Maternal diabetes alters the development of ductus venosus shunting in the fetus

Lund, Agnethe; Ebbing, Cathrine; Rasmussen, Svein; Kiserud, Torvid; Kessler, Jörg

doi:10.1111/aogs.13363

Cited by 20 publications

(23 citation statements)

References 42 publications

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“…In a study of macrosomic fetuses without maternal diabetes, the umbilical venous perfusion [12], left portal venous flow, portal and total venous liver flow, were all increased during the second half of pregnancy [7], even when corrected for fetal weight. Similarly, in the present study, high umbilical venous flow [14], correspondingly low placental impedance [36] and increased portal blood flow permit an up-regulation of liver flow before 30 gestational weeks (Table 3, Figs 2–5). In contrast, after 30 weeks gestation, fetuses of diabetic mothers had reduced portal and total venous liver flow when normalized for fetal weight, while in non-diabetic macrosomic fetuses no restriction in venous blood flow to the liver was observed (Table 3, Fig 7).…”

Section: Discussionsupporting

confidence: 80%

“…The study protocol was approved by the Regional Committee for Medical and Health Research Ethics (REK vest 2011/2030). We have reported the development of the umbilical venous and ductus venosus flows in this population [14]. Here we present data on the development of the venous supply to the fetal liver in PGDM pregnancies.…”

Section: Methodsmentioning

confidence: 85%

“…Further, portal venous flow was calculated in 52.5%, total venous liver flow (Q liver ) in 42.5%, and the portal venous fraction of the total venous liver flow in 42.5% of the sessions. The success rate for the umbilical vein and ductus venosus measurements have been published earlier [14].…”

Section: Resultsmentioning

confidence: 99%

“…In low-risk pregnancies, the portal venous contribution to the liver increases throughout gestation, and the same pattern is observed in macrosomic non-diabetic fetuses [7]. However, although the fetal liver is larger [13] and macrosomic growth is frequent in diabetic pregnancies [4], umbilical venous flow normalized for fetal weight, is lower [13, 14].…”

Section: Introductionmentioning

confidence: 99%

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Altered development of fetal liver perfusion in pregnancies with pregestational diabetes

et al. 2019

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BackgroundPregestational diabetes is associated with fetal macrosomia, and umbilical perfusion of the fetal liver has a role in regulating fetal growth. We therefore hypothesized that pregestational diabetes alters fetal liver blood flow depending on degree of glycemic control.MethodsIn a prospective study, 49 women with pregestational diabetes underwent monthly ultrasound examinations during 24–36 gestational weeks. Blood flow was determined in the umbilical vein, ductus venosus and portal vein, and blood velocity was measured in the left portal vein, the latter reflecting the watershed between splanchnic and umbilical flow. The measurements were compared with reference values by z-score statistics, and the effect of HbA1c assessed.ResultsThe umbilical venous flow to the liver (z-score 0.36, p = 0.002), total venous liver flow (z-score 0.51, p<0.001) and left portal vein blood velocity (z-score 0.64, p<0.001), were higher in the study group. Normalized portal venous flow was lower (z-score -0.42, p = 0.002), and normalized total venous liver flow tended to be lower after 30 gestational weeks (z-score -0.54, p = 0.047) in the diabetic pregnancies compared with reference values from a low-risk population. The left portal vein blood velocity was positively, and the portal fraction of total venous liver flow negatively correlated with first trimester HbA1C.ConclusionsIn spite of increased umbilical blood distribution to the fetal liver, graded according to glycemic control, the total venous liver flow did not match third trimester fetal growth in pregnancies with pregestational diabetes, thus contributing towards increased perinatal risks and possibly altered liver function with long-term metabolic consequences.

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Section: Discussionsupporting

confidence: 80%

Section: Methodsmentioning

confidence: 85%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Altered development of fetal liver perfusion in pregnancies with pregestational diabetes

et al. 2019

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“…These mechanisms that prioritize distribution of UV flow to the liver are emphasized in fetuses of pregnant women affected by gestational diabetes, in whom a significant correlation was found between reduced shunting of the DV in utero and higher lactate concentration at birth. This greater UV flow distribution to the liver appeared to reduce the compensatory mechanisms during hypoxic challenges during late pregnancy and birth …”

Section: Experimental Physiological Evidence From Animal and Human Rementioning

confidence: 99%

The controversial role of the ductus venosus in hypoxic human fetuses

Ferrazzi

Lees

Acharya

2019

Acta Obstet Gynecol Scand

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| INTRODUC TI ONIn the last two decades, research on the ductus venosus (DV) has been the subject of large observational and interventional clinical trials, 1-3 as well as many clinical studies focused on human pregnancies affected by fetal growth restriction. 4-7 These studies were based on consistent observations made in animal experiments [8][9][10] and human pregnancies. 5,11,12 The DV is a critical crossroads for the umbilical vein flow to perform complex tasks during gestation to balance fetal brain and body growth. 13 It plays an important role in circulatory adaptation to hypoxia in early severe fetal growth restriction (FGR), but the mechanisms remain controversial. 5,11,12 Both hypoxemia-associated dilation of isthmic region of the DV as well as cardiac dysfunction associated with increased afterload have been implicated as the determinants of abnormal DV Doppler velocity waveforms. Here we consider the evidence underpinning assumptions on the DV waveform in relation to its clinical applicability. | EMB RYOLOGY AND ANATOMYAt 6 weeks of gestation, the embryological development of hepatic circulation endows the human embryo, as well as most other mammals, with a peculiar venous channel, the ductus venosus, that originates at the hepatic venous crossroad (Figure 1). 14 The DV resembles AbstractThe ductus venosus plays a critical role in circulatory adaptation to hypoxia in fetal growth restriction but the mechanisms still remain controversial. Increased shunting of blood through the ductus venosus under hypoxic conditions has been shown in animal and human studies. The hemodynamic laws governing the accelerated flow in

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Doppler Sonography in Pregnancies Complicated by Pre-gestational Diabetes Mellitus

Vilchez

Maulik

2023

Doppler Ultrasound in Obstetrics and Gynecology

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Maternal diabetes alters the development of ductus venosus shunting in the fetus

Cited by 20 publications

References 42 publications

Altered development of fetal liver perfusion in pregnancies with pregestational diabetes

Altered development of fetal liver perfusion in pregnancies with pregestational diabetes

The controversial role of the ductus venosus in hypoxic human fetuses

Doppler Sonography in Pregnancies Complicated by Pre-gestational Diabetes Mellitus

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