.0% and, median (Q1 -Q3 ) daily total insulin dose was 25 U (10U-48U). There was no statistically significant correlation between MCA-PSV and pH, PO2, PCO2, base deficit, Hb, and birth weight (Spearman correlation, r:-.001[P = .99], r:-.011[P = .90], r:-.052 [P = .51], r: .049[P = .59], r: .049 [P = .59], r: .030 [P = .75], respectively). Using binary logistic regression analysis, no independent factor for the prediction of fetal acidosis (venous pH < 7.23), and metabolic acidosis (base deficit >6.3 mmol/L) was detected. CONCLUSION MCA-PSV is not a good indicator of fetal polycythemia or chronic hypoxia in fetuses of diabetic pregnant women. Fetal well-being should be monitored with other tools in these circumstances.
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Affiliation(s)
- Mehmet S Kutuk
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Dolanbay
- Department of Obstetrics and Gynecology, Erciyes University, Kayseri, Turkey
| | - Ayse F Gokmen Karasu
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey
| | - Mahmut T Ozgun
- Department of Obstetrics and Gynecology, Erciyes University, Kayseri, Turkey
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Kulkarni A, Garcia-Cañadilla P, Khan A, Lorenzo JM, Beckerman K, Valenzuela-Alcaraz B, Cruz-Lemini M, Gomez O, Gratacos E, Crispi F, Bijnens B. Remodeling of the cardiovascular circulation in fetuses of mothers with diabetes: A fetal computational model analysis. Placenta 2018; 63:1-6. [PMID: 29486850 DOI: 10.1016/j.placenta.2017.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 12/25/2017] [Accepted: 12/30/2017] [Indexed: 10/18/2022]
Abstract
AIMS Myocardial structural and functional abnormalities are known to occur in fetuses of mothers with diabetes mellitus (FMDM). The main aim of this investigation was to explore the cardiovascular circulatory patterns in FMDM using a validated lumped computational model of the cardiovascular system. METHODS This was a multi-institutional study involving FMDM compared to fetuses of maternal controls (FC). Fetal echocardiographic Doppler data from left and right ventricular outflow tracts, aortic isthmus, middle cerebral and umbilical arteries were fitted into a validated fetal circulation computational model to estimate patient-specific placental and vascular properties. Non-parametric comparisons were made between resistances, compliances and flows in the brain and placenta in FMDM and FC. RESULTS Data from 23 FMDM and 31 FC were fitted into the model. In FMDM, compared to FC, placental relative resistance was lower (0.59 ± 0.50 versus 0.91 ± 0.41; p < .05) with higher brain relative resistance (2.36 ± 1.65 versus 1.60 ± 0.85; p < .05). Middle cerebral artery flow was lower in FMDM than FC (0.12 ± 0.14 vs. 0.27 ± 0.21 ml/min; p 0.04) with a lower cerebral-placental flow ratio. Combined stroke volume was lower in FMDM (3.65 ± 2.05 ml) than FC (4.97 ± 2.45 ml) (p 0.04). CONCLUSIONS Blood flow is redistributed in FMDM to the placenta, away from the brain. This alteration may play a role in the postnatal health of these fetuses.
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Affiliation(s)
- Aparna Kulkarni
- Division of Pediatric Cardiology, Bronx Lebanon Hospital Center, Bronx, NY, USA.
| | - Patricia Garcia-Cañadilla
- Physense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain; BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, CIBER-ER, University of Barcelona, Spain
| | - Abdullah Khan
- Division of Pediatric Cardiology, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Jose Miguel Lorenzo
- Division of Pediatric Cardiology, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Karen Beckerman
- Department of Obstetrics, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Brenda Valenzuela-Alcaraz
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, CIBER-ER, University of Barcelona, Spain
| | - Monica Cruz-Lemini
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, CIBER-ER, University of Barcelona, Spain
| | - Olga Gomez
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, CIBER-ER, University of Barcelona, Spain
| | - Eduard Gratacos
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, CIBER-ER, University of Barcelona, Spain
| | - Fatima Crispi
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, CIBER-ER, University of Barcelona, Spain
| | - Bart Bijnens
- Physense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain; ICREA, Barcelona, Spain
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Winter J, Kulkarni A, Craft M, Li L, Hornberger LK, Danford DA, Kutty S. Depressed left and right ventricular cardiac output in fetuses of diabetic mothers. Echo Res Pract 2018; 5:ERP-17-0063. [PMID: 29335254 PMCID: PMC5776151 DOI: 10.1530/erp-17-0063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/12/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION We compared right and left ventricular cardiac output (RVCO and LVCO) in fetuses of diabetic mothers (FDM) to a large normal cohort. METHODS We prospectively enrolled 264 normal fetuses and 30 FDM. Fetal CO parameters: semilunar valve velocity time integrals (AVVTI, PVVTI), ventricular outflow diameters (LVOTD, RVOTD), stroke volumes (AVSV, PVSV) were measured, and LVCO and RVCO calculated. These were normalized using nonlinear regression to estimated fetal weight (EFW) to provide means and standard deviations. Among FDMs, mean Z-scores and 95% confidence limits (CL) were calculated, and compared to zero. RESULTS LVCO, RVCO, and parameters they were calculated from, increased predictably and non-linearly with increasing EFW. In FDM, LVCO was depressed (mean Z -1.679, 95% CL -2.404, -0.955, p<0.001), and AVVTI, LVOTD, AVSV significantly lower than normal. Similarly, RVCO (mean Z = -1.119, CL -1.839, -0.400, p=0.003), RVOTD (mean -2.085, CL -3.077, -1.093, p<0.001), and PVSV (mean -1.184, CL -1.921, -0.446, p=0.003) were lower than normal, however, PVVTI was not different (mean Z 0.078, CL -0.552, +0.707, p=0.803). CONCLUSION Normal biventricular stroke volumes and outputs follow a nonlinear regression with EFW. FDM have significantly lower right and left heart stroke volumes and outputs for weight than do normal fetuses.
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Affiliation(s)
- Jennifer Winter
- University of Nebraska Medical Center and Children’s Hospital and Medical CenterOmaha, Nebraska, USA
| | - Aparna Kulkarni
- Bronx Lebanon Hospital CenterDepartment of Pediatrics, Bronx, New York, USA
| | - Mary Craft
- University of Nebraska Medical Center and Children’s Hospital and Medical CenterOmaha, Nebraska, USA
| | - Ling Li
- University of Nebraska Medical Center and Children’s Hospital and Medical CenterOmaha, Nebraska, USA
| | | | - David A Danford
- University of Nebraska Medical Center and Children’s Hospital and Medical CenterOmaha, Nebraska, USA
| | - Shelby Kutty
- University of Nebraska Medical Center and Children’s Hospital and Medical CenterOmaha, Nebraska, USA
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Niromanesh S, Shirazi M, Eftekhariyazdi M, Mortazavi F. Comparison of umbilical artery Doppler and non-stress test in assessment of fetal well-being in gestational diabetes mellitus: A prospective cohort study. Electron Physician 2017; 9:6087-6093. [PMID: 29560164 PMCID: PMC5843438 DOI: 10.19082/6087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 09/20/2017] [Indexed: 11/20/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy and is related to poor perinatal outcomes. Reduction of neonatal complications of GDM is feasible by assessment of fetal well-being. Both fetal Doppler and NST are used for the screening of high-risk pregnancies. Objective We aimed to compare the non-stress test (NST) and umbilical artery (UA) Doppler assessments for evaluation of the adverse perinatal outcomes in GDM. Methods We conducted a prospective cohort study on 50 pregnant women with GDM in Jame Zanan Hospital, Tehran, Iran, from Oct 2014 to Sep 2015. A convenient sampling method was used for patient recruitment. Inclusion criteria were women with GDM, singleton pregnancies, and gestational age>32 weeks who had neither medical conditions nor fetal anomalies. Adverse perinatal outcomes were defined as Apgar scores at 1-min and 5-min <7, hypoglycemia (blood glucose <45 mg/dl), neonatal acidosis (PH<7.2), hypocalcemia (Ca<8 mg/dl), admission to the NICU for more than 24 hours, and perinatal death. Statistical analyses were performed with SPSS version 16 using Chi-square, Fisher's exact test, and independent-samples t-test. The significance level was considered at 0.05. Results Totally, 22% and 12% of women had an abnormal UA Doppler and a non-reactive NST respectively. Poor outcomes were detected in 13 women. The most frequent poor outcomes were hypoglycemia (n=9), Apgar 1-min <7 (n=8), neonate admitted in NICU (n=6), and respiratory distress syndrome (n=6). Poor outcome was more prevalent in women with non-reactive NST (p<0.001), abnormal UA Doppler (p=0.033), and those with infant birth weight >4000 gram (p=0.033). Sensitivity and specificity of the NST in predicting different poor outcomes were 76.9% and 97.3% respectively. Sensitivity and specificity of UA Doppler in predicting different poor outcomes were 30.8% and 94.6% respectively. Conclusion NST is a better predictor of adverse perinatal outcomes in GDM patients.
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Affiliation(s)
- Shirin Niromanesh
- Perinatologist, Professor, Maternal, Fetal and Neonatal Research Center, Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Shirazi
- Perinatologist, Professor, Maternal, Fetal and Neonatal Research Center, Women Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Perinatologist, Associate Professor, Breast Feeding Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Eftekhariyazdi
- Perinatologist, Assistant professor, Department of Obstetrics & Gynecology, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Forough Mortazavi
- Ph.D. of Reproductive Health, Assistant professor, Department of Midwifery, School of Nursing & Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
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10
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Gibbons A, Flatley C, Kumar S. Cerebroplacental ratio in pregnancies complicated by gestational diabetes mellitus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:200-206. [PMID: 27549587 DOI: 10.1002/uog.17242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the relationship between the cerebroplacental ratio (CPR) and intrapartum and perinatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). METHODS This was a retrospective cohort study of women with a non-anomalous singleton pregnancy diagnosed with GDM who delivered at Mater Mothers' Hospital between 2007 and 2015. CPR was measured in 1089 cases between 34 + 0 and 36 + 6 weeks' gestation. CPR values were compared between groups categorized according to GDM treatment (by diet, oral hypoglycemic agent (OHA) or insulin). The association between CPR and intrapartum and perinatal outcomes was evaluated. RESULTS No difference in CPR was observed between treatment groups. Fetuses with CPR < 10th centile were significantly more likely to have adverse composite perinatal outcome (odds ratio (OR) = 2.93 (95% CI, 1.95-4.40)), preterm delivery and low birth weight than fetuses with CPR ≥ 10th centile (all P < 0.001). These associations were present regardless of the type of GDM treatment. Fetuses of women with insulin-controlled GDM had poorer neonatal outcomes than did fetuses of women treated with OHA or dietary control alone. The risk of adverse outcome was significantly increased in the insulin-treated group (OR = 1.75 (95% CI, 1.34-2.28); P < 0.001), which also had higher rates of preterm delivery and higher birth weight. CONCLUSION Regardless of the type of treatment, a low CPR is associated with poorer neonatal outcome in women with GDM. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Gibbons
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - C Flatley
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
| | - S Kumar
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
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11
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Liu F, Liu Y, Lai YP, Gu XN, Liu DM, Yang M. Fetal Hemodynamics and Fetal Growth Indices by Ultrasound in Late Pregnancy and Birth Weight in Gestational Diabetes Mellitus. Chin Med J (Engl) 2017; 129:2109-14. [PMID: 27569240 PMCID: PMC5009597 DOI: 10.4103/0366-6999.189057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: The offspring of women with gestational diabetes mellitus (GDM) are prone to macrosomia. However, birth weight is difficult to be correctly estimated by ultrasound because of fetal asymmetric growth characteristics. This study aimed to investigate the correlations between fetal hemodynamics, fetal growth indices in late pregnancy, and birth weight in GDM. Methods: A total of 147 women with GDM and 124 normal controls (NC) were enrolled in this study. Fetal hemodynamic indices, including the systolic/diastolic ratio (S/D), resistance index (RI), pulsatility index (PI) of umbilical artery (UA), middle cerebral artery (MCA), and renal artery (RA), were collected. Fetal growth indices, including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length, were also measured by ultrasound. Birth weight, newborn gender, and maternal clinical data were collected. Results: The independent samples t-test showed that BPD, HC, and AC were larger in GDM than in NC (P < 0.05). Fetal hemodynamic indices of the UA and MCA were lower (P < 0.05), but those of the RA were higher (P < 0.001) in GDM than in NC. Birth weight was higher in GDM than in NC (P < 0.001). Pearson's correlation analysis showed that hemodynamic indices of the UA were negatively correlated with birth weight, BPD, HC, and AC in both groups (P < 0.05). MCA (S/D, PI, and RI) was negatively correlated with birth weight, HC, and AC in GDM (r = −0.164, −0.206, −0.200, −0.226, −0.189, −0.179, −0.196, −0.177, and − 0.172, respectively, P < 0.05), but there were no correlations in NC (P > 0.05). RA (S/D, PI, and RI) was positively correlated with birth weight in GDM (r = 0.168, 0.207, and 0.184, respectively, P < 0.05), but there were no correlations in NC (P > 0.05). Conclusion: Fetal hemodynamic indices in late pregnancy might be helpful for estimating newborn birth weight in women with GDM.
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Affiliation(s)
- Fang Liu
- Department of Ultrasound, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Yong Liu
- Department of Ultrasound, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Ya-Ping Lai
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Xiao-Ning Gu
- Department of Ultrasound, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Dong-Mei Liu
- Department of Ultrasound, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Min Yang
- Department of Ultrasound, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
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Matevosyan NR. Predictive accuracy of the first trimester Doppler scan: a meta-study. Wien Med Wochenschr 2015; 165:199-209. [PMID: 26077833 DOI: 10.1007/s10354-015-0358-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/29/2015] [Indexed: 12/16/2022]
Abstract
AIM To determine sensitivity and cut-off indices of the uterine artery Doppler (UAD) in prediction of preeclampsia and fetal growth restriction (FGR). METHODS Seventy-six studies published in 1995-2014, present 298,329 prenatal Doppler screenings performed in nullipara in the first and early second trimesters of singleton pregnancies. The sample is stratified into four groups based on the Doppler sensitivity and specificity indices pertaining to the major clinical endpoints of the cohort. RESULTS The FGR diagnostic specificity (r = 0.728) and bilateral notching index (r = 0.803) correlations indicate that the UAD accuracy depends on the placental bed and the screening mode. CONCLUSIONS Predictive sensitivity of the UAD increases after 16 weeks + 3 days (115 days) of gestation. The best predictive parameter of preeclampsia and FGR is the placental side uterine artery resistance index which confers to the highest means when the placenta is on the midline (OR 0.9).
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