Predictive Value of Uterine Doppler Waveform during Pregnancies Complicated by Diabetes

Abstract

Diabetes, whether or not it is insulin deficient, is frequently associated with vascular complications during pregnancy. It is accepted nowadays that the uterine artery velocity waveform is predictive concerning pregnancy-induced hypertension (PIH) and its complications. It thus seemed interesting to analyse the predictivity of vascular complications of diabetes by using uterine artery velocity waveforms. We have thus explored 37 diabetic patients [group 1: insulin-deficient diabetes (IDD), n = 10; group 2: gestational IDD, n = 6; and gestational non-IDD, n = 21). We have found vascular complications for 10 patients, divided between all 2 groups: 2 preeclampsia, 2 fetal suffering before any labour, 2 cases of intra-uterine growth retardation (including a trisomy 18) and 5 PIH. The uterine artery velocimetry measurement has been found to be pathological 5 times, and always in patients who later developed vascular complications. Among this selected population and excluding the trisomy 18, the sensitivity is of 44.5%, the specificity of 100%, the positive predictive value of 100%, and the negative predictive value of 84.3 %. If these results are confirmed, this examination could be an excellent marker of the vascular risk and thus would have its place during systematic survey of pregnancies complicated by diabetes.

How useful is uterine artery Doppler flow velocimetry in the prediction of pre‐eclampsia, intrauterine growth retardation and perinatal death? An overview

“…After independent review of the English manuscripts under masked conditions, 30 articles 6,16–44 were considered to be eligible to be included in the overview. The agreement concerning eligibility was 92% (kappa 0.85).…”

“…Two of these 6,18 were excluded from the overview when the first authors of these articles confirmed that the data had been reported elsewhere. Thus, 28 articles 16–17,19–44 were included into the overview; pre‐eclampsia was reported in 22 studies (79%) 16–17,19–20,22–25,27,28–33,38,40–42,44 , intrauterine growth retardation was reported in 24 studies (86%) 16–17,21–23,25,27–44 and eight studies (28%) 17,23,25–26,28,31,36–37 reported on perinatal death (Table 1). Of the eight articles that reported on perinatal death, the gestational age for fetal viability was defined as 24 weeks of gestation in one study 36 , 18–22 weeks of gestation in another study 17 and undefined in the remaining studies 23,25–26,28,31,37 .…”

“…Of the eight articles that reported on perinatal death, the gestational age for fetal viability was defined as 24 weeks of gestation in one study 36 , 18–22 weeks of gestation in another study 17 and undefined in the remaining studies 23,25–26,28,31,37 . Sixteen of these articles 16–17,20–21,25,27,33–37,39,41–44 provided data on low risk obstetric populations whereas twelve articles 19,22–24,26,28–32,38,40 reported on antenatal women who were considered to be at high risk of developing antenatal complications…”

First-trimester uterine artery Doppler examination in pregnancies complicated by gestational diabetes mellitus with or without pre-eclampsia

“…Previous studies on UtA Doppler examination in pregnancies complicated by GDM were mainly conducted in the second half of the pregnancy, when GDM was diagnosed. These studies suggested that UtA velocimetry was more likely to be abnormal in women with GDM who also developed placental‐related complications, such as PE and/or fetal growth restriction, compared with those who did not.…”

“…Gestational diabetes mellitus (GDM) is known to be associated with increased prevalence of PE. Doppler studies performed in the late second or third trimesters have reported that in pregnancies with GDM that also develop PE, impedance to flow in the UtAs was increased compared with pregnancies in which PE did not develop.…”