OP11.07: Changes of uterine and umbilical flow in pregnancy complicated by Diabetes Mellitus in relation to the perinatal outcome

Abstract

Objectives: To explore the association of uterine arteries (UA) waveform analysis with brachial artery flow-mediated dilation (BAFMD) in the prediction of preeclampsia in high-risk pregnancies. Methods: UA waveforms were recorded using Pulsed Doppler ultrasonography in 33 women at 22–24 weeks of gestation with high risk factors for preeclampsia (PE). Mean Pulsatility Index (PI) of both UA were registered. At the same time, brachial artery diameter was evaluated in basal and after stress conditions using Color Doppler; BAFMD was expressed as percent change in diameter from baseline. The onset of PE was divided in early (before 34 weeks of gestation) or late (after 34 weeks). Logistic regression models were developed, and their predictive ability assessed using ROC curves. Results: The prevalence of PE in the studied group was 24% (8/33), 5 early and 3 late-onset. Mean UA-PI and BAFMD values of cases without PE were lower, but not significant, than those developing PE (mean difference (MD): −0.39 (95% CI: −0.90–0.13) and −4.41% (95% CI: −16.1–7.3) respectively). Area under ROC curve for mean UA-PI was of 0.70 (95% CI: 0.41–0.99%), and for BAFMD of 0.59 (95% CI: 0.37–0.80). Logistic regression analysis was only significant for mean UA-PI (P = 0.034), and adding BAFMD did not improve the prediction. For early-onset PE, there were significant higher values in mean UA-PI (MD: 0.56 (95% CI: 0.19–0.94)), and higher BAFMD results but not significant (MD: 8.8% (95% CI: −4.6–22.2%)). Area under ROC curve for mean UA-PI was of 0.79 (95% CI: 0.44–1), and for BAFMD of 0.69 (95% CI: 0.46–0.91). Logistic regression analysis was only significant for mean UA-PI (P = 0.02), multivariate regression analysis combining UA-PI and BAFMD did not get better the prediction of early-onset PE. Conclusions: Although there is a trend of higher BAFMD in pregnancies with PE, the test in the second trimester did not improve the capacity for prediction of PE that provides the UA by itself.