OP16.03: Fetal cerebral perfusion in the third trimester of pregnancies with controlled maternal insulin‐dependent‐diabetes (IDD)

Abstract

Insulin dependent diabetes has been described to have an impact during pregnancy on the fetal heart and blood rheology. A fetal diabetes-induced cardiopathy is described. The present study assesses the fetal cerebral perfusion in pregnancies complicated by maternal IDD, asses the fetal middle cerebral artery (MCA) Doppler for 3rd trim. Cross-sectional study incl singleton pregnancies complicated by pre-gestational IDD after 20 weeks of gestation, followed-up in the Nat Inst for Diabetes “Nic Paulescu” Buc in collaboration with the Cantacuzino Hosp-Prenatal Diagnosis Unit. Exclusion criteria were: pre-eclampsia, IUGr < 10°P and treatment with beta-mimetics or calcium channel blockers. Recorded data, using Voluson730ProV Ultrasound System. Twenty-one patients (n = 21), aged 24–35 years with pre-gestational IDD, with an onset 2–10 years prior to pregnancy, without specific diabetes complications were matched with 20 non-complic pregnancies between 20–39 weeks. In diabetes, HbA1c levels were 5.54% ± 0.6%, (min. 4.4%–6.8%). Diabetic pregnancies have significant higher EFW in average 78° percentile (min 41°P-max 99°P). 35.3% above 90°P (P < 0.001). Hydramnios in diabetes is 14.3%. MCA PSV in diabetes was 1.04 ± 0.25 MoM, (min. 0.59 MoM-max. 1.53 MoM), not significantly different from the normal controls. Compared to the normal distribution of PSV MCA published by Kurmanavicius et al: 4/21diabetic cases (19%) were above 95′P. Well controlled maternal IDD, although is known to influence fetal cardiac morphology and blood rheology, does not influence fetal cerebral circulation at the level of the MCA PSV. It can be argued that the modifications at the level of the fetal heart, described as diabetic cardiac fetopathy, are only adaptation changes in order to preserve normal cerebral perfusion. This work was supported by CNCSIS -UEFISCSU, project number PNII-IDEIcode 1331/2008.