Moran M, Mulcahy C, Daly L, Zombori G, Downey P, McAuliffe F M
Diagnostic Imaging, School of Medicine and Medical Science, University College Dublin, Ireland.
UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.
Placenta. 2014 Aug;35(8):639-44. doi: 10.1016/j.placenta.2014.03.007. Epub 2014 Mar 27.
Management of women with pre-gestational diabetes continues to be challenging for clinicians. This study aims to determine if 3D power Doppler (3DPD) analysis of placental volume and flow, and calculation of placental calcification using a novel software method, differ between pregnancies with type 1 or type 2 diabetes and normal controls, and if there is a relationship between these ultrasound placental parameters and clinical measures in diabetics.
This was a prospective cohort study of 50 women with diabetes and 250 controls (12-40 weeks gestation). 3DPD ultrasound was used to evaluate placental volume, vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI). Placental calcification was calculated by computer analysis. Results in diabetics were compared with control values, and correlated with early pregnancy HbA1c, Doppler results and placental histology.
Placental calcification and volume increased with advancing gestation in pre-gestational diabetic placentae. Volume was also found to be significantly higher than in normal placentae. VI and VFI were significantly lower in diabetic pregnancies between 35 and 40 weeks gestation. A strong relationship was seen between a larger placental volume and both increasing umbilical artery pulsatility index and decreasing middle cerebral artery pulsatility index. FI was significantly lower in cases which had a booking HbA1c level ≥6.5%. Ultrasound assessed placental calcification was reduced with a histology finding of delayed villous maturation. No other correlation with placental histology was found.
This study shows a potential role for 3D placental evaluation, and computer analysis of calcification, in monitoring pre-gestational diabetic pregnancies.
对于临床医生而言，孕前糖尿病女性的管理仍然具有挑战性。本研究旨在确定1型或2型糖尿病孕妇与正常对照组孕妇在胎盘体积和血流的三维能量多普勒（3DPD）分析以及使用新型软件方法计算胎盘钙化方面是否存在差异，以及这些超声胎盘参数与糖尿病患者临床指标之间是否存在关联。
这是一项针对50名糖尿病孕妇和250名对照者（妊娠12 - 40周）的前瞻性队列研究。采用3DPD超声评估胎盘体积、血管化指数（VI）、血流指数（FI）和血管化 - 血流指数（VFI）。通过计算机分析计算胎盘钙化情况。将糖尿病患者的结果与对照值进行比较，并与孕早期糖化血红蛋白（HbA1c）、多普勒结果及胎盘组织学进行相关性分析。
孕前糖尿病胎盘的钙化和体积随孕周增加而增加。还发现其体积显著高于正常胎盘。在妊娠35至40周之间，糖尿病孕妇的VI和VFI显著降低。胎盘体积增大与脐动脉搏动指数增加和大脑中动脉搏动指数降低均存在密切关系。在HbA1c初诊水平≥6.5%的病例中，FI显著降低。超声评估的胎盘钙化在组织学显示绒毛成熟延迟时减少。未发现与胎盘组织学的其他相关性。
本研究表明三维胎盘评估及钙化的计算机分析在监测孕前糖尿病妊娠方面具有潜在作用。
