Comparison of Umbilical Arterial Doppler and Middle Cerebral Arterial Doppler Assessments of Fetal Well-being in Mothers with Diabetes Mellitus: A Prospective Study

摘要

Background: Diabetes mellitus may accompany and complicate a pregnancy, resulting in poor neonatal outcomes. Objectives: The aim of this study was to compare middle cerebral arterial (MCA) and umbilical arterial (UA) Doppler assessments for the evaluation of fetal well-being in mothers with pre-gestational or gestational diabetes mellitus. Methods: This cohort study was performed on 103 pregnant diabetic women, admitted for prenatal care to the department of gynecology and obstetrics of Jame Zanan hospital (Tehran, Iran) in 2015. Sampling was performed, using the convenience method. All women underwent one or more Doppler ultrasound examinations in the third trimester of pregnancy, which included blood flow measurement through umbilical and middle cerebral arteries. Women with abnormal UA or MCA Doppler test results were subjected to labor induction or cesarean section, according to different parameters. The outcomes included neonatal acidosis, one- and five-min Apgar scores, hypoglycemia, hypocalcaemia, neonatal intensive care unit (NICU) admission, gestational age at delivery, and neonatal death. Chi-square test, t-test or Fisher’s exact test, and logistic regression analysis were performed to analyze the data. Results: Based on the findings, poor outcomes were detected in 48 women. Nearly 17.5% and 9.7% of women had abnormal UA and MCA Doppler test results, respectively. In total, 62% of women gave birth via cesarean section. The UA Doppler test results were significantly related with hypoglycemia, respiratory distress syndrome (RDS), one-min Apgar score < 7, five-min Apgar score < 7, and NICU admission, while the MCA Doppler results were significantly associated with RDS and neonatal death (P < 0.05). The sensitivity of both tests ranged between 20% and 60%. Logistic regression analysis revealed that UA Doppler test could predict poor outcomes after fasting blood sugar control (P = 0.028, OR = 3.6, CI: 1.15 - 11.13).