Author/Authors :
Niromanesh Shirin نويسنده , Shariat Mamak نويسنده , Shirazi Mahboobeh نويسنده Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran , RABIEI MARYAM نويسنده 1Department of Oral Medicine, Dental School, Guilan University of Medical Sciences, Rasht, Iran , Mortazavi Forough نويسنده Education Development Center, Sabzevar University of Medical Sciences, Sabzevar, IR Iran , Eftekhariyazdi Mitra نويسنده Department of Obstetrics and Gynecology, Faculty of
Medicine, Sabzevar University of Medical Sciences, Sabzevar, IR
Iran
Abstract :
Background Diabetes mellitus may accompany and complicate a
pregnancy, resulting in poor neonatal outcomes. Objectives The aim of
this study was to compare middle cerebral arterial (MCA) and umbilical
arterial (UA) Doppler assessments for the evaluation of fetal well-being
in mothers with pre-gestational or gestational diabetes mellitus.
Methods This cohort study was performed on 103 pregnant diabetic women,
admitted for prenatal care to the department of gynecology and
obstetrics of Jame Zanan hospital (Tehran, Iran) in 2015. Sampling was
performed, using the convenience method. All women underwent one or more
Doppler ultrasound examinations in the third trimester of pregnancy,
which included blood flow measurement through umbilical and middle
cerebral arteries. Women with abnormal UA or MCA Doppler test results
were subjected to labor induction or cesarean section, according to
different parameters. The outcomes included neonatal acidosis, one- and
five-min Apgar scores, hypoglycemia, hypocalcaemia, neonatal intensive
care unit (NICU) admission, gestational age at delivery, and neonatal
death. Chi-square test, t-test or Fisher’s exact test, and logistic
regression analysis were performed to analyze the data. Results Based on
the findings, poor outcomes were detected in 48 women. Nearly 17.5% and
9.7% of women had abnormal UA and MCA Doppler test results,
respectively. In total, 62% of women gave birth via cesarean section.
The UA Doppler test results were significantly related with
hypoglycemia, respiratory distress syndrome (RDS), one-min Apgar score
< 7, five-min Apgar score < 7, and NICU admission, while
the MCA Doppler results were significantly associated with RDS and
neonatal death (P < 0.05). The sensitivity of both tests ranged
between 20% and 60%. Logistic regression analysis revealed that UA
Doppler test could predict poor outcomes after fasting blood sugar
control (P = 0.028, OR = 3.6, CI: 1.15 - 11.13). Conclusions Both UA and
MCA Doppler tests were associated with some neonatal outcomes. However,
sensitivity of both UA and MCA assessments was low in the prediction of
adverse neonatal outcomes. By the comparison of these two methods, we
found that UA Doppler assessment is a better predictor of neonatal
outcomes.
