Fetal Doppler Parameters at Term in Pregnancies Affected by Gestational Diabetes: Role in the Prediction of Perinatal Outcomes

Alessandra Familiari; Caterina Neri; Chiara Vassallo; Giulia Di Marco; Serafina Garofalo; Carmelinda Martino; Valentina Degennaro; Antonio Lanzone

doi:10.1055/a-0753-0120

Ultraschall in der Medizin - European Journal of Ultrasound, Table of Contents

Ultraschall Med 2020; 41(06): 675-680
DOI: 10.1055/a-0753-0120

Original Article

Fetal Doppler Parameters at Term in Pregnancies Affected by Gestational Diabetes: Role in the Prediction of Perinatal Outcomes

Fetale Doppler-Parameter um den Entbindungstermin bei Schwangerschaften mit Gestationsdiabetes: Rolle bei der Vorhersage des perinatalen Outcomes

Authors

Alessandra Familiari

Department of Women and Child Health, Policlinico A. Gemelli, High-Risk-Pregnancy-Unit, Obstetrics and Neonatology Area, Rome, Italy
Caterina Neri

Department of Women and Child Health, Policlinico A. Gemelli, High-Risk-Pregnancy-Unit, Obstetrics and Neonatology Area, Rome, Italy
Chiara Vassallo

Department of Women and Child Health, Policlinico A. Gemelli, High-Risk-Pregnancy-Unit, Obstetrics and Neonatology Area, Rome, Italy
Giulia Di Marco

Department of Women and Child Health, Policlinico A. Gemelli, High-Risk-Pregnancy-Unit, Obstetrics and Neonatology Area, Rome, Italy
Serafina Garofalo

Department of Women and Child Health, Policlinico A. Gemelli, High-Risk-Pregnancy-Unit, Obstetrics and Neonatology Area, Rome, Italy
Carmelinda Martino

Department of Women and Child Health, Policlinico A. Gemelli, High-Risk-Pregnancy-Unit, Obstetrics and Neonatology Area, Rome, Italy
Valentina Degennaro

Department of Women and Child Health, Policlinico A. Gemelli, High-Risk-Pregnancy-Unit, Obstetrics and Neonatology Area, Rome, Italy
Antonio Lanzone

Department of Women and Child Health, Policlinico A. Gemelli, High-Risk-Pregnancy-Unit, Obstetrics and Neonatology Area, Rome, Italy

Abstract

Objective The timing of delivery for women affected by gestational diabetes (GDM) is still controversial. Good clinical practice often suggests offering induction of labor at term in order to reduce the complications associated with this condition, while recent evidence supports expectant management. Fetal Doppler parameters represent a validated tool for testing fetal well-being at term and can select pregnancies that need increased surveillance. The aim of the present study was to evaluate the role of fetal Doppler parameters at term for the prediction of pregnancy outcomes in patients affected by GDM.

Methods Prospective cohort study in a single center. Evaluation of umbilical artery (UA) PI, middle cerebral artery (MCA) PI, cerebroplacental ratio (CPR) and umbilical-to-cerebral ratio (UCR) at > 37 weeks of gestation in singleton, morphologically normal pregnancies affected by GDM, was performed in order to estimate the association between ultrasound measurements at term and perinatal outcome. Regression linear analysis was used to estimate the association between fetal Doppler parameters and neonatal pH, neonatal Apgar score, neonatal weight and a composite adverse outcome. The receiver operating characteristic (ROC) curve was used to estimate the possible predictive value of the above association.

Results Our results on 130 women showed MCA PI to be the best predictor of perinatal outcomes in terms of low Apgar score at the 1st minute (p = 0.00), pH (p = 0.02) and composite adverse outcome (p = 0.05). UCR showed a significant correlation with neonatal pH (p = 0.02). No significant correlations for UA PI and CPR MoMs have been demonstrated in our population. However, the small sample size is a limitation of the study.

Conclusion Evaluation of MCA Doppler and eventually UCR at term can be a useful tool to discriminate pregnancies affected by GDM that can benefit from IOL before 41 weeks in order to reduce complications related to this condition.

Zusammenfassung

Ziel Bei Frauen mit Gestationsdiabetes (GDM) ist die Terminierung der Entbindung nach wie vor umstritten. Gemäß der guten klinischen Praxis wird zur Verringerung der mit dieser Erkrankung einhergehenden Komplikationen empfohlen, die Wehen-Einleitung zum Geburtstermin anzubieten, während jüngste Beweise für „Beobachten und Abwarten“ sprechen. Fetale Doppler-Parameter sind eine validierte Methode, um das fetale Wohlergehen am Geburtstermin zu untersuchen und kann diejenigen Schwangerschaften identifizieren, bei denen eine engere Überwachung nötig ist. Das Ziel der vorliegenden Studie war die Bewertung der Rolle fetaler Doppler-Parameter am Geburtstermin für die Vorhersage des Schwangerschaftsausgangs bei Patienten mit GDM.

Methoden Prospektive Kohortenstudie in einem einzigen Zentrum. Die Bewertung von PI der Nabelschnurarterie (UA), PI der A. cerebri media (MCA), der cerebroplacental ratio (CPR) und der umbilical-to-cerebral-ratio (UCR) wurde bei morphologisch normalen Einlings-Schwangerschaften > 37 Schwangerschaftswochen mit GDM durchgeführt, um eine Assoziation zwischen Ultraschallmessungen am Geburtstermin und dem perinatalen Outcome abzuschätzen. Die lineare Regressionsanalyse wurde verwendet, um den Zusammenhang zwischen den fetalen Doppler-Parametern und dem pH-Wert, Apgar-Score, Gewicht und dem kombinierten schlechten Outcome des Neugeborenen zu untersuchen. Die Receiver-Operating-Characteristic (ROC) -Kurve wurde zur Abschätzung des möglichen Vorhersagewertes der obigen Assoziation verwendet.

Ergebnisse Unsere Ergebnisse bei 130 Frauen zeigten, dass MCA-PI der beste Prädiktor für das perinatale Outcome ist in Bezug auf einen niedrigen Apgar-Score in der 1. Minute (p = 0,00), pH-Wert (p = 0,02) und den kombinierten schlechten Outcome (p = 0,05). Die UCR zeigte eine signifikante Korrelation mit dem neonatalen pH-Wert (p = 0,02). In unserer Population wurden keine signifikanten Korrelationen für UA und CPR-MoMs nachgewiesen. Die geringe Stichprobengröße ist jedoch eine Einschränkung der Studie.

Schlussfolgerung Die Bewertung von MCA-Doppler und letztlich UCR am Geburtstermin können nützliche Methoden sein, um Schwangerschaften mit GDM zu unterscheiden, die von einer IOL vor der 41. Woche profitieren könnten, um die mit dieser Erkrankung einhergehenden Komplikationen zu reduzieren.

Key words

at term surveillance - fetal Doppler - cerebro-placental ratio - gestational diabetes - middle cerebral artery

Full Text

References

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