Gestational Diabetes Mellitus and Early Hemodynamic Changes in Fetus

Abstract

Background: Gestational diabetes mellitus (GDM) incidence can increase up to 14%. GDM creates a risk for developing type 2 diabetes mellitus after pregnancy. Umbilical artery (UA) and fetal middle cerebral artery (MCA) changes in GDM have been studied before. The previous studies have contradictory results. In the current study, we aim to detect and define the impairment of color Doppler ultrasound (CDUS) characteristics in UA and MCA for the pregnant with GDM. Methods: US examinations were all performed at 18–22 weeks of gestation with a 3.5 MHz convex transducer. We recorded peak systolic velocity (PSV), end diastolic velocity, pulsatility index, resistive index, and systole/diastole ratio values of both UA and MCA at 18–22 weeks of gestation. GDM diagnosis was created according to the American Diabetes Association guidelines. Results: Sixty GDM patients and 61 healthy controls were included into the study. Median MCA PSV value was lower in GDM group (28 cm/s vs. 32 cm/s, P = 0.37). Among UA CDUS parameters, we cannot find any significant difference. In GDM group, we could not detect any significant correlation between CDUS parameters and HbA1C values. Conclusion: GDM changes fetal brain hemodynamics and the change can be detected at 18–22 weeks of gestation. Decreased fetal MCA PSV values can serve as an early warning for GDM.

Vascular effects of gestational diabetes can be recognized by carotid intima-media thickness: a prospective case-control study

“…A prospective doppler study that was performed to predict GDM patients' perinatal outcomes showed that Middle Cerebral Artery Pulsatility Index could be an indicator; parallel to the current investigation, it found no important differences in umbilical artery values and reported that they cannot be used as an indicator [19]. A case-control study that evaluated early hemodynamic changes in the fetus aged 18-22 weeks old reported a decrease in the Middle Cerebral Artery peak systolic velocity values of the GDM group, and similar to our study, umbilical artery doppler parameters indicated no differences between the groups [20]. In addition to doppler measurements, maternal UtA doppler measurements are used to predict perinatal and maternal outcomes.…”

Doppler Indices of the Uterine, Umbilical and Fetal Middle Cerebral Artery in Diabetic versus Non-Diabetic Pregnancy: Systematic Review and Meta-Analysis

“…It is known that long-term uncontrolled hyperglycemia, chronic hypertension, preeclampsia, and IUGR can lead to placental vascular dysfunction with changes even in fetal circulation [ 53 , 82 , 104 , 105 , 106 ]. But the effect of metabolic changes due to diabetes mellitus during pregnancy on the fetus may be acidemia without hypoxemia, thus that redistribution seen in fetal hypoxemia may not occur even in severely compromised fetuses; and, therefore, it is of huge importance not to misrepresent this state by apparently normal fetal Doppler results [ 80 ].…”

“…The green squares represent each study individual SMD and the extending lines the 95% confidence intervals. The black diamond represents the overall estimate result [ 18 , 21 , 32 , 34 , 36 , 39 , 53 , 56 , 60 , 61 , 80 , 82 , 83 ].…”

“…The UA-RI, UtA-PI, and UtA-S/D ratio were significantly higher in diabetic in contrast to non-diabetic pregnancies (SMD = 0.40, 95%CI = 0.07-0.73, p = 0.020 (Figure 2); SMD = 1.62, 95%CI = 0.36-2.88, p = 0.010 (Figure 3), and SMD = 1.02, 95%CI = 0.02-2.03, p = 0.050 (Figure 4), respectively). [18,21,32,34,36,39,53,56,60,61,80,82,83]. [18,21,32,34,36,39,53,56,60,61,80,82,83].…”

Ultrasonographic diagnosis of fetal hemodynamic parameters in pregnant women with diabetes mellitus in the third trimester of pregnancy

“…Studies have suggested that nutritional supplements such as inositol and α -lipoic acid, vitamin D, and metformin can reduce the risk of diabetes, while monitoring fetal hemodynamic parameters can reduce the risk of hypertension and preeclampsia [ 7 , 8 ]. Therefore, the use of color Doppler ultrasound to monitor the hemodynamic parameters of fetal MCA in late pregnancy can be used to predict fetal hypoxia and severity [ 9 ]. When the fetus is in intrauterine hypoxia, the blood flow RI increases after RA contraction, and the blood flow redistribution is realized.…”