Role of ultrasound in the management of diabetes in pregnancy

Ahmed, Badreldeen; Abushama, Mandy; Khraisheh, Majeda; Dudenhausen, J. W.

doi:10.3109/14767058.2014.971745

Cited by 20 publications

(12 citation statements)

References 75 publications

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“…Given the importance of monitoring fetal size, the American College of Obstetricians and Gynecologists (ACOG) recommends performing ultrasonographic surveillance in mothers with pregnancies complicated by GDM [ 32 , 33 ]. The diagnostic threshold and treatment target may need to be individualized by fetal condition (e.g., women with small for gestational age fetuses due to placental insufficiency may require loose glycemic control).…”

Section: Offspring Complications Of Gdmmentioning

confidence: 99%

Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications

2022

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Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. GDM is associated with adverse pregnancy outcomes and long-term offspring and maternal complications. For GDM screening and diagnosis, a two-step approach (1-hour 50 g glucose challenge test followed by 3-hour 100 g oral glucose tolerance test) has been widely used. After the Hyperglycemia and Adverse Pregnancy Outcome study implemented a 75 g oral glucose tolerance test in all pregnant women, a one-step approach was recommended as an option for the diagnosis of GDM after 2010. The one-step approach has more than doubled the incidence of GDM, but its clinical benefit in reducing adverse pregnancy outcomes remains controversial. Long-term complications of mothers with GDM include type 2 diabetes mellitus and cardiovascular disease, and complications of their offspring include childhood obesity and glucose intolerance. The diagnostic criteria of GDM should properly classify women at risk for adverse pregnancy outcomes and long-term complications. The present review summarizes the strengths and weaknesses of the one-step and two-step approaches for the diagnosis of GDM based on recent randomized controlled trials and observational studies. We also describe the long-term maternal and offspring complications of GDM.

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Section: Offspring Complications Of Gdmmentioning

confidence: 99%

Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications

2022

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“…Doppler study of umbilical artery and middle cerebral artery(MCA) provides adequate monitoring of placental insufficiency in non-diabetic pregnancies. However, most authors believe that we cannot use the same Doppler criteria of placental insufficiency to evaluate the fetuses of diabetic mothers, since there is a difference in the mechanism which leads to fetal death 38 .…”

Section: Fetal Wellbeingmentioning

confidence: 99%

“…This is because hypoxia releases catecholamines and diverts more flow from the liver to the fetal heart, thus dilating the ductus venosus. Hepatic artery is also a vessel for further study on the evaluation of the wellbeing of the fetus of a diabetic mother, due to the large metabolic role of the liver in intrauterine life 38 .…”

Section: Fetal Wellbeingmentioning

confidence: 99%

The management of the macrosomic fetus and the assessment of wellbeing in gestational diabetes mellitus

Pandraklakis¹,

Pappa²

2019

HJOG

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IntroductionDiabetes mellitus(DM) in pregnancy is associated with an increased risk of fetal, neonatal, and offspring complications, as well as with long term complications in adulthood. DM may be pregestational (ie, type 1 or 2 diabetes diagnosed before pregnancy with a prevalence 1.8%) or gestational (ie, diabetes diagnosed during pregnancy with a prevalence 7.5%). The outcome mainly is related to the onset and duration of glucose intolerance during pregnancy and the severity of DM. The burden in public health of maternal DM has dramatically increased worldwide. Not only its prevalence rate at present, but the increase of its incidence in the near future will rise a global health problem. Diabetic population will increase from 415 million today to 642 million by the year 2040. In 2015, 199.5 million women counted with DM and 60 million of them were in reproductive age (18-44 years old). 1 It is estimated that the percentage of gestational diabetes mellitus (GDM) globally is about 5-20% depending on racial and socioeconomic factors. The majority of women remains undiagnosed until usual screening pregnancy tests. According to 7th Diabetes Atlas, hyperglycaemia in pregnancy is classified into three main types: diabetes detected prior to pregnancy or preexisting diabetes (type 1 and type 2), diabetes first detected in pregnancy and GDM which is defined as any degree of glucose intolerance with onset or first recognized during pregnancy.The 15-45% of diabetic mother babies present macrosomia, which is a 3-fold higher risk compared to normoglycemic ones. Macrosomia is defined as a birth weight above the 90th percentile for gestational age or alternatively over 4,000 g.Other maternal factors that cause fetal macrosomia ,except maternal hyperglycemia, are maternal

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“…Furthermore, increases in inflammatory markers due to persistent hyperglycemia can cause damage within the placenta such as villous maturation, vascularization, and branching ( 10 ). Ultrasonography is a non-invasive, readily available tool to examine and assess the fetus, which is helpful in instituting early therapeutic interventions for pregnancies complicated by diabetes ( 11 ). Improvements in three-dimensional (3D) ultrasonography have pointed out the role of placental volume (PV) and the potentially associated factors contributing to pregnancy complications.…”

Section: Introductionmentioning

confidence: 99%

Investigation Into the Predictive Potential of Three-Dimensional Ultrasonographic Placental Volume and Vascular Indices in Gestational Diabetes Mellitus

Han

Zhang

et al. 2021

Front. Endocrinol.

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BackgroundThe use of ultrasonography in pregnancies complicated with gestational diabetes mellitus (GDM) can vary according to clinical practice. This study aims to compare the changes of placental volume (PV) and vascular indices measured by three-dimensional (3D) Power Doppler between pregnant women with and without GDM.Materials and MethodsThis was a prospective study of singleton pregnancies who took the early nuchal translucency examination from January 2018 to September 2019. Data on PV and vascular indices including vascularization index (VI), flow index (FI), and vascularization flow index (VFI) between pregnant women with and without GDM were measured by 3D Power Doppler ultrasound machine. Univariate and multivariate logistic regression determined the association between risk factors and GDM. Receiver operating characteristic (ROC) and area under the ROC curve (AUC) were applied to evaluate the diagnostic value of different parameters for GDM.ResultsOf the 141 pregnant women enrolled, 35 developed GDM and 106 did not. The maternal age and gravida in the GDM group were significantly higher than that in the non-GDM group. The PV, VI, FI, and VFI in the GDM group were significantly lower than that in the non-GDM group. There were no significant differences in other clinical parameters between the two groups. After adjustments in multivariate logistic regression analysis, significant differences were observed in VI [odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.951–1.002], FI (OR = 0.93, 955 CI: 0.86–1.00), and VFI (OR = 0.67, 95% CI = 0.52–0.87). ROC analysis indicated that the combination of maternal age, gravida, PV, and VFI was more accurate as a marker for detecting GDM than the PV, VI, FI, or VFI alone.ConclusionsThe 3D ultrasonography results suggest that PV and vascular indices (VI, FI, and VFI) during the first trimester may serve as potential markers for GDM diagnosis. The combination of maternal age, gravida, and sonographic markers may have good diagnostic values for GDM, which should be confirmed by further investigations.

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Role of ultrasound in the management of diabetes in pregnancy

Cited by 20 publications

References 75 publications

Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications

Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications

The management of the macrosomic fetus and the assessment of wellbeing in gestational diabetes mellitus

Investigation Into the Predictive Potential of Three-Dimensional Ultrasonographic Placental Volume and Vascular Indices in Gestational Diabetes Mellitus

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