Fetomaternal Doppler sonography for the prediction of perinatal outcome in term pregnancies complicated by gestational diabetes mellitus: does it have potential?

Ultrasound International Open, vol. 11, pp. a25540806

Abstract

Purpose: Little is known about the benefit and interpretation of fetomaternal Doppler sonography in GDM for the prediction of an adverse perinatal outcome (APO). The aim of this study was to examine the performance of fetomaternal Doppler for APO prediction in pregnancies with GDM at term. Materials and Methods: This is a retrospective cohort study of singleton, non-anomalous fetuses of women with GDM, who primarily had a vaginal delivery attempt. Study inclusion also required no other major fetomaternal abnormalities that make placental dysfunction likely. Data on fetomaternal Doppler sonography including umbilical artery pulsatility index (PI), middle cerebral artery (MCA) PI, cerebroplacental ratio (CPR), mean uterine artery PI, cerebro-placental-uterine ratio (CPUR) was collected from 37+0 weeks on. Multivariate logistic regression analyses were performed using maternal characteristics, neonatal characteristics, and Doppler ultrasound parameters as independent variables with CAPO as a binary outcome. Results: A total of n=88 cases were included. Nulliparity (p=0.032) and CPUR (p=0.052) were independent predictors of CAPO. However, CPUR had borderline significance. All other Doppler indices were not independent predictors of CAPO. The ability of CPUR alone (AUC=0.65, 95% CI 0.51 to 0.80) to discriminate between GDM pregnancies with and without CAPO was poor. Conclusion: This study shows that there is no significant clinical relationship between fetomaternal Doppler indices and CAPO among pregnancies with GDM. This raises the question regarding the extent to which fetomaternal Doppler indices, which reflect placental function, can be helpful for CAPO prediction in GDM pregnancies.

Authors 6

1. Oliver Graupner corresponding Aachen Department of Obstetrics and Gynecology

   Universitätsklinikum Aachen · Technical University of Munich · TUM Klinikum

   Affiliation as printed

   Department of Obstetrics and Gynecology, Klinikum rechts der Isar der Technischen Universität München, Munchen, Germany

   Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany

2. Caroline Rath Aachen Department of Obstetrics and Gynecology

   Universitätsklinikum Aachen

   Affiliation as printed

   Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany

3. Linda Lecker Aachen Department of Obstetrics and Gynecology

   Universitätsklinikum Aachen

   Affiliation as printed

   Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany

4. Jochen Ritgen Aachen Department of Obstetrics and Gynecology

   Universitätsklinikum Aachen

   Affiliation as printed

   Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany

   Praenatalplus, Cologne, Germany

5. Bernhard Haller

   Technical University of Munich · TUM Klinikum

   Affiliation as printed

   Institute for Medical Informatics, Statistics and Epidemiology (IMedIS), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany

6. C Enzensberger Aachen Department of Obstetrics and Gynecology

   Universitätsklinikum Aachen

   Affiliation as printed

   Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany