Prognostic accuracy of antenatal doppler ultrasound measures in predicting adverse perinatal outcomes for pregnancies complicated by diabetes: a systematic review

Rane, Ben M.; Malau-Aduli, Bunmi S.; Alele, Faith; O'Brien, Cecelia

doi:10.1016/j.xagr.2023.100241

Cited by 6 publications

(3 citation statements)

References 36 publications

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“…According to national and international guidelines, fetal Doppler sonography is not indicated because of an isolated GDM diagnosis [1,4]. In particular, the role of fetoplacental Doppler including umbilical artery pulsatility index (PI), middle cerebral artery PI, and cerebroplacental ratio (CPR) in predicting APO in GDM has been investigated to date [3]. To the best of our knowledge, little is known about the role of ductus venosus (DV) Doppler in predicting APO in GDM.…”

Section: Introductionmentioning

confidence: 99%

“…In the last decade, the prevalence of gestational diabetes mellitus (GDM) showed a significant increase, which is assumed to correlate with changes in the overall GDM screening performance and the increase in crucial risk factors such as maternal age and obesity 1 . GDM pregnancies have a higher risk of an adverse perinatal outcome (APO) including fetal acidosis, neonatal intensive care unit (NICU) admission, and operative delivery (OD) due to intrapartum fetal compromise (IFC) 2 3 . The management of optimal fetal surveillance in GDM pregnancies is still controversial.…”

Section: Introductionmentioning

confidence: 99%

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Role of Ductus Venosus Doppler Sonography for the Prediction of Perinatal Outcome in Term Pregnancies Complicated by Gestational Diabetes Mellitus

Graupner,

Rath,

Lecker

et al. 2024

Z Geburtshilfe Neonatol

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Purpose Ductus venosus (DV) Doppler velocimetry reflects fetal cardiac function. Gestational diabetes mellitus (GDM) is assumed to impair cardiac function due to fetal hyperglycemia. The purpose of this study was to assess the ability of DV Doppler to predict an adverse perinatal outcome (APO) in term pregnancies with GDM. Methods This is a retrospective cohort study including GDM pregnancies of singleton, non-anomalous fetuses without any signs of placental dysfunction. All GDM women who primarily had a vaginal delivery attempt and in which DV Doppler was examined from 37+0 weeks on were included. Receiver operating characteristic curve (ROC) analyses were performed to assess the predictive value of DV pulsatility index (DV-PI) regarding a composite APO (CAPO). Furthermore, a subgroup analysis was performed regarding the presence of a large-for-gestational-age (LGA) newborn. Results A total of n=89 cases were included. Overall, CAPO occurred in 26 out of 89 cases (29.2%). All DV Doppler examinations showed a positive A wave. DV-PI was>95th percentile in 8 out of 89 cases (9%). Overall, ROC analysis showed no significant association of DV-PI with CAPO (AUC=0.523, p=0.735). However, regarding individual APO parameters, ROC analysis showed a significant association of DV-PI with 5th-min AGPAR (AUC=0.960, p=0.027), which was not confirmed after exclusion of LGA cases. Conclusion In GDM pregnancies at term, DV Doppler sonography seems to have no benefit for APO prediction.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of Ductus Venosus Doppler Sonography for the Prediction of Perinatal Outcome in Term Pregnancies Complicated by Gestational Diabetes Mellitus

Graupner,

Rath,

Lecker

et al. 2024

Z Geburtshilfe Neonatol

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“…In their systematic review, Rane et al suggested that abnormal umbilical artery pulsatility index (UA-PI) may be more clinically valuable in predicting worse newborn outcomes in diabetes complicated pregnancies compared to the cerebroplacental ratio and middle cerebral artery pulsatility index. [21]. Also, the impact of increased maternal blood glucose on fetoplacental hemodynamics is far from being elucidated [14], [22], [23] especially in patients with uncontrolled GDM necessitating insulin therapy.…”

Section: Introductionmentioning

confidence: 99%

Does Insulin treatment affect Umbilical Artery Doppler indices in pregnancies complicated by gestational diabetes?

Troìa,

Ferrari,

Dotta

et al. 2024

Preprint

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Purpose Gestational diabetes mellitus (GDM) is one of the most common morbidities of pregnancy. The impact of increased maternal blood glucose on fetoplacental hemodynamics is not fully elucidated, especially in patients with uncontrolled GDM necessitating insulin therapy. The objective of this study was to assess the impact of insulin therapy on the umbilical artery dopplers in GDM pregnancies with adequate for gestational age fetuses. Methods Retrospective observational study among 447 GDM pregnant women, divided according to their treatment: nutritiona therapy (NT), long acting (LA) insulin and combined insulin. The umbilical artery pulsatility index (UA-PI) was recorded at 28, 32 and 36 weeks. Results UA-PI values declined in both GDM and healthy controls at all 3 time interval. The combined insulin group showed always a reduced UA-PI values in comparison to LA insulin group but the difference never reached statistical significance. The combined insulin group exhibited significant reduced UA-PI values at 32 and 36-weeks’ gestation compared to the NT groups. Conclusion A decreased impedence to blood flow in the umbilical artery of diabetic mothers on insulin therapy was observed, more pronounced during the final stage of pregnancy. Maternal hyperglycemia could have a worsening effect on fetal vasculature. Nevertheless, the extent to which umbilical artery PI can predict unfavorable outcomes associated with maternal hyperglycemia has yet to be determined. Further additional prospective studies are necessary to confirm the precise impact of glucose levels and medical interventions on the circulation of both the fetus and the mother.

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Utility of the cerebro‐placental‐uterine ratio in predicting composite adverse perinatal outcomes in pregestational diabetes: A prospective cohort study

Agaoglu,

Tanacan,

Ipek

et al. 2024

J of Clinical Ultrasound

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PurposeTo examine the cerebro‐placental‐uterine ratio (CPUR) in pregnant women with pregestational diabetes and determine its role in predicting adverse prenatal outcomes.MethodsThis prospective, cohort study conducted at a tertiary hospital included 65 patients with pregestational diabetes (25 with type1 diabetes, 40 with type2 diabetes) and 130 low‐risk patients in the control group. The cerebroplacental (CPR) ratio and the CPUR were calculated. Composite adverse perinatal outcome (CAPO) is defined as the presence of any of the following: (1) Neonatal intensive care unit (NICU) admission, (2) Apgar at 5 min <7, and (3) umbilical cord arterial pH <7.10. The relationship of CPR and CPUR with CAPO was investigated.ResultsCPR and CPUR were significantly lower in the pregestational diabetes group than in the control group. The NICU admission was higher in the case group. In receiver operating characteristic analyses, the optimal cut‐off value of CPUR was 1.46 (AUC = 0.72, p = 0.003, 80% sensitivity, and 69% specificity) to predict CAPO and the optimal cut‐off value of CPUR was 1.50 for NICU admission (AUC = 0.70, p = 0.013, 77% sensitivity, and 66% specificity).ConclusionLow CPUR values were found to be associated with adverse perinatal outcomes in women with pregestational diabetes. With the increasing number of studies, CPUR is expected to be utilized more widely in routine obstetric practice.

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Prognostic accuracy of antenatal doppler ultrasound measures in predicting adverse perinatal outcomes for pregnancies complicated by diabetes: a systematic review

Cited by 6 publications

References 36 publications

Role of Ductus Venosus Doppler Sonography for the Prediction of Perinatal Outcome in Term Pregnancies Complicated by Gestational Diabetes Mellitus

Role of Ductus Venosus Doppler Sonography for the Prediction of Perinatal Outcome in Term Pregnancies Complicated by Gestational Diabetes Mellitus

Does Insulin treatment affect Umbilical Artery Doppler indices in pregnancies complicated by gestational diabetes?

Utility of the cerebro‐placental‐uterine ratio in predicting composite adverse perinatal outcomes in pregestational diabetes: A prospective cohort study

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