Occurrence Of Fetal Growth Restriction Research Articles

Associations of serum D-dimer and glycosylated hemoglobin levels with third-trimester fetal growth restriction in gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is a special type of diabetes that commonly occurs in women during pregnancy and involves impaired glucose tolerance and abnormal glucose metabolism; GDM is diagnosed for the first time during pregnancy and can affect fetal growth and development. To investigate the associations of serum D-dimer (D-D) and glycosylated hemoglobin (HbA1c) levels with third-trimester fetal growth restriction (FGR) in GDM patients. The clinical data of 164 pregnant women who were diagnosed with GDM and delivered at the Obstetrics and Gynecology Hospital of Fudan University from January 2021 to January 2023 were analyzed retrospectively. Among these women, 63 whose fetuses had FGR were included in the FGR group, and 101 women whose fetuses had normal body weights were included in the normal body weight group (normal group). Fasting venous blood samples were collected from the elbow at 28-30 wk gestation and 1-3 d before delivery to measure serum D-D and HbA1c levels for comparative analysis. The diagnostic value of serum D-D and HbA1c levels for FGR was evaluated by receiver operating characteristic analysis, and the influencing factors of third-trimester FGR in GDM patients were analyzed by logistic regression. Serum fasting blood glucose, fasting insulin, D-D and HbA1c levels were significantly greater in the FGR group than in the normal group, while the homeostasis model assessment of insulin resistance values were lower (P < 0.05). Regarding the diagnosis of FGR based on serum D-D and HbA1c levels, the areas under the curves (AUCs) were 0.826 and 0.848, the cutoff values were 3.04 mg/L and 5.80%, the sensitivities were 81.0% and 79.4%, and the specificities were 88.1% and 87.1%, respectively. The AUC of serum D-D plus HbA1c levels for diagnosing FGR was 0.928, and the sensitivity and specificity were 84.1% and 91.1%, respectively. High D-D and HbA1c levels were risk factors for third-trimester FGR in GDM patients (P < 0.05). D-D and HbA1c levels can indicate the occurrence of FGR in GDM patients in the third trimester of pregnancy to some extent, and their combination can be used as an important index for the early prediction of FGR.

Sleep-disordered breathing and pregnancy outcomes: The impact of maternal oxygen saturation.

To investigate pathological associations between sleep-disordered breathing (SDB) and pregnancy outcomes. From May 2016 to September 2019, obese women during their uncomplicated singleton pregnancies underwent screening sleep questionnaires, oxygen saturation monitoring, and, in proper cases, complete overnight polysomnography. Their medical records were also recorded. In all, 112 pregnant women were included in the study cohort; 44 showed an oxygen desaturation index ≥10, and their newborns had a significantly higher rate of congenital abnormalities and respiratory distress syndrome compared with the women with normal pulse oximetry. Stepwise multivariate regression analysis showed that basal oxygen saturation was independently associated with the occurrence of fetal growth restriction. Among obese pregnant women, the rate of congenital abnormalities is higher in the ones with altered pulse oximetry. Maternal basal oxygen saturation in the first trimester of pregnancy predicts fetal growth restriction independently of maternal age, ethnicity, body mass index, gravidity, and hypertensive disorders of pregnancy.

Factors associated with fetal growth restriction and small for gestational age newborns.

To identify risk factors that contribute to the occurrence of fetal growth restriction (FGR) and small for gestational age (SGA) and quantify the strength of their impact. This study was designed as a retrospective-prospective observational cohort study conducted on pregnant women at the Clinic for Gynecology and Obstetrics at the University Clinical Centre Kragujevac, Serbia. We measured the intrauterine degree of fetal development through the estimated fetal weight (EFW) on ultrasound examination, which was calculated using Hadlock's formula 3. Fetuses whose EFW was below the 10th percentile on the World Health Organization (WHO) fetal growth charts adjusted for gender and gestational age were classified as FGR fetuses, while newborns weighing less than the 10th percentile were considered SGA. The study included 320 pregnant women with an average age of 30.3 ± 5.5 years who gave birth to 332 newborns. The results of univariate and multivariate stepwise backward conditional binary logistic regression showed that the occurrence of FGR during the second trimester was more likely in pregnant women with lower body height and proteinuria. The risk factors for the occurrence of FGR during the third trimester were lower body height and proteinuria, while iron supplementation had a protective effect. SGA newborns were more common in pregnant women who were shorter, had proteinuria, used corticosteroids, or smoked during pregnancy. Clinicians should pay special attention to pregnant women with lower body height, proteinuria, who smoke and use corticosteroids in order to prevent FGR and SGA.

Maternal polymorphic loci of rs1979277 serine hydroxymethyl transferase and rs1805087 5-methylenetetrahydrofolate are correlated with the development of fetal growth restriction: A case-control study.

BackgroundKey reactions in folate-mediated single-carbon metabolism are regulated by folate cycle enzymes. Violations of the folate cycle may be associated with the occurrence of fetal growth restriction (FGR) in pregnant women.Objective To study the relationship between polymorphisms of folate cycle genes in the mother with the development of FGR.Materials and MethodsIn this case-control study, 122 pregnant women with FGR and 243 pregnant women with normal newborn weight were enrolled. The polymorphic loci of folate cycle genes including rs1805087 5-methylenetetrahydrofolate (MTR) and rs1979277 serine hydroxymethyl transferase (SHMT1) were examined. The study of polymorphisms was carried out through the TaqMan probe detection method using polymerase chain reaction. Logistic regression was used to analyze the associations of the polymorphisms.ResultsIt was established that the T allele rs1979277 of the SHMT1 gene was correlated with the development of FGR within the framework of the allelic (OR = 1.67, 95% CI 1.20-2.33, p 0.01), additive (OR = 1.69, 95% CI 1.20-2.37, p 0.01), dominant (OR = 1.81, 95% CI 1.15-2.87, p = 0.01) and recessive (OR = 2.34, 95% CI 1.15-4.73, p = 0.01) models. The association of the G rs1805087 allele of the MTR gene with the occurrence of FGR was also identified following the recessive model (OR = 3.01, 95% CI 1.05-8.68, p = 0.04).ConclusionOur results indicated that maternal polymorphic loci rs1979277 SHMT1 and rs1805087 MTR may be associated with the development of FGR.

The Effect and Mechanism of Asymmetric Dimethylarginine Regulating Trophoblastic Autophagy on Fetal Growth Restriction.

Fetal growth restriction (FGR) is an important cause of perinatal death and adverse pregnancy outcomes. Asymmetric dimethylarginine (ADMA) is associated with FGR, but the mechanisms have not been thoroughly studied. Here, we determined the levels of ADMA and autophagy-related molecules in human blood samples and placental tissues. And we also used the human chorionic carcinoma cell line BeWo to investigate the mechanism of ADMA-induced FGR in vitro. Compared with the control group, ADMA levels in maternal blood and placenta were increased in patients with FGR, and the birth weight (BW) percentile was negatively correlated with maternal serum ADMA concentration in the FGR group. The expression of mammalian target of rapamycin (mTOR) in the placenta of the FGR group was lower than the control group, while the expression of Beclin-1 and microtubule-associated protein 1 light chain 3-II (LC3-II)/LC3-I was significantly increased in the FGR group. And the expression of matrix metalloproteinase 9 (MMP9) was decreased in the placenta of patients with FGR. In in vitro cell experiments, compared with the control group, the expression of mTOR and MMP9 in BeWo cells was decreased and the expression of Beclin-1 and LC3-II/LC3-I was increased in the ADMA-treated group. Moreover, ADMA had favorable effects on the formation of autophagic vacuoles, and the autophagy inhibitor 3-Methyladenine (3-MA) could reduce the autophagy-induction effect of ADMA on BeWo cells. This study found that ADMA could participate in the occurrence of FGR through inducing autophagy in trophoblasts.

Association between fetal growth restriction and maternal exposure to polybrominated diphenyl ethers.

Humans are exposed to polybrominated diphenyl ethers (PBDEs) via ingestion of food, dust inhalation, and dermal absorption. Exposure to PBDEs via the placenta and breast milk is a special and important pathway in infants. This nested case-control study aimed to investigate the levels of PBDEs in maternal serum and colostrum, and to assess the association between the occurrence of fetal growth restriction (FGR) and prenatal exposure to PBDEs. We recruited 293 mother-newborn pairs, including 98 FGR cases and 195 healthy controls in Wenzhou, China. Maternal serum and colostrum samples were collected during pregnancy and after delivery, respectively, and the levels of PBDEs were measured by gas chromatography-tandem mass spectrometry. The total levels of PBDEs in maternal serum and colostrum were found to be in equilibrium, but congener profiles of PBDEs in these matrices were different. Increased BDE-207, BDE-209, ∑BDE196-209 and ∑PBDEs levels in maternal serum and BDE-99, ∑BDE17-154 and ∑PBDEs levels in colostrum were correlated with decreased birth weight Z score. Increased concentrations of higher brominated BDEs in maternal serum (odds ratio (OR)=1.010, 95%CI=1.003-1.018) and low-to moderately brominated BDEs in colostrum (OR=1.004, 95%CI=1.000-1.009) were associated with increased risk of FGR, which showed an exposure-response relationship. In addition, infants with FGR were more exposed to PBDEs in colostrum after birth than healthy infants. Longitudinal birth cohort studies are needed to determine the prolonged effect of PBDEs exposure on the growth of FGR infants in the future.

Expression of serum retinol binding protein 4 in gravidas with fetal growth restriction

Objective To investigate the changes of serum retinol binding protein 4 (RBP4) concentration in peripheral blood of normal gravidas at different stages during pregancy and the differential expression of serum RBP4 in gravidas with fetal growth restriction (FGR) in second trimester. Methods This study enrolled 80 gravidas who received routine prenatal examination and delivered in the Beijing Luhe Hospital Affiliated to Capital Medical University from January 2014 to January 2015. Forty gravidas were classified to FGR group as the birth weight of their fetuses was below two standard deviations or below the 10th percentile for the corresponding gestationas and same sex, or less than 2 500 g after 37 weeks. The other 40 gravidas who delivered newborns with normal birth weight (2 500 g < birth weight < 4 000 g) were used as control group. Levels of serum RBP4, plasma albumin, fasting blood glucose, triglyceride, total cholesterol, low density lipoprotein-cholesterol (LDL-C), hemoglobin, fasting insulin and vitamin A were determined before pregnancy and at 12-16, 20-24, 28-32 and 36-40 weeks of gestation. Homeostasis model assessment-insulin resistance (HOMA-IR) was calculated. Independent sample t test or analysis of variance, Chi-square test or Fisher exact test was used for statistical analysis. Pearson correlation was used to analyze the relationship between peripheral blood RBP4 level and neonatal birth weight at 20-24 weeks. Results (1) Serum RBP4 levels in normal gravidas were (24.65±10.02), (29.86±23.40), (56.10±12.28), (65.80±20.56) and (53.71±24.17) μg/ml before pregnancy and at 12-16, 20-24, 28-32 and 36-40 weeks of gestation, respectively, showing a gradually increasing trend with gestational week until a peak at 28-32 weeks and then followed by a decrease (F=14.173, P<0.001). (2) The body mass index and placental weight of gravidas in FGR group were lower than those in control group [20.7±3.3 vs 22.9±2.1, (401.3±56.2) vs (501.3±64.7) g; t=22.590 and 2.487, both P<0.05]. (3) The fasting blood glucose, fasting insulin, HOMA-IR, RBP4 and plasma albumin in FGR group were lower than those in control group [(4.06±0.4) vs (4.38±0.4) mmol/L, (21.84±15.2) vs (31.76±1.5) μU/ml, 0.5±0.2 vs 0.7±0.2, (41.78±12.8) vs (65.80±20.5) μg/ml, (35.1±2.7) vs (36.5±2.3) g/L; t=3.419, 2.355, 3.419, 6.263 and 2.462, all P<0.05]. Maternal serum RBP-4 at 20-24 weeks of normal gravidas and FGR gravidas were positively correlated with the birth weight of newborns (r=0.717 and 0.748, both P<0.05). Conclusions Serum RBP4 of gravidas may be associated with the occurrence of FGR. Key words: Fetal growth retardation; Retinol-binding proteins, plasma; Pregnancy trimester, second; birth weight

Cell-Free DNA (cfDNA) Fetal Fraction in Early- and Late-Onset Fetal Growth Restriction.

Our objective was to retrospectively evaluate whether the levels of cell-free DNA (cfDNA) fetal fraction differed in the first trimester of pregnancies between controls and those who subsequently developed early- or late-onset fetal growth restriction (FGR). This was a case-control study conducted between May 2015 and May 2018 in 231 low-risk women who had received first trimester screening for major fetal aneuploidies (Panorama, Natera, San Carlos, CA, USA). Early- and late-onset FGR developed in 5 and 16 women, respectively, according to Delphi criteria. Multiples of median (MoM) were used to evaluate the differences in cfDNA fetal fraction between cases and controls. cfDNA fetal fraction was adjusted for gestational age (from 10 + 0 to 13 + 6 gestational weeks) and maternal weight (43-96kg). The median cfDNA fetal fractions for controls and early- and late-onset FGR were 1.00 (interquartile range [IQR] 0.89-1.12), 0.69 (IQR 0.44-0.84) and 0.93 (IQR 0.83-1.03) MoM, respectively. Statistically lower cfDNA fetal fraction MoM values were observed onlyin patients with early-onset FGR (Kruskal-Wallis test with Dunn post hoc test). In a 1:35 ratio (one case of early-onset FGR: 35 controls), the mean observed rank of 2.00 ± 2.23 in the cases was significantly lower than the expected 18.97 ± 10.17 (p < 0.001). Low-risk pregnancies that developed early-onset FGR had lower cfDNA fetal fractions than did the matched controls. This result is consistent with the placental dysfunction typical of early-onset FGR. For possible clinical use, the cfDNA fetal fraction would yield a better predictive value if adjusted for maternal weight, since maternal weight affects both cfDNA fetal fraction and the occurrence of FGR.

Pathogenesis of Zika Virus-Associated Embryopathy.

A strong causal association has become evident between Zika virus (ZIKV) infection during pregnancy and the occurrence of fetal growth restriction, microcephaly and eye defects. Circumstantial evidence is presented in this paper in support of the hypothesis that these effects, as well as the Guillain-Barré syndrome, are due to an endogenous form of hypervitaminosis A resulting from ZIKV infection-induced damage to the liver and the spillage of stored vitamin A compounds (“retinoids”) into the maternal and fetal circulation in toxic concentrations. Retinoids are mainly stored in the liver (about 80%) and are essential for numerous biological functions. In higher concentration, retinoids are potentially cytotoxic, pro-oxidant, mutagenic and teratogenic, especially if sudden shifts occur in their bodily distribution. Although liver involvement has not been mentioned specifically in recent reports, conventional liver enzyme tests underestimate the true extent of liver dysfunction. The proposed model could be tested by comparing retinoid concentration and expression profiles in microcephalic newborns of ZIKV-infected mothers and nonmicrocephalic newborn controls, and by correlating these profiles with measures of clinical severity.

Prediction of Fetal Growth Restriction by Analyzing the Messenger RNAs of Angiogenic Factor in the Plasma of Pregnant Women.

To predict the occurrence of fetal growth restriction (FGR) by analyzing messenger RNA (mRNA) expression levels of vascular endothelial growth factor receptor 1 (fms-like tyrosine kinase 1 [Flt-1]) in maternal blood. Eleven women with FGR were matched with 88 controls. Plasma samples were obtained during each trimester. The Flt-1 mRNA expression levels were compared between groups. Predicted probabilities were calculated, and sensitivity-specificity (receiver-operating characteristic [ROC]) curves were assessed based on regression models for each trimester measurement and possible combinations of measurements. The mRNA levels of the FGR group during all trimesters were significantly higher than those of the control group. The ROC curve of combined first and second trimester data yielded a detection rate of 60% at a 10% false-positive rate, with an area under curve of 0.79. The Flt-1 mRNA expression in maternal blood can be used as a marker to predict the development of FGR, long before a clinical diagnosis is made.

Von Willebrand Factor and ADAMTS13

The goal of this study was to search for an association between a desintegrin-like and metalloprotease thrombospondin type 1 motif, member 13 (ADAMTS13) levels and the occurrence of preeclampsia, its characteristics (time-onset and severity), and its consequences (occurrence of fetal growth restriction or preterm delivery). We studied 140 pairs of women in a case-control study with 3 matching criteria: maternal age, gestational age, and ethnic origin. We measured ADAMTS13 activity using a fluorescence resonance energy transfer assay with the fluorescence resonance energy transfer-VWF73 peptide. ELISA was used to assess protein antigen levels: ADAMTS13, von Willebrand Factor (VWF), interleukin-6, C-reactive protein, P-selectin, and thrombospondin-1. The lowest levels of ADAMTS13 (activity ≤ 70% or antigen ≤ 592 ng/mL) were significantly associated with preeclampsia (odds ratios [OR] [95% confidence interval] of 4.2 [1.1 to 15] and 14.3 [1.7 to 123], respectively). This association was independent of VWF levels and preeclampsia risk factors but dependent on interleukin-6 and C-reactive protein levels for ADAMTS13 activity. Levels of ADAMTS13 activity (≤ 57%) were significantly associated with early-onset preeclampsia (OR = 2.5 [1.1 to 5.8]). Severe preeclampsia was associated with the highest levels of P-selectin (>57 ng/mL) (OR = 3.4 [1.2 to 9.7]). Preeclampsia is associated with decreased levels of ADAMTS13, independently of VWF. This decrease is quantitative, occurs early, and seems to be dependent on inflammation. Our results suggest that ADAMTS13 could participate in the pathophysiology of preeclampsia.

Interaction between risk factors for fetal growth retardation associated with abnormal umbilical artery Doppler studies.

The role of antenatal risk factors associated with the occurrence of fetal growth restriction complicated by abnormal umbilical artery Doppler studies has not yet been studied extensively. We evaluated the role and the interactions of antenatal antecedents of fetal growth restriction complicated by abnormal umbilical artery end-diastolic velocities. We compared antenatal variables in 183 pregnancies complicated by fetal growth retardation and abnormal umbilical artery Doppler studies and 549 appropriately grown fetuses with normal end-diastolic velocity waveform in the umbilical artery. Logistic regression was used to evaluate the association between antenatal variables and fetal growth retardation and to test for interaction. In logistic models, increasing maternal age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.01-1.11], nulliparity (OR 2.2, 95% CI 1.37-3.5), smoking during pregnancy (OR 2.56, 95% CI 1.56-4.22), preeclampsia (OR 27.5, 95% CI 15.1-49.9), first-trimester hemorrhage (OR 2.25, 95% CI 1.32-3.82) and low (< 0.2 kg/week) weight gain in pregnancy (OR 3.48, 95% CI 1.71-3.05) were significantly associated with an increased risk of fetal growth restriction complicated by abnormal Doppler studies. These risk factors were also significantly correlated with the occurrence of absent/reversed end-diastolic blood flow in the umbilical artery. Maternal smoking during pregnancy interacted negatively with preeclampsia but positively with a low weight gain in pregnancy. The results of this study have shown that antenatal risk factors for intrauterine growth retardation (IUGR) complicated by abnormal Doppler studies are similar to those associated with the birth of a small-for-gestational-age infant. Preeclampsia, maternal smoking and low weight gain in pregnancy play a significant causal role in the origin of fetal growth restriction associated with abnormal uteroplacental blood flow.

Interaction between risk factors for fetal growth retardation associated with abnormal umbilical artery Doppler studies

Background. The role of antenatal risk factors associated with the occurrence of fetal growth restriction complicated by abnormal umbilical artery Doppler studies has not yet been studied extensively. We evaluated the role and the interactions of antenatal antecedents of fetal growth restriction complicated by abnormal umbilical artery end-diastolic velocities. Methods. We compared antenatal variables in 183 pregnancies complicated by fetal growth retardation and abnormal umbilical artery Doppler studies and 549 appropriately grown fetuses with normal end-diastolic velocity waveform in the umbilical artery. Logistic regression was used to evaluate the association between antenatal variables and fetal growth retardation and to test for interaction. Results. In logistic models, increasing maternal age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.01–1.11], nulliparity (OR 2.2, 95% CI 1.37–3.5), smoking during pregnancy (OR 2.56, 95% CI 1.56–4.22), preeclampsia (OR 27.5, 95% CI 15.1–49.9), first-trimester hemorrhage (OR 2.25, 95% CI 1.32–3.82) and low (< 0.2 kg/week) weight gain in pregnancy (OR 3.48, 95% CI 1.71–3.05) were significantly associated with an increased risk of fetal growth restriction complicated by abnormal Doppler studies. These risk factors were also significantly correlated with the occurrence of absent/reversed end-diastolic blood flow in the umbilical artery. Maternal smoking during pregnancy interacted negatively with preeclampsia but positively with a low weight gain in pregnancy. Conclusions. The results of this study have shown that antenatal risk factors for intrauterine growth retardation (IUGR) complicated by abnormal Doppler studies are similar to those associated with the birth of a small-for-gestational-age infant. Preeclampsia, maternal smoking and low weight gain in pregnancy play a significant causal role in the origin of fetal growth restriction associated with abnormal uteroplacental blood flow.

Neonatal Outcomes With Placenta Previa

In Brief Objective To identify neonatal complications associated with placenta previa. Methods This was a population-based, retrospective cohort study involving all singleton deliveries in Nova Scotia from 1988 to 1995. The study group consisted of all completed singleton pregnancies complicated by placenta previa; all other singleton pregnancies were considered controls. Patient information was collected from the Nova Scotia Atlee perinatal database. Neonatal complications were evaluated while controlling for potential confounders. The data were analyzed using χ2, Fisher exact test, and multiple logistic regression. Results Among 92,983 pregnancies delivered during the study period, 305 cases of placenta previa were identified (0.33%). After controlling for potential confounders, neonatal complications significantly associated with placenta previa included major congenital anomalies (odds ratio [OR] 2.48), respiratory distress syndrome (OR 4.94), and anemia (OR 2.65). The perinatal mortality rate associated with placenta previa was 2.30% (compared with 0.78% in controls) and was explained by gestational age at delivery, occurrence of congenital anomalies, and maternal age. Although there was a higher rate of preterm births in the placenta previa group (46.56% versus 7.27%), there was no difference in birth weights between groups after controlling for gestational age at delivery. Conclusion Neonatal complications of placenta previa included preterm birth, congenital anomalies, respiratory distress syndrome, and anemia. There was no increased occurrence of fetal growth restriction. Preterm births, congenital anomalies, respiratory distress syndrome, and anemia are independent neonatal complications of placenta previa.

Neonatal outcomes with placenta previa

Objective: To identify neonatal complications associated with placenta previa. Methods: This was a population-based, retrospective cohort study involving all singleton deliveries in Nova Scotia from 1988 to 1995. The study group consisted of all completed singleton pregnancies complicated by placenta previa; all other singleton pregnancies were considered controls. Patient information was collected from the Nova Scotia Atlee perinatal database. Neonatal complications were evaluated while controlling for potential confounders. The data were analyzed using χ 2, Fisher exact test, and multiple logistic regression. Results: Among 92,983 pregnancies delivered during the study period, 305 cases of placenta previa were identified (0.33%). After controlling for potential confounders, neonatal complications significantly associated with placenta previa included major congenital anomalies (odds ratio [OR] 2.48), respiratory distress syndrome (OR 4.94), and anemia (OR 2.65). The perinatal mortality rate associated with placenta previa was 2.30% (compared with 0.78% in controls) and was explained by gestational age at delivery, occurrence of congenital anomalies, and maternal age. Although there was a higher rate of preterm births in the placenta previa group (46.56% versus 7.27%), there was no difference in birth weights between groups after controlling for gestational age at delivery. Conclusion: Neonatal complications of placenta previa included preterm birth, congenital anomalies, respiratory distress syndrome, and anemia. There was no increased occurrence of fetal growth restriction.

Comparison of umbilical Doppler velocimetry, nonstress testing, and biophysical profile in pregnancies complicated by diabetes.

The purpose of this study was to determine which test is best for predicting adverse outcomes in pregnancies complicated by diabetes: the nonstress test, biophysical profile, or umbilical artery velocimetry. We evaluated 207 singleton pregnancies complicated by diabetes within 1 week of delivery using the afore-mentioned pregnancy surveillance tests. Adverse pregnancy outcome was defined as delivery before 37 weeks of gestation or the occurrence of fetal growth restriction, hypocalcemia, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, or fetal risk requiring cesarean delivery. The prognostic value of each of the three tests was assessed, after controlling for the mothers' White classification and third trimester glycosylated hemoglobin value. Among the 207 pregnancies, 75 (36.2%) had an adverse outcome. In pregnancies in which the umbilical artery systolic to diastolic ratio was > or = 3.0, the relative risk of adverse outcome was 2.6 (95% confidence interval: 1.9-3.5, P < 0.001). For those with a biophysical profile < or = 6 the relative risk was 1.7 (95% confidence interval: 0.9-2.9, P = 0.109). Patients with a nonreactive nonstress test had a relative risk of 1.7 (95% confidence interval: 1.2-2.5, P = 0.009). Umbilical artery Doppler velocimetry was superior to either the nonstress test or the biophysical profile in identifying the subgroup of pregnancies complicated by diabetes that resulted in an adverse outcome.