Abstract
This study was designed to test umbilical indices and establish a reference in pregnancies complicated by type 1 diabetes mellitus, and to correlate the pulsatility index to other clinical parameters. We included consecutively 129 type 1 diabetic pregnant women during a five year period. During their pregnancy HbA1c, electrolytes, uric acid, diurnal blood pressure was measured and 24-h urine collected for measurement of albumin excretion rate. Umbilical blood flow measurements were done routinely from week 32 and started before week 32 on indication. Resistance and pulsatility indices and systolic-diastolic ratio were measured. The weekly repeated measurements from gestational 32 to 34 had the lowest levels of pulsatility index in the normoalbuminuria group and highest in the micro- and macroalbuminuria group combined (p = 0.01). We found an association of pulsatility index and umbilical pH (p<0.006). Even when adjusted for birth weight ratio, blood pressure, albumin excretion rate and HbA1c the association of pulsatility index and umbilical pH persisted (r = -0.30, p = 0.016). Glycemia expressed as HbA1c was associated with pulsatility index at nearly all measurements from week 31 to 35 and associated with albumin excretion rate. We were not able to predict adverse feto-maternal outcome in our pregnancies using umbilical indices. The correlation of pulsatility index and HbA1c underlines the importance of glycemic status during pregnancy. Albumin excretion rate affects the level of the umbilical pulsatility index.
Highlights
Abnomal umbilical blood flow is an indicator of fetal distress
Our aim was to test umbilical indices in their ability to predict adverse feto-maternal outcome, establish a reference in pregnancies complicated by type 1 diabetes mellitus (T1DM), and to correlate the pulsatility index to other clinical parameters
The clinical data show that duration of T1DM was longer, HbA1c, and blood pressures were higher in the group of women with macroalbuminuria (Table 1)
Summary
Abnomal umbilical blood flow is an indicator of fetal distress. Serial measurement is an established tool used for timing of delivery of fetuses with intrauterine growth restriction. Reference values for umbilical flow are defined according to gestational weeks in normal pregnancies with little morbidity. Even in high-risk pregnancy like those of women with type 1 diabetes mellitus (T1DM) fetal morbidity is difficult to foresee. In diabetic pregnancies relative large birth weight is a prominent feature even in preterm delivery [2]. Even when normoglycemia is achieved macrosomia is still a prominent feature in diabetic pregnancies [3]. Our aim was to test umbilical indices in their ability to predict adverse feto-maternal outcome, establish a reference in pregnancies complicated by T1DM, and to correlate the pulsatility index to other clinical parameters
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