Graupner Oliver, Rath Caroline, Lecker Linda, Ritgen Jochen, Haller Bernhard, Enzensberger Christian
Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany.
Department of Obstetrics and Gynecology, Klinikum rechts der Isar der Technischen Universität München, Munchen, Germany.
Ultrasound Int Open. 2025 Apr 29;11:a25540806. doi: 10.1055/a-2554-0806. eCollection 2025.
Little is known about the benefit and interpretation of fetomaternal Doppler sonography in GDM for the prediction of an adverse perinatal outcome (APO). The aim of this study was to examine the performance of fetomaternal Doppler for APO prediction in pregnancies with GDM at term.
This is a retrospective cohort study of singleton, non-anomalous fetuses of women with GDM, who primarily had a vaginal delivery attempt. Study inclusion also required no other major fetomaternal abnormalities that make placental dysfunction likely. Data on fetomaternal Doppler sonography including umbilical artery pulsatility index (PI), middle cerebral artery (MCA) PI, cerebroplacental ratio (CPR), mean uterine artery PI, cerebro-placental-uterine ratio (CPUR) was collected from 37+0 weeks on. Multivariate logistic regression analyses were performed using maternal characteristics, neonatal characteristics, and Doppler ultrasound parameters as independent variables with CAPO as a binary outcome.
A total of n=88 cases were included. Nulliparity (p=0.032) and CPUR (p=0.052) were independent predictors of CAPO. However, CPUR had borderline significance. All other Doppler indices were not independent predictors of CAPO. The ability of CPUR alone (AUC=0.65, 95% CI 0.51 to 0.80) to discriminate between GDM pregnancies with and without CAPO was poor.
This study shows that there is no significant clinical relationship between fetomaternal Doppler indices and CAPO among pregnancies with GDM. This raises the question regarding the extent to which fetomaternal Doppler indices, which reflect placental function, can be helpful for CAPO prediction in GDM pregnancies.
关于妊娠期糖尿病（GDM）中母胎多普勒超声检查对预测不良围产期结局（APO）的益处及解读，目前所知甚少。本研究的目的是探讨足月GDM妊娠中母胎多普勒超声检查对APO预测的效能。
这是一项对GDM孕妇单胎、无异常胎儿的回顾性队列研究，这些孕妇主要尝试经阴道分娩。纳入研究还要求不存在其他可能导致胎盘功能障碍的重大母胎异常情况。从孕37 + 0周起收集母胎多普勒超声检查数据，包括脐动脉搏动指数（PI）、大脑中动脉（MCA）PI、脑胎盘比率（CPR）、子宫动脉平均PI、脑 - 胎盘 - 子宫比率（CPUR）。以母亲特征、新生儿特征和多普勒超声参数作为自变量，以APO作为二元结局进行多因素逻辑回归分析。
共纳入n = 88例病例。初产（p = 0.032）和CPUR（p = 0.052）是APO的独立预测因素。然而，CPUR具有临界显著性。所有其他多普勒指标不是APO的独立预测因素。单独使用CPUR区分有无APO的GDM妊娠的能力较差（AUC = 0.65，95% CI 0.51至0.80）。
本研究表明，GDM妊娠中母胎多普勒指标与APO之间不存在显著的临床关系。这就提出了一个问题，即反映胎盘功能的母胎多普勒指标在多大程度上有助于GDM妊娠的APO预测。
