From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.).
Radiographics. 2022 Jan-Feb;42(1):302-319. doi: 10.1148/rg.210164. Epub 2021 Dec 2.
Diabetes mellitus, whether preexisting or gestational, poses significant risk to both the mother and the developing fetus. A myriad of potential fetal complications in the setting of diabetic pregnancies include, among others, congenital anomalies, delayed fetal lung maturity, macrosomia, and increased perinatal morbidity and mortality. Congenital anomalies most commonly involve the nervous, cardiovascular, genitourinary, and musculoskeletal systems. Delayed fetal lung maturity, probably secondary to hyperglycemia suppressing surfactant secretion, is a major determinant of perinatal morbidity and mortality. Besides the potential complications encountered during cesarean delivery in macrosomic fetuses, vaginal delivery is also associated with increased risks of shoulder dystocia, clavicular and humeral fractures, and brachial plexus palsy. Maternal complications are related to the increased risk of hypertensive diseases of pregnancy and associated preeclampsia and emolysis, levated iver function, and ow latelets (HELLP) syndrome, as well as complications encountered at the time of delivery secondary to fetal macrosomia and cesarean delivery. Additional conditions encountered in the setting of maternal diabetes include polyhydramnios, placental thickening, and two-vessel umbilical cord, each of which is associated with adverse fetal and maternal outcomes including fetal growth restriction, preterm labor, placental abruption, and premature rupture of membranes. Imaging plays a vital role in the evaluation of the mother and the fetus and can provide invaluable information that can be used by maternal fetal medicine to manage this patient population effectively. The authors review the pathophysiologic alterations induced by diabetes in pregnancy, discuss the imaging spectrum of diabetic embryopathy, and provide a detailed review of potential associated maternal complications. RSNA, 2021.
糖尿病，无论是原发的还是妊娠型的，都会给母亲和发育中的胎儿带来重大风险。在糖尿病孕妇中，胎儿可能会出现多种潜在并发症，包括先天畸形、胎儿肺成熟延迟、巨大儿，以及围产儿发病率和死亡率增加等。先天畸形最常涉及神经系统、心血管系统、泌尿生殖系统和肌肉骨骼系统。胎儿肺成熟延迟可能是由于高血糖抑制表面活性物质分泌所致，这是围产儿发病率和死亡率的主要决定因素。除了巨大儿剖宫产时可能遇到的潜在并发症外，阴道分娩还与肩难产、锁骨和肱骨骨折以及臂丛神经麻痹的风险增加相关。母体并发症与妊娠高血压疾病及相关子痫前期和溶血性贫血、肝酶升高和血小板减少（HELLP）综合征的风险增加有关，还与胎儿巨大儿和剖宫产引起的分娩时并发症有关。在母体糖尿病的情况下还会出现其他情况，包括羊水过多、胎盘增厚和双脐带动脉，这些情况都与不良的胎儿和母体结局相关，包括胎儿生长受限、早产、胎盘早剥和胎膜早破。影像学在评估母亲和胎儿方面发挥着重要作用，可以提供宝贵的信息，有助于母胎医学有效管理这类患者人群。作者回顾了妊娠糖尿病引起的病理生理改变，讨论了糖尿病胚胎病的影像学表现，并详细回顾了潜在的相关母体并发症。RSNA，2021 年。
