Key result
Gestational diabetes was associated with a lower fetal cerebral-umbilical Doppler ratio compared to controls (P=0.031), which correlated significantly with mean daily glycemia (r=0.54, P<0.01).
Why the study?
Does maternal glycemic control influence fetal circulation in diabetic pregnancies?
Cohort (n=51)
Does maternal glycemic control influence fetal circulation in diabetic pregnancies?
p-value: p=0.031
Tighter maternal glycemic control in diabetic pregnancies is associated with changes in fetal circulation that resemble a brain-sparing effect.
Maternal glycemia may influence fetal cerebral redistribution in GDM; leaves open whether optimizing control affects perinatal outcomes.
In order to determine the influence of maternal glycemic control on the fetal circulation, Doppler flow velocity waveforms (DFVWs) were obtained at 30, 33, and 36–40 weeks in 17 women with overt diabetes, 20 with gestational diabetes (GDM), and 14 low-risk pregnant women. DFVWs were obtained from the umbilical artery (UA), internal carotid artery (ICA), ascending aorta, and main pulmonary artery. The ICA resistance index was lower in GDM than controls (P = 0.014). As a result, the cerebral-umbilical Doppler ratio (ICA resistance index/UA resistance index) was lower in GDM than controls (P = 0.031). There was a significant correlation between either the mean daily glycemia (r = 0.54, P < 0.01) or the mean daily M-value, an index of glucose excursion and mean glycemia (r = 0.61, P< 0.001), and the cerebral-umbilical Doppler ratio. As the maternal glycemic control became tighter, the fetal cerebral-umbilical Doppler ratio decreased to values similar to the “brain-sparing” effect described in growth-retarded fetuses. This effect of maternal glycemic control on the fetal circulation was independent of gestational age.
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Gagnon et al. (1994) conducted a cohort in Diabetic pregnancies (n=51). Gestational diabetes and maternal glycemic control vs. Low-risk pregnant women was evaluated on Cerebral-umbilical Doppler ratio (p=0.031). Gestational diabetes was associated with a lower fetal cerebral-umbilical Doppler ratio compared to controls (P=0.031), which correlated significantly with mean daily glycemia (r=0.54, P<0.01).
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