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

TL;DR

This study examines if Doppler sonography can predict poor outcomes in pregnancies with gestational diabetes, finding limited usefulness.

Contribution

The study evaluates the clinical relevance of fetomaternal Doppler indices for predicting adverse perinatal outcomes in GDM pregnancies.

Findings

CPUR showed borderline significance as a predictor of adverse perinatal outcomes.

Other Doppler indices were not independent predictors of adverse outcomes.

The overall ability of CPUR to discriminate outcomes was poor (AUC=0.65).

Abstract

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.

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.

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.

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.

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