Abstract
To explore the predictive value of fetal lung volume (FLV), pulmonary artery resistance index (PARI) and adrenal gland volume (AGV) in the prediction of neonatal respiratory distress (RDS) in diabetic pregnancies. This is a prospective cohort study that included pregnant women with diabetes at gestational age 37 weeks or more. Singleton pregnancies that are devoid of fetal congenital anomalies were enrolled. They underwent 2D-US to record fetal biometry, estimated fetal weight (EFW) and amniotic fluid index (AFI), followed by 3D-US to evaluate FLV and AGV. A 3D-US rotational multiplanar technique was utilized for volume measurements (VOCAL), and the mean of two volumes was calculated. A pulsed Doppler signal was introduced to asses PARI. ROC curves and logistic regression models were constructed for predictability of RDS. A total of 57 diabetic pregnancies were included in the final analysis; 40 of them (70.2%) were pre-gestational diabetes. Of all, twenty-two (38.6%) newborns exhibited RDS. Comparable gestational age at delivery, EFW, neonatal birth weight, and AGV were demonstrated between neonates with and without RDS. However, neonates with RDS had higher AFI (16.3±1.9vs14.7±1.8,P<0.005) than healthy neonates. Moreover, RDS neonates showed higher PARI and lower FLV than healthy neonates (0.89±0.02vs0.83±0.04,p<0.001;24±3.6vs.31.8±5.3,p<0.001, respectively). Analysis based on the type of diabetes failed to detect any difference in FLV, AGV and PARI between women with gestational and pre-gestational diabetes. In ROC curve analysis, newborns with FLV of 28.4 or less and PARI of 0.85 or more were more likely to have RDS (AUC; 0.89 and 0.92, respectively). A predictive model that comprised both FLV and PARI would have more accuracy (89.7%) and negative predictive value (89.2%) than utilizing either measure alone. In multivariable regression analysis, only FLV was a predictor for fetal lung maturity (OR:1.8,95%CI=1.1–2.9,P<0.02). Utilizing 3D-US for measuring FLV and PRRI could serve as non-invasive accurate method for prediction of neonatal RDS in diabetic mothers.View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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