Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Medizinische Klinik und Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany.
Ultrasound Obstet Gynecol. 2018 Sep;52(3):347-351. doi: 10.1002/uog.18823. Epub 2018 Jul 26.
Maternal gestational diabetes mellitus (GDM) is known to influence fetal physiology. Phase-rectified signal averaging (PRSA) is an innovative signal-processing technique that can be used to investigate fetal heart signals. The PRSA-calculated variables average acceleration capacity (AAC) and average deceleration capacity (ADC) are established indices of autonomic nervous system (ANS) function. The aim of this study was to evaluate the influence of GDM on the fetal cardiovascular and ANS function in human pregnancy using PRSA.
This was a prospective clinical case-control study of 58 mothers with diagnosed GDM and 58 gestational-age matched healthy controls in the third trimester of pregnancy. Fetal cardiotocography (CTG) recordings were performed in all cases at entry to the study, and a follow-up recording was performed in 19 GDM cases close to delivery. The AAC and ADC indices were calculated by the PRSA method and fetal heart rate short-term variation (STV) by CTG software according to Dawes-Redman criteria.
Mean gestational age of both groups at study entry was 35.7 weeks. There was a significant difference in mean AAC (1.97 ± 0.33 bpm vs 2.42 ± 0.57 bpm; P < 0.001) and ADC (1.94 ± 0.32 bpm vs 2.28 ± 0.46 bpm; P < 0.001) between controls and fetuses of diabetic mothers. This difference could not be demonstrated using standard computerized fetal CTG analysis of STV (controls, 10.8 ± 3.0 ms vs GDM group, 11.3 ± 2.5 ms; P = 0.32). Longitudinal fetal heart rate measurements in a subgroup of women with diabetes were not significantly different from those at study entry.
Our findings show increased ANS activity in fetuses of diabetic mothers in late gestation. Analysis of human fetal cardiovascular and ANS function by PRSA may offer improved surveillance over conventional techniques linking GDM pregnancy to future cardiovascular dysfunction in the offspring. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
母体妊娠糖尿病（GDM）已知会影响胎儿的生理机能。相位校正信号平均（PRSA）是一种创新的信号处理技术，可用于研究胎儿心脏信号。PRSA 计算得出的平均加速度能力（AAC）和平均减速能力（ADC）是自主神经系统（ANS）功能的既定指标。本研究旨在使用 PRSA 评估 GDM 对人类妊娠中胎儿心血管和 ANS 功能的影响。
这是一项前瞻性的病例对照研究，共纳入 58 例确诊为 GDM 的母亲和 58 例妊娠晚期年龄匹配的健康对照组。所有病例在研究入组时均进行胎儿胎心监护（CTG）记录，19 例接近分娩的 GDM 病例进行了随访记录。AAC 和 ADC 指数通过 PRSA 方法计算，胎儿心率短期变异（STV）通过 CTG 软件根据 Dawes-Redman 标准计算。
两组在研究入组时的平均孕龄均为 35.7 周。与对照组相比，糖尿病母亲胎儿的平均 AAC（1.97±0.33bpm 与 2.42±0.57bpm；P<0.001）和 ADC（1.94±0.32bpm 与 2.28±0.46bpm；P<0.001）均有显著差异。使用标准计算机化胎儿 CTG 分析 STV（对照组 10.8±3.0ms 与 GDM 组 11.3±2.5ms；P=0.32）无法显示这种差异。糖尿病组中一组女性的胎儿心率纵向测量值与入组时无显著差异。
我们的研究结果表明，晚期妊娠糖尿病母亲的胎儿自主神经活动增加。通过 PRSA 对人类胎儿心血管和 ANS 功能进行分析，可能比传统技术更能监测 GDM 妊娠与后代未来心血管功能障碍之间的关系。版权所有©2017 ISUOG。由 John Wiley & Sons Ltd 出版。
