Aortic isthmus Doppler hemodynamics and ımpacts on perinatal outcomes in pregestational and gestational diabetes mellitus

TL;DR

This study explores how fetal aortic isthmus Doppler measurements can predict poor outcomes in pregnancies affected by diabetes.

Contribution

The study introduces the aortic isthmus Doppler as a potential new tool for predicting adverse perinatal outcomes in diabetic pregnancies.

Findings

PGDM pregnancies had significantly higher rates of prematurity, cesarean delivery, NICU admission, and adverse perinatal outcomes.

AoI Doppler parameters showed modest predictive value for adverse outcomes, with AUC values of 0.627 and 0.638.

Abstract

To assess the sensitivity of the fetal aortic isthmus (AoI) Doppler changes in predicting the adverse perinatal outcome with pregestational and gestational diabetes mellitus compared with other Doppler parameters.

This prospective case–control study was undertaken between Agust 2023 and May 2024 in Ankara Etlik City Hospital perinatology department. Maternal age, gravidity, parity, maternal body mass index (BMI), gestational age at ultrasonographic examination, fetal AoI, umbilical artery (UA), middle cerebral artery (MCA), and uterine artery (UtA) Doppler parameters were compared between four groups: Pregestational diabetes mellitus (PGDM) (n = 30), diet-regulated gestational diabetes mellitus (DRGDM) (n = 30), insulin-regulated GDM (IRGDM) (n = 30), and controls (n = 75). HbA1c values were evaluated only in pregnancies complicated by diabetes mellitus. The composite adverse perinatal outcomes (CAPO) was defined as Apgar score at 5 min < 7, cord blood pH < 7, sepsis, phototherapy for neonates, respiratory distress syndrome (RDS), mechanical ventilation, neonatal intensive care unit (NICU) admission, hypoglycemia.

Maternal age and BMI levels were significantly higher in the PGDM group (p < 0.001). HbA1c levels were significantly higher in the PGDM group compared to other diabetic groups (p < 0.001). While most Doppler parameters were similar across groups, PGDM cases had higher rates of prematurity (40%), cesarean delivery (90%), NICU admission (60%), and CAPO (63.3%) compared to controls (p < 0.01 for all). HbA1c was positively correlated with MCA S/D, AoI-PSV, and AoI S/D (p < 0.05). ROC analysis showed that AoI Ta-max and EDV had modest predictive value for CAPO (AUC = 0.627 and 0.638, respectively; p < 0.05).

The AoI Doppler flow measurements may serve as a potential adjunctive marker in the assessment of adverse perinatal outcomes in pregnancies complicated by diabetes mellitus. However, further large-scale prospective studies are warranted to validate its clinical applicability and establish its role in routine obstetric practice.

Figures