The association between fetal renal artery indices in late pregnancy and birth weight in gestational diabetes mellitus: A cohort study

Abstract

Background: Estimation of the fetal birth weight and diagnosis of small for gestational age in the fetuses of women with gestational diabetes mellitus (GDM) are currently imprecise.
 Objective: We aimed to evaluate the association between fetal renal artery Doppler indices and neonatal birth weight in women with GDM in late pregnancy.
 Materials and Methods: This cohort study recruited 246 pregnant women from Shariati Hospital in Tehran, Iran, in two GDM and healthy control groups. Participants underwent weekly Doppler ultrasounds in the late pregnancy period (37-40 wk) to determine the Doppler indices of the umbilical artery, middle cerebral, and renal arteries. Fetal growth indices including biparietal diameter, abdominal circumference, head circumference, and femur length were also recorded and compared between the two groups.
 Results: Fetal growth indices and estimated fetal weight were not significantly different between the two groups. Neonatal birth weight was significantly higher in the GDM group (p < 0.01). The GDM group had significantly higher renal artery indices (resistance index: p = 0.01, pulsatility index [PI]: p = 0.03, and systolic/diastolic ratio [S/D]: p = 0.01) compared to the control group. Also, there was an inverse linear correlation between umbilical indices and birth weight (PI: p = 0.01, S/D: p < 0.01), and between renal artery indices and birth weight (resistance index: p = 0.02, PI: p = 0.01, and S/D: p = 0.03). In the control group, only umbilical artery PI had an inverse linear correlation with birth weight (p = 0.03) and there was no correlation between renal artery indices and birth weight.
 Conclusion: Using Doppler hemodynamic indices of the renal artery in late pregnancy in women with GDM can be helpful for early detection of hypoxic fetuses, who are at risk of being small for gestational age or having intrauterine growth restriction, even when of normal weight.
 Key words: Fetus, Gestational diabetes mellitus, Infant, Middle cerebral artery, Renal artery, Doppler ultrasound, Umbilical artery.

Comparative evaluation of fetal renal artery hemodynamics in normohydramnios, idiopathic oligohydramnios and polyhydramnios in third trimester pregnancy

“…One similar study conducted showed potential correlation between RA indices and perinatal outcome [27]. Another study showed early detection of hypoxic fetuses using RA hemodynamics in patients with gestational diabetes mellitus [28]. One significant limitation of our study was the limited number of patients with polyhydramnios leading to insufficient evaluation of RA indices.…”

Ultrasonographic diagnosis of fetal hemodynamic parameters in pregnant women with diabetes mellitus in the third trimester of pregnancy

“…When pregnancy is complicated by diabetes, renal blood perfusion levels increase. When end-diastolic blood flow is blocked in RA, the S/D level enhances, which indicates the level of fetal renal blood flow, leading to the reduction of urine volume and amniotic fluid volume, then forming intrauterine hypoxia [ 24 , 25 ]. The results suggested that the RI, PI, and S/D levels of fetal UA in GDM patients were evidently enhanced.…”

Doppler Indices of the Uterine, Umbilical and Fetal Middle Cerebral Artery in Diabetic versus Non-Diabetic Pregnancy: Systematic Review and Meta-Analysis

“…The green squares represent each study individual SMD and the extending lines the 95% confidence intervals. The black diamond represents the overall estimate result [ 18 , 21 , 32 , 34 , 36 , 39 , 53 , 56 , 60 , 61 , 80 , 82 , 83 ].…”

“…The UA-RI, UtA-PI, and UtA-S/D ratio were significantly higher in diabetic in contrast to non-diabetic pregnancies (SMD = 0.40, 95%CI = 0.07-0.73, p = 0.020 (Figure 2); SMD = 1.62, 95%CI = 0.36-2.88, p = 0.010 (Figure 3), and SMD = 1.02, 95%CI = 0.02-2.03, p = 0.050 (Figure 4), respectively). [18,21,32,34,36,39,53,56,60,61,80,82,83]. [18,21,32,34,36,39,53,56,60,61,80,82,83].…”