Role of Ductus Venosus Doppler Sonography for the Prediction of Perinatal Outcome in Term Pregnancies Complicated by Gestational Diabetes Mellitus

Abstract

Purpose Ductus venosus (DV) Doppler velocimetry reflects fetal cardiac function. Gestational diabetes mellitus (GDM) is assumed to impair cardiac function due to fetal hyperglycemia. The purpose of this study was to assess the ability of DV Doppler to predict an adverse perinatal outcome (APO) in term pregnancies with GDM.

Methods This is a retrospective cohort study including GDM pregnancies of singleton, non-anomalous fetuses without any signs of placental dysfunction. All GDM women who primarily had a vaginal delivery attempt and in which DV Doppler was examined from 37+0 weeks on were included. Receiver operating characteristic curve (ROC) analyses were performed to assess the predictive value of DV pulsatility index (DV-PI) regarding a composite APO (CAPO). Furthermore, a subgroup analysis was performed regarding the presence of a large-for-gestational-age (LGA) newborn.

Results A total of n=89 cases were included. Overall, CAPO occurred in 26 out of 89 cases (29.2%). All DV Doppler examinations showed a positive A wave. DV-PI was>95th percentile in 8 out of 89 cases (9%). Overall, ROC analysis showed no significant association of DV-PI with CAPO (AUC=0.523, p=0.735). However, regarding individual APO parameters, ROC analysis showed a significant association of DV-PI with 5th-min AGPAR (AUC=0.960, p=0.027), which was not confirmed after exclusion of LGA cases.

Conclusion In GDM pregnancies at term, DV Doppler sonography seems to have no benefit for APO prediction.

Zusammenfassung

Ziel Der Ductus venosus (DV) Doppler spiegelt die fetale kardiale Funktion wider. Beim Gestationsdiabetes mellitus (GDM) kann die kardiale Funktion aufgrund einer fetalen Hyperglykämie beeinträchtigt sein. Das Ziel dieser Studie besteht darin, den prädiktiven Wert des DV-Doppler zur Vorhersage eines adversen perinatalen Outcomes (APO) bei GDM-Schwangerschaften in Terminnähe zu untersuchen. Material und

Methodik In diese retrospektive Kohortenstudie wurden GDM-Einlingsschwangerschaften ohne fetale Anomalien oder plazentare Dysfunktion eingeschlossen, bei denen ab 37+0 SSW eine DV-Doppler-Untersuchung durchgeführt und ein vaginaler Entbindungsversuch unternommen wurde. Es wurden Receiver Operating Characteristic Curves (ROC) eingesetzt, um den prädiktiven Wert des DV Pulsatilitätsindex (PI) bezogen auf ein zusammengesetztes APO (CAPO) zu bewerten. Eine Subgruppenanalyse erfolgte bezüglich des Vorhandenseins eines large-for-gestational-age (LGA) Neugeborenen.

Ergebnisse Insgesamt wurden n=89 Fälle eingeschlossen. Alle DV-Doppler-Untersuchungen zeigten eine positive a-Welle. Der DV-PI war in 8 von 89 Fällen (9%)>95. Perzentile. Die ROC- Analysen zeigten keinen signifikanten Zusammenhang von DV-PI mit CAPO (AUC=0,523, p=0,735). Bezüglich einzelner APO-Parameter zeigte die ROC-Analyse jedoch einen signifikanten Zusammenhang zwischen DV-PI und 5-Min-Apgar (AUC=0,960, p=0,027), der nach Ausschluss von LGA-Fällen nicht bestätigt wurde.

Schlussfolgerung Bei GDM-Schwangerschaften in Terminnähe scheint die DV-Doppler-Sonographie keinen Nutzen für die APO-Vorhersage zu haben.

Keywords

gestational diabetes mellitus - ductus venosus - doppler sonography - adverse perinatal outcome

Schlüsselwörter

Gestationsdiabetes mellitus - Ductus venosus - Dopplersonographie - adverses perinatales Outcome

Publication History

Received: 25 September 2023

Accepted after revision: 04 February 2024

Article published online:
22 March 2024

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