Doppler umbilical artery flow velocity waveforms in diabetic pregnancy

Abstract

Objective To assess the effect of uncomplicated diabetes on umbilical artery flow velocity waveforms (FVWs); to investigate the relation between glycaemic control and FVWs and the predictive value of umbilical artery FVWs for antenatal fetal compromise. Design Prospective descriptive study. Setting A large diabetic pregnancy clinic in a teaching hospital. Subjects 128 pregnancies complicated by diabetes mellitus. 170 non diabetic women with no pre‐existing or pregnancy complications. Interventions In diabetic pregnancies, umbilical artery resistance index (RI) Doppler recordings and glycosylated haemoglobin were measured every 2 weeks from 28 weeks. Main outcome measures Umbilical artery RI and antenatal fetal compromise defined as a non reactive, decelerative cardiotocograph and/or a biophysical profile score persistently <6 and leading to immediate caesarean section. Results Uncomplicated diabetic pregnancies had FVW values similar to those in the non‐diabetic range. Glycaemic control was unrelated to umbilical artery FVW values. Abnormal umbilical artery RI was found in nine pregnancies, these were more likely to show evidence of fetal compromise and to be associated with birth weights of <50th centile. In seven pregnancies there was evidence of fetal compromise, but only three of these pregnancies had abnormal FVW values. Conclusions The non‐diabetic range of umbilical artery RI values is appropriate for diabetic pregnancies. Long‐term glycaemic control, within the range in this study, does not seem to affect umbilical artery RI. Abnormal umbilical artery RI is a significant predictor of fetal compromise in diabetic pregnancy, but fetal compromise can occur in association with normal RI values. Undue reliance should not be placed on normal FVW values in diabetic pregnancies.

Abnormal Uterine Doppler Is Related to Vasculopathy in Pregestational Diabetes Mellitus

“…7 In their group there were only 6 cases with vasculopathy. Abnormal blood flow in the uterine artery in pregnancies complicated by diabetes with vasculopathy were reported by Johnstone et al 10 In contrast to our findings, the changes in blood flow velocity in the uterine artery were independent of the vasculopathy in maternal vessels. These results may indicate that pregnancy induced de novo constituted vessels of the uteroplacental circulation, independent of the actual balance of diabetes.…”

“…In contrast to our results, others authors found no correlation between abnormal uterine artery Doppler and White classification, which might be due to small numbers of women with vasculopathy. 7,10,18,19 Zimmermann et al 20 reported that changes in uterine flow were more significant in women with hyperglycemia. Salvesen et al 7 described no changes in maternal or fetal placental Doppler velocimetry and fetal circulation in diabetic pregnancy.…”

“…Information about correlations between glycemic control and changes in utero-placental circulation are conflicting, and the value of Doppler examination for surveillance of diabetic pregnancies is still not widely accepted. [7][8][9][10][11][12][13] The aim of the present study was to evaluate the relation between maternal placental Doppler velocimetry and levels of maternal glucose and signs of vasculopathy in pregnancy complicated by pregestational diabetes mellitus (PGDM).…”

Fetal cardiac performance in uncomplicated and well‐controlled maternal type I diabetes

“…In both fetal study groups, pulmonary and aortic time-topeak flow velocities lengthened with advancing gestation while the umbilical artery pulsatility indices declined, indicating a decrease in placental resistance. These findings confirm that Doppler indices of the placental circulation remain essentially normal throughout uncomplicated diabetic pregnancies 17,18 . The potential impact of maternal diabetes, particularly on accelerated fetal cardiac growth 2-4 and diastolic cardiac dysfunction 2,3,6 , has been well documented.…”

Applications of Doppler Studies for Fetal Surveillance in Diabetic Pregnancies

“…The use of Doppler studies of the umbilical artery has been demonstrated to reduce perinatal adverse outcome in non-diabetic pregnancies (Alfirevic et al, 1995), but its use in diabetic pregnancies have shown conflicting results. While umbilical artery Doppler studies have been shown to be more predictive of adverse outcome than cardiotocography and biophysical profile in diabetic pregnancies (Bracero et al, 1996), fetal compromise would occasionally still be observed despite normal Doppler studies (Johnstone et al, 1992). Thus, the precise value of Doppler studies in the monitoring of GDM pregnancies remains controversial.…”