Reduced short-term variability of fetal heart rate in association with maternal hyperglycemia during pregnancy in insulin-dependent diabetic women

Kariniemi, V.; Forss, M.; Siegberg, Rita; Ämmälä, Pirkko

doi:10.1016/0002-9378(83)90040-6

Cited by 7 publications

(4 citation statements)

References 6 publications

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“…The present study shows that in diabetic pregnancies the number of false positives is comparable with those in other risk groups [12,22]. We have observed that low DIs during diabetic pregnancies are associated with maternal hyperglycemia [11]. Whether episodes of low DIs during diabetic pregnancies are associated with lowered intervillous placental blood flow, as we presume, remains to be investigated.…”

Section: Discussionsupporting

confidence: 71%

Short term variability of fetal heart rate during insulin-dependent diabetic pregnancies

Ämmälä¹,

Kariniemi²

1983

Journal of Perinatal Medicine

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Section: Discussionsupporting

confidence: 71%

Short term variability of fetal heart rate during insulin-dependent diabetic pregnancies

Ämmälä¹,

Kariniemi²

1983

Journal of Perinatal Medicine

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“…The first is that in these diabetic pregnancies, abnormal antenatal monitoring results have not reflected fetal compromise. Biophysical tests are influenced by maternal blood glucose levels (Teramo et al 1983; Karineiemi et al 1983) and fetal compromise is more difficult to define in diabetic pregnancy. The second reason may be the multifactorial nature of fetal compromise in diabetic pregnancy.…”

Section: Resultsmentioning

confidence: 99%

Doppler umbilical artery flow velocity waveforms in diabetic pregnancy

Johnstone

Steel

Haddad

et al. 1992

BJOG

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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.

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“…This speculation has important implications for the management of maternal glycaemia during diabetic pregnancy. Previous reports in the human have demonstrated a high incidence of late gestation stillbirths [1,2], anteparturn [27,28] and intrapartum fetal distress [5,29], and neonatal polycythaemia [30] in diabetic pregnancy. Previously we have reported that fetuses of diabetic mothers have increased levels of plasma Ep concentration at delivery [3,14], while others have documented direct and indirect evidence for increased fetal erythropoiesis [31,32].…”

Section: Discussionmentioning

confidence: 99%

Direct relationship of antepartum glucose control and fetal erythropoietin in human Type 1 (insulin-dependent) diabetic pregnancy

et al. 1990

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Summary. In the present study the antepartum relationship between maternal diabetic glucose control and fetal hypoxaemia was examined in 44 Type i (insulin-dependent) diabetic and 23 non-diabetic control pregnancies. Maternal HbAlc was used to assess maternal integrated blood glucose control while fetal metabolic control was evaluated by antepartum glucose, insulin, and C-peptide determinations in amniotic fluid at elective caesarean delivery. Fetal hypoxaemia was assessed indirectly by fetal umbilical vein plasma erythropoietin level at delivery. A prospectively developed statistical pathway model was used to examine the relationship of these variables. In applying forced stepwise multiple regression with this model, we observed in the diabetic subjects that mean maternal HbA~c during the last month of pregnancy correlated significantly with fetal umbilical venous erythropoietin at delivery (r = 0.57,p < 0.001). Additional significant contributions to umbilical venous erythropoietin were found for amniotic fluid glucose and amniotic fluid insulin when these two independent variables were added in stepwise fashion (p < 0.01). We conclude that in diabetic pregnancy, antepartum control of maternal hyperglycaemia is a significant factor associated with fetal hypoxaemia. We speculate that this effect is mediated through perturbations which accelerate fetal metabolism and which is expressed by amniotic fluid levels of glucose and insulin.Key words: Erythropoietin, HbAlc, fetus, oxygenation, diabetes mellitus.Although in recent years the outcome of diabetic pregnancies has dramatically improved, fetal and neonatal morbidity and mortality remain increased relative to normal pregnancies [1,2]. Some of the pathological features observed in offspring of these pregnancies have been shown to be associated with maternal hyperglycaemia (eg., respiratory distress syndrome, congenital malformations, and neonatal hypoglycaemia); others have not. Among the latter are the increased incidence of late gestation fetal death, antepartum and intrapartum fetal distress, and neonatal polycythaemia. We and others have speculated that these features of diabetic pregnancies have their origins in chronic and/or acute fetal hypoxaemia [3][4][5].The purpose of the present study was to indirectly examine the antepartum relationship between chronic maternal hyperglycaemia and fetal oxygenation in Type 1 (insulin-dependent) diabetic pregnancies delivered by elective caesarean section before the confounding effect of labour [6]. To do so, we prospectively developed a hypothetical pathway model for statistical analyses in which chronic maternal hyperglycaemia was related to chronic fetal hypoxaemia through several intermediate steps. Subjects and methods SubjectsAfter obtaining approval by the Ethical Committee at the University of Helsinki and after obtaining each patient's consent, control and Type i (insulin-dependent) diabetic subjects carrying singleton fetuses were studied at the Women's Hospital of the University Central Hospital of Helsink...

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Reduced short-term variability of fetal heart rate in association with maternal hyperglycemia during pregnancy in insulin-dependent diabetic women

Cited by 7 publications

References 6 publications

Short term variability of fetal heart rate during insulin-dependent diabetic pregnancies

Short term variability of fetal heart rate during insulin-dependent diabetic pregnancies

Doppler umbilical artery flow velocity waveforms in diabetic pregnancy

Direct relationship of antepartum glucose control and fetal erythropoietin in human Type 1 (insulin-dependent) diabetic pregnancy

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