妊娠晚期胎儿肾动脉指数与妊娠期糖尿病出生体重之间的关联：一项队列研究。
The association between fetal renal artery indices in late pregnancy and birth weight in gestational diabetes mellitus: A cohort study.
作者信息
Sadat Jamal Ashraf, Naemi Mahsa, Eslamian Laleh, Marsoosi Vajiheh, Moshfeghi Maryam, Nurzadeh Maryam, Geran Taraneh, Ghaemi Marjan, Zanbagh Leila
机构信息
Fetomaternal Department, Shariati Hospital Tehran University of Medical Sciences, Tehran, Iran.
Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute, Tehran, Iran.
出版信息
Int J Reprod Biomed. 2022 Feb 18;20(1):21-28. doi: 10.18502/ijrm.v20i1.10405. eCollection 2022 Jan.
BACKGROUND
Estimation of the fetal birth weight and diagnosis of small for gestational age in the fetuses of women with gestational diabetes mellitus (GDM) are currently imprecise.
OBJECTIVE
We aimed to evaluate the association between fetal renal artery Doppler indices and neonatal birth weight in women with GDM in late pregnancy.
MATERIALS AND METHODS
This cohort study recruited 246 pregnant women from Shariati Hospital in Tehran, Iran, in two GDM and healthy control groups. Participants underwent weekly Doppler ultrasounds in the late pregnancy period (37-40 wk) to determine the Doppler indices of the umbilical artery, middle cerebral, and renal arteries. Fetal growth indices including biparietal diameter, abdominal circumference, head circumference, and femur length were also recorded and compared between the two groups.
RESULTS
Fetal growth indices and estimated fetal weight were not significantly different between the two groups. Neonatal birth weight was significantly higher in the GDM group (p 0.01). The GDM group had significantly higher renal artery indices (resistance index: p = 0.01, pulsatility index [PI]: p = 0.03, and systolic/diastolic ratio [S/D]: p = 0.01) compared to the control group. Also, there was an inverse linear correlation between umbilical indices and birth weight (PI: p = 0.01, S/D: p 0.01), and between renal artery indices and birth weight (resistance index: p = 0.02, PI: p = 0.01, and S/D: p = 0.03). In the control group, only umbilical artery PI had an inverse linear correlation with birth weight (p = 0.03) and there was no correlation between renal artery indices and birth weight.
CONCLUSION
Using Doppler hemodynamic indices of the renal artery in late pregnancy in women with GDM can be helpful for early detection of hypoxic fetuses, who are at risk of being small for gestational age or having intrauterine growth restriction, even when of normal weight.
背景
目前，妊娠期糖尿病（GDM）孕妇胎儿出生体重的估计以及小于胎龄儿的诊断并不精确。
目的
我们旨在评估妊娠晚期GDM孕妇胎儿肾动脉多普勒指数与新生儿出生体重之间的关联。
材料与方法
这项队列研究从伊朗德黑兰的沙里亚蒂医院招募了246名孕妇，分为GDM组和健康对照组。参与者在妊娠晚期（37 - 40周）每周接受一次多普勒超声检查，以确定脐动脉、大脑中动脉和肾动脉的多普勒指数。还记录并比较了两组胎儿的生长指标，包括双顶径、腹围、头围和股骨长度。
结果
两组之间胎儿生长指标和估计胎儿体重无显著差异。GDM组新生儿出生体重显著更高（p < 0.01）。与对照组相比，GDM组肾动脉指数显著更高（阻力指数：p = 0.01，搏动指数[PI]：p = 0.03，收缩/舒张比[S/D]：p = 0.01）。此外，脐动脉指数与出生体重之间存在负线性相关（PI：p = 0.01，S/D：p < 0.01），肾动脉指数与出生体重之间也存在负线性相关（阻力指数：p = 0.02，PI：p = 0.01，S/D：p = 0.03）。在对照组中，只有脐动脉PI与出生体重存在负线性相关（p = 0.03），肾动脉指数与出生体重之间无相关性。
结论
对于妊娠晚期的GDM孕妇，使用肾动脉多普勒血流动力学指数有助于早期发现即使体重正常但有小于胎龄或宫内生长受限风险的缺氧胎儿。
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