Cardiac Doppler in poorly controlled gestational diabetics and its link to markers of intra-uterine hypoxia and adverse outcome

Bhorat, Ismail; Foolchand, Serantha; Reddy, Tarylee

doi:10.1080/01443615.2019.1710480

Cited by 10 publications

(27 citation statements)

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“…All control births had a normal outcome. This was corroborated in a follow up study investigating 44 poorly controlled gestational diabetics [7]. Adverse outcomes in this study were observed in 20 out of the 44 cases in the diabetic group, which corresponded to an adverse outcome rate of 45% with a similar correlation between increasing MPI values and adverse outcome.…”

Section: Resultssupporting

confidence: 85%

“…We also showed that even in milder forms of gestational diabetes there is a percentage of patients whose fetuses are sensitive to the impaired glucose tolerance and these pregnancies can behave adversely despite the clinical label of mild disease resulting in a higher than an expected rate of adverse outcome in the gestational impaired glucose tolerance (GIGT) group of 25% [8] as well as in the wellcontrolled gestational diabetic group with an adverse outcome rate of 22% [9]. Macrosomia and polyhydramnios were also noted to be associated with a signi cantly higher risk for adverse outcome in these studies [6,7,8,9].…”

Section: Resultsmentioning

confidence: 71%

“…In a series of prospective studies [6,7,8,9] we identi ed four parameters that could potentially be used in a scoring system to risk categorise gestational diabetics in terms of fetal outcome and serve as a guide to clinicians managing gestational diabetics to optimize timing of delivery. Our score is based on the myocardial performance index (MPI), E/A ratio (marker of diastolic dysfunction), increasing fetal weight (macrosomia) and increased amniotic uid index (AFI).…”

Section: Discussionmentioning

confidence: 99%

“…(re ecting evidence of tissue hypoxia) in worsening cardiac function [7], it is reasonable to hypothesise that fetal cardiac dysfunction appears to predict abnormal metabolic mileus (and possible metabolic shifts) in diabetic pregnancies and that direct myocardial depression from the "hypoxia" leads to global cardiac dysfunction as re ected in the increased MPI. The concept of a "hypoxic" state in gestational diabetes is based on the fact that hyperinsulinaemia results in an increased metabolic rate which results in increased glucose oxidation and oxygen consumption but the capacity for oxidative metabolism is reduced in fetuses due to low pyruvate dehydrogenase activity and the risk for anaerobic metabolism increases irrespective of the prevailing po2 in the fetal circulation, thus increasing the risk for fetal acidosis.…”

Section: ------------------------------------------------------------mentioning

confidence: 99%

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A Proposed Fetal Risk Scoring System for Gestational Diabetes to assist in optimizing Timing of Delivery

Bhorat¹,

Reddy²

2021

Preprint

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Background: Gestational diabetes is characterized by three main factors: macrosomia, increased metabolic rate and large vascular cross sections. A critical and crucial finding in diabetic pregnancies is that significant acidaemia and hyperlacticemia can occur in fetuses in the absence of hypoxaemia. The increased metabolic rate results in significant increases in oxidative metabolism but this capacity is reduced in fetuses due to low pyruvate dehydrogenase activity increasing the risk for acidosis. This pathophysiology is not recognized by standard monitoring models which revolves around placental insufficiency which is in fact not the problem in a gestational diabetic pregnancy. A proposed risk scoring system has been developed based on our previous studies to risk categorise gestational diabetics in terms of fetal outcome.Methods: The diabetic cases from four case-control studies were combined to form a total sample of 159 cases for validation of the risk scoring system. Univariate logistic regression was used to assess the effect of individual risk factors with proposed cutoffs on adverse pregnancy outcome. The diagnostic accuracy of the total summative score, was assessed by computing the area under the ROC curve.Results: Four potential parameters were identified to risk- categorise fetuses in a gestational diabetic pregnancy ie the myocardial performance index (MPI), E/A ratio (marker of diastolic dysfunction), increasing fetal weight (macrosomia) and increased amniotic fluid index (AFI). The total score, obtained by summation of the composite scores for parameters ranged from 0 to 11. The total score performed as an excellent predictor of adverse outcome, evidenced by the ROC area under the curve of 0.94. A cutpoint of 6 on the score confers a sensitivity of 84.2% and specificity of 90.2% for detection of adverse outcome. Conclusion: To our knowledge this is the first Gestational Diabetic Scoring system proposed to predict an adverse outcome.

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Section: Resultssupporting

confidence: 85%

Section: Resultsmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: ------------------------------------------------------------mentioning

confidence: 99%

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A Proposed Fetal Risk Scoring System for Gestational Diabetes to assist in optimizing Timing of Delivery

Bhorat¹,

Reddy²

2021

Preprint

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“…Antepartum priming creates a vulnerability to intrapartum stresses that may be the final straw in the pathway leading to NE. Probable priming factors are antenatal and perinatal infections, [10,11] placental-mediated disease including the important condition of late-onset intrauterine growth restriction, [12][13][14] diabetes and the fetal metabolic instability that accompanies it, [15][16][17] toxic factors, maternal factors and postmaturity. [18][19][20][21][22] Placental histology can identify associated placental disorders.…”

Section: Supplementmentioning

confidence: 99%

Cerebral Palsy and Criteria Implicating Acute Intrapartum Hypoxia in Neonatal Encephalopathy – An Obstetric Perspective for the South African Setting

et al. 2021

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Causes and obstetric factors associated with timing of neonatal deaths in Soweto, South Africa

Chikandiwa,

Mahtab,

Nakwa

et al. 2024

Repro Female Child Health

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ObjectiveDescribe characteristics of women whose decedents died during the neonatal period and explore factors associated with postnatal age at time of death.MethodsAnalysis of data collected at the Child Health and Mortality Prevention Surveillance (CHAMPS) South Africa study site. CHAMPS generates cause of death data in children across nine sites in low‐ and middle‐income countries. Postnatal age at time of neonatal death was evaluated by Kaplan–Meier methods. Factors associated with time to neonatal death were evaluated using Cox proportional hazards regression models. Analyses were conducted in Stata 15.0®. p < 0.05 was considered statistically significant.ResultsThere were 225 neonatal deaths during the study period, of which 197 (87.5%) had data for mother‐neonate pairs, with 184 (81.7%) neonates having complete data. The median (IQR) maternal age at booking was 27 (23–34) years. Majority (72.3%, 142/197) of women were unmarried, unemployed (76.0%, 149/197) and were booked (85.0%, 141/166). There were 19.5% of women who had hypertensive disorders of pregnancy (HDP, 36/184) while 2.7% (5/184) had diabetes mellitus and 31.5% (58/184) were HIV positive. Most were early neonatal deaths (ENND; 79.4%, 146/184) and remainder (20.6%, 38/184) late neonatal deaths (LNND). The main underlying causes of death were prematurity (60.3%, 111/184), intrapartum hypoxia (17.4%, 32/184), neonatal sepsis (10.3%, 19/184) and congenital anomalies (9.2%, 17/184). Intrapartum hypoxia (Adjusted Hazard Ratio [aHR] = 2.01, 95% CI: 1.23–3.27, p = 0.01), assisted‐vaginal delivery compared to normal vaginal delivery (aHR = 1.96, 95% CI: 1.03–3.71, p = 0.04), preterm delivery (aHR = 1.62, 95% CI: 1.03–2, p = 0.04), Apgar score <7 at 5 min (aHR = 1.59, 95% CI: 1.01–2.31, p = 0.02) and a previous neonatal death ([aHR] = 1.33; 95% CI: 1.10–1.89, p = 0.04) were associated with earlier time to neonatal death.ConclusionIntrapartum complications were associated with earlier time to neonatal death. Improving intrapartum care can reduce neonatal deaths.

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Cardiac Doppler in poorly controlled gestational diabetics and its link to markers of intra-uterine hypoxia and adverse outcome

Cited by 10 publications

References 27 publications

A Proposed Fetal Risk Scoring System for Gestational Diabetes to assist in optimizing Timing of Delivery

A Proposed Fetal Risk Scoring System for Gestational Diabetes to assist in optimizing Timing of Delivery

Cerebral Palsy and Criteria Implicating Acute Intrapartum Hypoxia in Neonatal Encephalopathy – An Obstetric Perspective for the South African Setting

Causes and obstetric factors associated with timing of neonatal deaths in Soweto, South Africa

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