Behavioural State Percentages and Doppler Velocimetry Values Cuts-Off in Gestational Diabetic Pregnancies

Abstract

j 65 pregnancies complicated by gestational diabetes and 102 healthy pregnancies (with i no pre-existing or pregnancy complications) vvere monitored on tvvo occasions (between the 27th and the 36th vveek of gestation) by behavioural state analysis (quiet state percentages, S1F; activity state percentages, S2F), umbilical artery Doppier velocimetry (UA) (Resistance Index, Rl) and by maternal glycemia controls.The objective of our study was: 1) to investigate fetal behavioural states and Doppier velocimetry differences in diabetic pregnancies and control cases during the last trimes-| ter; 2) to assess the predicative value of behavioural state on some perinatal outcomes (Apgar score < 7 at Ist and 5th min, respiratory distress syndrome, neonatal hypoglycemia, neurological injury and neonatal long-term follovv up); 3) to relate UA RI l values to maternal glycemia in gestational diabetic pregnancies.In our series we have found that: 1) there are significanl behavioural states and Doppier velocimetry differences between normal and diabetic cases; 2) stable S1F percentages and increased S2F percentages (> 35%) are predictive factors of normal perinatal outcomes and neonatal follow up; 3) stable S1F percentages and decreased S2F percentages (< 35%) are predictive factors of fetal distress, pathological perinatal outcome and can be related to long term neonatal follow up; 4) pathological UA Rl values (> 0.65) can be related with maternal glucose serum levels between the 27th/32nd week bf pregnancy.In conclusion our findings:1) confirm the relationship concerning behavioural states parameters and perinatal outcomes; 2) suggest that activity state cut-off can predict which fetuses are at highest risk for ominous perinatal outcome and for subsequent neurological long term morbidity äs previously described in IUGR fetuses; 3) abnormal UA RI values can be considered äs a fetal response to maternal transient or persisting hyperglycemia in absence of evident vasculopathy process; 4) UA RI cul-off can predict which feluses are al lovv or high for adverse perinatal outcome; 5) suggest that behavioural state and Doppier velocimetry can be useful methods for gestational diabeles detection, management and predictors of neonatal neurological development in the first year of life.