Abstract
BackgroundThe aim of the study was to evaluate the ultrasound-derived measurements of the fetal soft-tissue, heart, liver and umbilical cord in pregnancies complicated by gestational (GDM) and type 1 diabetes mellitus (T1DM), and further to assess their applicability in the estimation of the fetal birth-weight and prediction of fetal macrosomia.MethodsMeasurements were obtained from diet-controlled GDM (GDMG1) (n = 40), insulin-controlled GDM (GDMG2) (n = 40), T1DM (n = 24) and healthy control (n = 40) patients. The following parameters were selected for analysis: fetal sub-scapular fat mass (SSFM), abdominal fat mass (AFM), mid-thigh fat/lean mass (MTFM/MTLM) and inter-ventricular septum (IVS) thicknesses, heart and thorax circumference and area (HeC/HeA; ThC/ThA), liver length (LL), umbilical cord/vein/arteries circumference and area (UmC/UmA; UvC/UvA; UaC/UaA) together with total umbilical vessels (UveA) and Wharton's jelly area (WjA). Regression models were created in order to assess the contribution of selected parameters to fetal birth-weight (FBW) and risk of fetal macrosomia.ResultsMeasurements of the fetal SSFM, AFM, MTFM, MTFM/MTLM ratio, HeC, HeA, IVS, LL, UmC, UmA, UaC, UaA, UveA and WjA were significantly increased among patients with GDMG2/T1DM as compared to GDMG1 and/or control groups (p < .05). The regression analysis revealed that maternal height as well as fetal biparietal diameter, abdominal circumference (AC), AFM and LL measurements were independent predictors of the FBW (p < .05). In addition, increase in the fetal AFM, AC and femur length (FL) was associated with a significant risk of fetal macrosomia occurrence (p < .05). The equation developed for the FBW estimation [FBW(g) = − 2254,942 + 17,204 * FL (mm) + 105,531 * AC (cm) + 131,347 * AFM (mm)] provided significantly lower mean absolute percent error than standard formula in the sub-group of women with T1DM (5.7% vs 9.4%, p < .05). Moreover, new equation including AC, FL and AFM parameters yielded sensitivity of 93.8%, specificity 77.7%, positive predictive value 54.5% and negative predictive value of 97.8% in the prediction of fetal macrosomia.ConclusionsUltrasound measurements of the fetal soft tissue, heart, liver and umbilical cord are significantly increased among women with GDM treated with insulin and T1DM. In addition to standard biometric measurements, parameters, such as AFM, may find application in the management of diabetes-complicated pregnancies.
Highlights
The aim of the study was to evaluate the ultrasound-derived measurements of the fetal soft-tissue, heart, liver and umbilical cord in pregnancies complicated by gestational (GDM) and type 1 diabetes mellitus (T1DM), and further to assess their applicability in the estimation of the fetal birth-weight and prediction of fetal macrosomia
Ultrasound measurements of the fetal soft tissue, heart, liver and umbilical cord are significantly increased among women with gestational diabetes mellitus (GDM) treated with insulin and T1DM
The participants were divided into four groups: (1) GDMG1—40 patients diagnosed with GDM and treated exclusively with diet; (2) GDMG2—40 patients diagnosed with GDM, who required additional therapy with insulin; (3) T1DM—24 patients with type 1 diabetes mellitus and (4) a control group—40 women in uncomplicated pregnancy
Summary
The aim of the study was to evaluate the ultrasound-derived measurements of the fetal soft-tissue, heart, liver and umbilical cord in pregnancies complicated by gestational (GDM) and type 1 diabetes mellitus (T1DM), and further to assess their applicability in the estimation of the fetal birth-weight and prediction of fetal macrosomia. According to the recent epidemiological data, the estimated prevalence of gestational diabetes mellitus (GDM) and type 1 diabetes mellitus (T1DM) in the population of pregnant women constitutes 5.8–12.9% and 0.16–0.24%, respectively [1,2,3] During pregnancy, both types of diabetes are associated with numerous adverse obstetric and neonatal outcomes, including pre-eclampsia, pre-term delivery, congenital abnormalities, perinatal death, respiratory distress syndrome, increased risk of Cesarean section, birth injuries and fetal macrosomia [3]. Both types of diabetes are associated with numerous adverse obstetric and neonatal outcomes, including pre-eclampsia, pre-term delivery, congenital abnormalities, perinatal death, respiratory distress syndrome, increased risk of Cesarean section, birth injuries and fetal macrosomia [3] The stimulating effect of growth factors refers to the entire feto-placental unit as large amounts of insulin receptors and IGF-I were detected in the placenta and Wharton’s jelly i.e. mucoid connective tissue that surrounds the two arteries and vein of the umbilical cord [10, 11]
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