Use of umbilical artery Doppler velocimetry in the monitoring of pregnancy in women with pre‐existing diabetes

Wong, Shiu F.; Chan, Felicia; Cincotta, Robert; McIntyre, David; Stone, M L

doi:10.1046/j.0004-8666.2003.00094.x

Cited by 41 publications

(34 citation statements)

References 12 publications

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“…As such there is currently no consensus over the definition of IUGR; however, commonly used definitions include estimated fetal weight below the 10th, 5th, or 3rd percentile for gestational age, consistent with our methods (17). The utility of umbilical artery Doppler has been demonstrated in pregnancy complicated by IUGR and preeclampsia; however, it has not been validated in a diabetic population (34)(35)(36)(37). This may explain why we found no difference in the S/D ratio in our study, whereas Giles et al (20) have previously shown that a high S/D ratio correlates with significant reduction in small artery vessel count on placental histopathology.…”

Section: Discussionmentioning

confidence: 99%

Falling Insulin Requirements Are Associated With Adverse Obstetric Outcomes in Women With Preexisting Diabetes

2014

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OBJECTIVETo investigate the clinical significance of falling insulin requirements in women with preexisting or overt diabetes in pregnancy. RESEARCH DESIGN AND METHODSA retrospective review of 139 pregnancies was conducted in women, with preexisting diabetes, delivering between January 2010 and January 2013. Women with falling insulin requirements of 15% or more from the peak total daily dose in late pregnancy were considered case subjects (n = 35). The primary outcome consisted of a composite of clinical markers of placental dysfunction, including preeclampsia, small for gestational age (SGA, £5th percentile for gestational age), stillbirth (>20 weeks), and premature delivery (£30 weeks). RESULTSA total of 25.2% of women had >15% fall in insulin requirements with nulliparity as the only predictor at baseline (odds ratio [OR] 2.5 [95% CI 1.1-5.7], P = 0.03). Falling insulin requirements were associated with an increased risk of preeclampsia (OR 3.5 [1.1-10.7], P < 0.05) and the composite of clinical markers of placental dysfunction (4.4 [1.73-11.26], P = 0.002). Although falling insulin requirements were associated with higher rates of SGA (3.4 [1.0-11.3], P = 0.048), they were not associated with other adverse neonatal outcomes. However, there was a higher incidence of neonatal intensive care unit admission (15.5 [3.1-77.6], P = 0.001) and earlier delivery in this group (median 37.7 weeks ], P = 0.014). CONCLUSIONSFalling insulin requirements, in women with preexisting diabetes, are associated with an increased risk of complications related to placental dysfunction. Further prospective studies are needed to guide clinical management.Falling insulin requirements in late pregnancy are thought to signify feto-placental compromise, often prompting admission to hospital for maternal and fetal monitoring as well as emergency delivery in some cases (1). Most women with preexisting diabetes experience an increase in insulin requirements during the second half of pregnancy (2) to maintain euglycemia, in light of a 50-70% rise in insulin resistance (3). Because insulin resistance is driven by placental-mediated hormone production, including human placental lactogen (hPL), cortisol, and progesterone

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Section: Discussionmentioning

confidence: 99%

Falling Insulin Requirements Are Associated With Adverse Obstetric Outcomes in Women With Preexisting Diabetes

2014

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“…Conflicting reports on the value of PI in diabetic pregnancy may well stem from the fact that high and low risk populations are studied combined including gestational diabetes [2,5]. Wong et al concluded that type 1 diabetes is the only group with sufficient risk to warrant repeat investigation [6]. Mean glycemic values are significantly higher in diabetic women with pathologic PIs suggesting that hyperglycemia causes increase in placental resistance [4].…”

Section: Discussionmentioning

confidence: 99%

“…Wong et al find that if the umbilical measurements are carried out within 2 weeks of delivery, they are significantly associated with adverse perinatal outcome. In their study 80% of pregnancies with elevated umbilical PI have adverse outcome if the PI is measured within one week before delivery [6]. We had an even narrower interval between measurements and delivery (≤ 3 days) because of the timed delivery in most cases; 50% were induced and 50% delivered by cesarean.…”

Section: Discussionmentioning

confidence: 99%

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Umbilical Pulsatility Index is Associated with Fetalacidemia in Type 1 Diabetic Pregnancies

Rasmussen¹

2013

Gynecol Obstet

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This study was designed to test umbilical indices and establish a reference in pregnancies complicated by type 1 diabetes mellitus, and to correlate the pulsatility index to other clinical parameters.We included consecutively 129 type 1 diabetic pregnant women during a five year period. During their pregnancy HbA1c, electrolytes, uric acid, diurnal blood pressure was measured and 24-h urine collected for measurement of albumin excretion rate. Umbilical blood flow measurements were done routinely from week 32 and started before week 32 on indication. Resistance and pulsatility indices and systolic-diastolic ratio were measured.The weekly repeated measurements from gestational 32 to 34 had the lowest levels of pulsatility index in the normoalbuminuria group and highest in the micro-and macroalbuminuria group combined (p = 0.01).We found an association of pulsatility index and umbilical pH (p<0.006). Even when adjusted for birth weight ratio, blood pressure, albumin excretion rate and HbA1c the association of pulsatility index and umbilical pH persisted (r = -0.30, p = 0.016). Glycemia expressed as HbA1c was associated with pulsatility index at nearly all measurements from week 31 to 35 and associated with albumin excretion rate.We were not able to predict adverse feto-maternal outcome in our pregnancies using umbilical indices. The correlation of pulsatility index and HbA1c underlines the importance of glycemic status during pregnancy. Albumin excretion rate affects the level of the umbilical pulsatility index.

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“…Only 30% of women with adverse perinatal outcome had abnormal umbilical artery Doppler measurements. The authors thus concluded that the performance of umbilical artery Doppler was not satisfactory even in this group of high risk women with pre-existing diabetes, and that it was not a good predictor of adverse perinatal outcome (Wong et al, 2003). To investigate whether complications were higher in diabetic pregnancies with cardiac maladaptation, fetal, uteroplacental and echocardiographic examinations were compared in the second and third trimester between diabetic and healthy pregnant women.…”

Section: Fetal Umbilical Artery Dopplermentioning

confidence: 99%

Applications of Doppler Studies for Fetal Surveillance in Diabetic Pregnancies

To¹

2011

Gestational Diabetes

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Use of umbilical artery Doppler velocimetry in the monitoring of pregnancy in women with pre‐existing diabetes

Abstract: Umbilical artery Doppler velocimetry is not a good predictor of adverse perinatal outcomes in diabetic pregnancies.

Cited by 41 publications

References 12 publications

Falling Insulin Requirements Are Associated With Adverse Obstetric Outcomes in Women With Preexisting Diabetes

Falling Insulin Requirements Are Associated With Adverse Obstetric Outcomes in Women With Preexisting Diabetes

Umbilical Pulsatility Index is Associated with Fetalacidemia in Type 1 Diabetic Pregnancies

Applications of Doppler Studies for Fetal Surveillance in Diabetic Pregnancies

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