Abnormal Uterine Doppler Is Related to Vasculopathy in Pregestational Diabetes Mellitus

Abstract

Background-The aim of the study was to evaluate the relation between maternal placental Doppler velocimetry, levels of the maternal glucose, and clinical signs of vasculopathy in pregnancy complicated by pregestational diabetes mellitus. Methods and Results-A retrospective study of 155 pregestational diabetic women between the 22nd and 40th weeks of pregnancy, categorized in White classification as B, 49; C, 40; D, 22; R,20; F,5; and RIF,19. Cases in classes R, F, and R/F were defined as having vasculopathy. Doppler velocimetry of umbilical and uterine arteries was evaluated for vascular impedance, both in terms of pulsatility index (PI) for both arteries and a notch in early diastole in the uterine arteries. The last examination before delivery was used for analysis. Increased umbilical artery PI was seen in 19 and a uterine artery abnormality in 45 cases. There was a correlation between levels of HbA lc and increased vascular impedance in the uterine and umbilical arteries. Signs of increased uterine artery vascular impedances were significantly related to pregestational vasculopathy. In cases of small-for-gestational-age newborn infants, PI was significantly increased in uterine and umbilical arteries. Furthermore, PI in macrosomic fetuses was significantly lower than in normal infants. Abnormal uterine artery Doppler was also strongly related to adverse outcome. Conclusions-Abnormal

White’s classification and pregnancy outcome in women with type 1 diabetes: a population-based cohort study

“…The results are in agreement with previous reports [12,13]. These trends are probably due to increasing degrees of systemic vascular pathology across White's classes [26][27][28], rather than differences in glycaemic control, as the mid-pregnancy and late pregnancy HbA 1c levels from class B to F were comparable in the present study. Maresh et al [29] showed that an HbA 1c level ≥6% (≥42 mmol/mol) at 26 and 34 weeks of gestation predicted large for gestational age infants, and an HbA 1c ≥6.5% (≥48 mmol/mol) predicted preterm delivery, pre-eclampsia and adverse neonatal outcomes.…”

Role of impaired endothelial cell Ca2+signaling in uteroplacental vascular dysfunction during diabetic rat pregnancy

“…Both animal and human studies (14,25,59,64) have provided evidence for decreased maternal uterine blood flow in pregnancies complicated by diabetes. Normal pregnancy is associated with a significant increase in maternal uterine blood flow mainly due to remodeling of the uterine vasculature and enhanced uterine vasodilation (8, 12, 52, 55).…”

“…The prevalence of an abnormal uterine artery Doppler velocity waveform is much higher in diabetic than nondiabetic populations (6,9,39,59). The strongest correlation between abnormal uterine artery Doppler waveform and adverse pregnancy outcome has been reported in diabetic pregnant women with preexisting vascular complications (59).…”

“…The prevalence of an abnormal uterine artery Doppler velocity waveform is much higher in diabetic than nondiabetic populations (6,9,39,59). The strongest correlation between abnormal uterine artery Doppler waveform and adverse pregnancy outcome has been reported in diabetic pregnant women with preexisting vascular complications (59). Impaired uteroplacental blood flow was also documented in a rodent model of streptozotocin (STZ)-induced diabetes and a mouse model of gestational diabetes (14,25,63,64).…”

Histogram Based Classification of Ultrasound Images of Placenta

“…Further increase in the resistance causes reversed enddiastolic velocity, which is considered a late step in the cascade of events leading to intrauterine fetal demise. [8] Grannum et al [11] reported the observation of subtle differences in the in vivo placenta using ultrasonic images in relation with different stages of pregnancy. As a result this study they proposed a 4-grade classification based on variations in placental appearance, which occur during gestation.…”