Short title: Fetal cerebroplacental ratio and gestational diabetes mellitus. This article is protected by copyright. All rights reserved.This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/uog.17242 Accepted Article Abstract ObjectiveThis study aimed to assess the relationship between the cerebroplacental ratio (CPR) and intrapartum and perinatal outcomes in pregnancies complicated by gestational diabetes mellitus. MethodsThis was a retrospective cohort study of women diagnosed with gestational diabetes mellitus (GDM) birthing at the Mater Mothers' Hospital in Brisbane between 2007 and 2015.The CPR in 1089 non-anomalous singleton fetuses measured between 34+0 and 36+6 weeks gestation was compared between types of GDM treatment groups and correlated with intrapartum and perinatal outcomes. ResultsNo difference in the CPR was observed between treatment groups. Fetuses with a CPR <10 th centile were significantly more likely to have an adverse composite perinatal outcome (OR 2.93, 95% CI: 1.95-4.40, p<0.0001) and had higher rates of delivery with low birth weight and at an earlier gestation. This association was present regardless of type of diabetes treatment. Fetuses of women with insulin-controlled GDM had poorer neonatal outcomes than infants of women treated with oral hypoglycaemic agents or diet-control alone. The odds of having an adverse outcome were significantly increased in the insulin-treated group, (OR 1.75, 95%CI: 1.34-2.28, p<0.0001). This cohort also had higher rates of preterm birth and higher birth weights. ConclusionsRegardless of the type of treatment, a low CPR was associated with increased rates of emergency operative birth and poorer neonatal outcomes in women with gestational diabetes mellitus.
Please cite this article as: Gibbons Anthea, Flatley Christopher, Kumar Sailesh.The fetal cerebro-placental ratio in diabetic pregnancies is influenced more by the umbilical artery rather than middle cerebral artery pulsatility index.European Journal of Obstetrics and Gynecology and Reproductive Biology http://dx.doi.org/10.1016/j.ejogrb.2017.02.001 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.The fetal cerebro-placental ratio in diabetic pregnancies is influenced more by the umbilical artery rather than middle cerebral artery pulsatility index Abstract ObjectiveThis study aimed to assess the relationship between the cerebro-placental ratio (CPR) and intrapartum and perinatal outcomes in pregnancies complicated by pre-existing insulin dependent diabetes (pT1DM) mellitus, pre-existing non-insulin dependent diabetes mellitus (pT2DM) and gestational diabetes mellitus (GDM). Study DesignThis was a retrospective cohort study of 1281 women with diabetes mellitus birthing at the ResultsOf the study cohort, 9.7% (124/1281) had pT1DM, 5.3% (68/1281) had pT2DM and 85.0% (1089/1281) had GDM. Of women with pT2DM and GDM, 61.8% (42/68) and 28.9% (315/1089) respectively, required insulin during pregnancy. Women with pT1DM had an increased odds of having a CPR <5 th centile (OR 3.73, 95%CI: 1.90-6.96, p=0.0001) or a CPR <10 th centile (OR 3.01, 95%CI: 1.80-4.91, p<0.0001) respectively. The odds of a UA PI >90 th centile (OR 2.69, 95% CI: 1.60-4.39, p=0.0001) was higher in the pT1DM cohort. There was however no significant difference in the mean MCA PI between the three groups. Stratification by CPR centiles (<10 th centile vs. >10 th centile) demonstrated a lower birth weight in the CPR <10 th centile cohort for all DM categories. The proportion of neonates with birth weights <10 th centile were higher in the CPR <10 th centile cohort with the GDM cohort having an odds ratio of 8.28 p<0.0001) of this complication. The CPR <10 th centile cohort also had a greater proportion of adverse composite neonatal outcome regardless of type of DM. ConclusionsRegardless of the type of DM, a low CPR was associated with poorer neonatal outcomes.Women with pT1DM also had the highest mean UA PI and lowest mean CPR despite no difference in the mean MCA PI between the three groups.
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