Comparison of umbilical artery Doppler and non-stress test in assessment of fetal well-being in gestational diabetes mellitus: A prospective cohort study

Abstract

BackgroundGestational 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.ObjectiveWe aimed to compare the non-stress test (NST) and umbilical artery (UA) Doppler assessments for evaluation of the adverse perinatal outcomes in GDM.MethodsWe 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.ResultsTotally, 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.ConclusionNST is a better predictor of adverse perinatal outcomes in GDM patients.

Gestational Diabetes Mellitus and Early Hemodynamic Changes in Fetus

“…reported that abnormal UA Doppler assessment is related with poor neonatal outcome. [ 7 ] In addition Shabani et al . emphasized that MCA PI value increased in GDM patients.…”

“…Furthermore, Niromanesh et al . [ 7 ] emphasized that UA and MCA CDUS changes were effective in predicting poor neonatal outcome in pregnant with GDM. Their method were different, they have evaluated the effect of CDUS changes over pregnancy outcome.…”

“…[ 5 ] Whereas, some indicated that UA and MCA vascular impedance changes were related with pregnancy outcome, such as birth weight pregnant with GDM. [ 6 7 ]…”

Doppler Ultrasound of the Umbilical Artery: Clinical Application

“…119,120 In pregnancies complicated by gestational diabetes, 121 or with pre-existing diabetes mellitus without vascular disease, the non-stress test was found to be better than the UA Doppler US at predicting adverse perinatal outcomes. 98,121 Only those complicated with vasculopathy due to diabetes could benefit from periodic UA Doppler US monitoring. 98…”

“…117,118 Thus, twin pregnancies benefit from fetal well-being assessment with the UA Doppler US when there is a growth discordance, twin-totwin transfusion syndrome, or IUGR. 119,120 In pregnancies complicated by gestational diabetes, 121 or with pre-existing diabetes mellitus without vascular disease, the non-stress test was found to be better than the UA Doppler US at predicting adverse perinatal outcomes. 98,121 Only those complicated with vasculopathy due to diabetes could benefit from periodic UA Doppler US monitoring.…”