Fetal Hemodynamics and Fetal Growth Indices by Ultrasound in Late Pregnancy and Birth Weight in Gestational Diabetes Mellitus

Abstract

Background:The offspring of women with gestational diabetes mellitus (GDM) are prone to macrosomia. However, birth weight is difficult to be correctly estimated by ultrasound because of fetal asymmetric growth characteristics. This study aimed to investigate the correlations between fetal hemodynamics, fetal growth indices in late pregnancy, and birth weight in GDM.Methods:A total of 147 women with GDM and 124 normal controls (NC) were enrolled in this study. Fetal hemodynamic indices, including the systolic/diastolic ratio (S/D), resistance index (RI), pulsatility index (PI) of umbilical artery (UA), middle cerebral artery (MCA), and renal artery (RA), were collected. Fetal growth indices, including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length, were also measured by ultrasound. Birth weight, newborn gender, and maternal clinical data were collected.Results:The independent samples t-test showed that BPD, HC, and AC were larger in GDM than in NC (P < 0.05). Fetal hemodynamic indices of the UA and MCA were lower (P < 0.05), but those of the RA were higher (P < 0.001) in GDM than in NC. Birth weight was higher in GDM than in NC (P < 0.001). Pearson's correlation analysis showed that hemodynamic indices of the UA were negatively correlated with birth weight, BPD, HC, and AC in both groups (P < 0.05). MCA (S/D, PI, and RI) was negatively correlated with birth weight, HC, and AC in GDM (r = −0.164, −0.206, −0.200, −0.226, −0.189, −0.179, −0.196, −0.177, and − 0.172, respectively, P < 0.05), but there were no correlations in NC (P > 0.05). RA (S/D, PI, and RI) was positively correlated with birth weight in GDM (r = 0.168, 0.207, and 0.184, respectively, P < 0.05), but there were no correlations in NC (P > 0.05).Conclusion:Fetal hemodynamic indices in late pregnancy might be helpful for estimating newborn birth weight in women with GDM.

Colostrum and mature breast milk analysis of serum irisin and sterol regulatory element-binding proteins-1c in gestational diabetes mellitus

“…Furthermore, we report a higher birth weight as well as infant weight 6 weeks post birth for GDM mothers. The incidence of fetal macrosomia ranges between 20 and 40% in GDM positive cases [34], but the baby weight normalizes with time [35]. However, our findings suggests that the constant stress in terms of low irisin though mature breast milk was a trigger for the deranged body fat accumulation and higher body weight of these infants.…”

The accuracy of prenatal diagnosis of selective fetal growth restriction with second trimester Doppler ultrasound in monochorionic diamniotic twin pregnancies

“…The pathological mechanism of sFGR in MCDA pregnancy depended not only on the presence of abnormal placental sharing, but also on the magnitude and direction of blood flow interchange through placental anastomosis [ 27 ]. The UA is a major vascular pathway connecting fetus and placenta, supplying nutrition and oxygen for fetal growth and development [ 29 ]. If sFGR occurs in the twins, the placenta function will be damaged and blood flow resistance in the UA may increase [ 30 ].…”

Influence of blood flow on cardiac development

“…Ultrasound is possibly the most ubiquitous method for assessing hemodynamic parameters in developing embryos. It is popular for use in humans (Chang et al, 2000; Liu et al, 2016) and in mice, and while the size of the probe can be cumbersome for chick studies; it has been used both in ovo and ex ovo (Figure 4A) (Stewart et al, 1986; Hu and Clark, 1989; Lucitti et al, 2005; McQuinn et al, 2007; Oosterbaan et al, 2009). In conjunction with ultrasound structural images, pulsed-wave Doppler ultrasound enables depth-specific blood velocity measurement (Atkinson and Wells, 1977) and is the basis for color Doppler technology, which provides images of color-mapped flow fields.…”

“…High-frequency ultrasound, also known as ultrasound biomicroscopy (UBM), has been further developed to examine morphological changes in the smaller embryonic cardiovascular systems. UBM transducers have frequencies between 30 and 55 MHz, considerably higher than the 2–15 MHz used in human clinical applications (McQuinn et al, 2007; Hahurij et al, 2014; Liu et al, 2016). These high frequencies allow for up to 30 µm axial and 75 µm lateral spatial resolution (Phoon and Turnbull, 2003; McQuinn et al, 2007).…”

“…For optically accessible hearts, such as those in early chick (<5 days of incubation) (McQuinn et al, 2007), frog (Deniz et al, 2012), and zebrafish embryos, simple video microscopy can provide a wealth of information on the hemodynamic conditions within the heart. A camera mounted on an inverted microscope records the beating heart, and the resulting images are used to measure heart rate, cardiac rhythm, vessel diameters, blood velocity, heart tube shape, and/or changes in heart wall motion (Suga et al, 1973; Hou and Burggren, 1995; Kopp et al, 2005; Lucitti et al, 2005; Jamison et al, 2013; Liu et al, 2016). From these measurements and possibly in combination with pressure data, parameters such as shear stress on the endocardium, stroke volume, cardiac output, ejection fraction, systolic and diastolic area as well as inflow/outflow rates, total arterial compliance, and total vascular resistance may be calculated (Kopp et al, 2005; Lucitti et al, 2005; Deniz et al, 2012; Jamison et al, 2013; Stovall et al, 2016).…”