Pulsed Tissue Doppler in the Surveillance of Diabetic Pregnancies: Prenatal Changes of Fetal Cardiac Time Intervals and Postnatal Outcome

Abstract

PurposeTo investigate the usefulness of pulsed Tissue Doppler as a new tool for surveillance of diabetic pregnancies.Material & MethodsWe investigated 274 pregnancies between 14 and 39 weeks of gestation. 59 Pregnancies were complicated by either impaired glucose tolerance, preexistent diabetes or gestational diabetes; 38 were insulin-dependent. Pulsed Tissue Doppler measurements were performed in the right subvalvular ventricular myocardium and measured cardiac time intervals were used to calculate TD-Tei Index. Postnatal outcome measures were GA at birth and birth weight. Measurments of TD-Tei were not used as an indication for labor induction.ResultsThe Tissue Doppler-derived Tei index values were 0,60 + /- 0,09 (SD) in the control group and 0,73 + /- 0,13 in the diabetic group. Mean birth weights at delivery in the diabetic group were high: 3402 + /- 563g compared with an expected mean birth weight of 3270 + /- 382g (calculated from regional and gender-specific percentile charts, Voigt 2006). TD-Tei did not significantly correlate with birth weight but with gestational age at delivery (pearson R -0,344).ConclusionMaternal diabetes causes fetal macrosomia as well as growth restriction. Hence fetal growth measurements may not always suffice in the surveillance of these high-risk pregnancies. TD-Tei index can aid as an additional component in the assessment of diabetic pregnancies. PurposeTo investigate the usefulness of pulsed Tissue Doppler as a new tool for surveillance of diabetic pregnancies. To investigate the usefulness of pulsed Tissue Doppler as a new tool for surveillance of diabetic pregnancies. Material & MethodsWe investigated 274 pregnancies between 14 and 39 weeks of gestation. 59 Pregnancies were complicated by either impaired glucose tolerance, preexistent diabetes or gestational diabetes; 38 were insulin-dependent. Pulsed Tissue Doppler measurements were performed in the right subvalvular ventricular myocardium and measured cardiac time intervals were used to calculate TD-Tei Index. Postnatal outcome measures were GA at birth and birth weight. Measurments of TD-Tei were not used as an indication for labor induction. We investigated 274 pregnancies between 14 and 39 weeks of gestation. 59 Pregnancies were complicated by either impaired glucose tolerance, preexistent diabetes or gestational diabetes; 38 were insulin-dependent. Pulsed Tissue Doppler measurements were performed in the right subvalvular ventricular myocardium and measured cardiac time intervals were used to calculate TD-Tei Index. Postnatal outcome measures were GA at birth and birth weight. Measurments of TD-Tei were not used as an indication for labor induction. ResultsThe Tissue Doppler-derived Tei index values were 0,60 + /- 0,09 (SD) in the control group and 0,73 + /- 0,13 in the diabetic group. Mean birth weights at delivery in the diabetic group were high: 3402 + /- 563g compared with an expected mean birth weight of 3270 + /- 382g (calculated from regional and gender-specific percentile charts, Voigt 2006). TD-Tei did not significantly correlate with birth weight but with gestational age at delivery (pearson R -0,344). The Tissue Doppler-derived Tei index values were 0,60 + /- 0,09 (SD) in the control group and 0,73 + /- 0,13 in the diabetic group. Mean birth weights at delivery in the diabetic group were high: 3402 + /- 563g compared with an expected mean birth weight of 3270 + /- 382g (calculated from regional and gender-specific percentile charts, Voigt 2006). TD-Tei did not significantly correlate with birth weight but with gestational age at delivery (pearson R -0,344). ConclusionMaternal diabetes causes fetal macrosomia as well as growth restriction. Hence fetal growth measurements may not always suffice in the surveillance of these high-risk pregnancies. TD-Tei index can aid as an additional component in the assessment of diabetic pregnancies. Maternal diabetes causes fetal macrosomia as well as growth restriction. Hence fetal growth measurements may not always suffice in the surveillance of these high-risk pregnancies. TD-Tei index can aid as an additional component in the assessment of diabetic pregnancies.