Prediction of fetal acidaemia in pregnancies complicated by maternal diabetes mellitus by biophysical profile scoring and fetal heart rate monitoring

Abstract

Objective To determine whether computer assisted fetal heart rate analysis or the biophysical profile score can provide noninvasive prediction of fetal acidaemia. Design Cross sectional study. Setting Harris Birthright Research Centre for Fetal Medicine, King's College Hospital School of Medicine, London. Subjects Forty‐one women with pregnancies complicated by diabetes mellitus. Interventions Fetal heart rate (FHR) monitoring with computer assisted analysis, biophysical profile score (BPS) and cordocentesis for measurement of umbilical venous blood glucose concentration and blood gases, up to 24 h before delivery at 27 to 39 weeks gestation. Results The mean umbilical venous blood pH was significantly lower than the normal mean for gestation, and was below the 5th centile in 18 pregnancies, including all six cases where the mother had nephropathy and hypertension. The mean pO2 was not significantly different from the normal mean for gestation. There were significant associations between fetal acidaemia and both the BPS (r= 0.46, P<0.01) and FHR variation (r= 0.42, P<0.01). However, of the 12 acidaemic fetuses of non‐nephropathic mothers, nine had normal BPS and six had normal FHR variation. Conclusions In pregnancies complicated by maternal diabetes mellitus, BPS and FHR variation are of limited value in the prediction of fetal blood pH.

Perinatal mortality in pregestational diabetes

“…Mean umbilical venous blood pH was significantly lower in diabetic pregnancies and was significantly related to fetal insulin levels. In a subsequent study, the authors found that biophysical score and fetal heart rate variability were of limited value in the prediction of acidemia in these fetuses [41].…”

Antepartum Fetal Surveillance and Timing of Delivery in the Pregnancy Complicated by Diabetes Mellitus

“…Their conclusion was that the BPP was a poor predictor of fetal acidemia in pregnancies complicated by diabetes. 31 Johnson et al 32 used the BPP as the primary mode of testing in 50 patients with insulin-dependent diabetes, who had twice weekly testing and 188 patients with gestational diabetes, who underwent weekly testing. There were no stillbirths and the incidence of an abnormal test was 3.3%.…”

Troponin T and Pro–B-Type Natriuretic Peptide in Fetuses of Type 1 Diabetic Mothers

“…Our group has reported previously that stillborn infants of diabetic mothers have heavier hearts than stillborn infants of nondiabetic mothers after correction for fetal size, suggesting that cardiomyopathy may have a role in “unexplained” fetal death in diabetic pregnancy (7). The etiology of this cardiomyopathy is poorly understood with proposed mechanisms including fetal hyperglycemia, hyperinsulinemia, and chronic hypoxia (8). More recently our group has suggested that cardiomyopathy occurs in response to functional changes evident in the first trimester in fetuses of pregestational type 1 diabetic mothers (9).…”