الفهرس 
GESTATIONAL DIABETES MELLITUSOnly 14 pages are availabe for public view
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Abstract
Gestational diabetes mellitus accounts for 90% of cases
of diabetes mellitus in pregnancy. The most common and
significant neonatal complication clearly associated with GDM
is macrosomia.
About 15–45% of babies born to diabetic mothers can
have macrosomia, which is a three fold higher rate when
compared to normoglycemic controls.
The accuracy of fetal weight estimation using ultrasound
carries a margin of error of 5-10% for fetuses that are normal or
small in size. The percentage of inaccuracy increases
significantly in very large fetuses such that any EFW calculated
to be greater than 3.8 kg should be interpreted with great
caution.
Also birth weight is often inaccurately estimated using
ultrasound in gestational diabetic mothers in late pregnancy
because of fetal asymmetric growth characteristics.
Many previous studies conducted that fetal
hemodynamic indices in late pregnancy might be helpful for
estimating newborn birth weight in women with GDM.
Thus current study aimed to find another way for fetal
weight estimation using fetal hemodynamic indices (S/D, PI,
and RI) of the UA, MCA, and RA. The study investigated the
correlation between fetal hemodynamic indices and neonatal
birth weight in both diabetic and normal control groups.This prospective correlational study was conducted at
Ain Shams Maternity Hospital during the period from
September 2017 till April 2018.
The Study included 360 pregnant women with singleton
gestation presented between 38-40 weeks gestation divided into
two groups:
group I [Study Group]:
Including 180 pregnant controlled diabetic women.
group II [Control Group]:
Including 180 healthy pregnant women with no history of DM.
All subjects undergone complete history taking including
personal history, menstrual history, obstetric history, present
history and history of past illness.
All subjects undergone examination including general,
abdominal and vaginal examination.
All subjects undergone investigation for fasting blood
glucose level, two hour post prandial blood glucose level and
Hb A1C was done for diabetic group.
Transabdominal 2D ultrasound was done for all subjects
to detect fetal heart rate, fetal presentation, amniotic fluid index
and placental site.The BPD, HC, AC and the FL were measured. Fetal
weight was automatically calculated using Hadlock’s formula
by the ultrasonic instrument.
Followed by Doppler Ultrasound assessment for all
subjects to measure hemodynamic parameters of the UA,
MCA, and RA.
The arterial hemodynamic parameters included the S/D,
RI, and PI of the UA, MCA and RA.
All women were followed up to assess mode of delivery,
fetal birth weight and need for neonatal ICU admission.
The results showed that the mean estimated fetal weight
(EFW), using Hadlock’s formula, was 3552.03± 250.22g in
group I and 3065.29± 230.46g in group II. The mean birth
weight in neonates of the included women was 3616.67±
202.08g in group I and 3169.44± 154.30g in group II. Thus a
highly statistically significant difference was found between
group I and group II as regard birth weight and EFW where
birth weight and EFW were higher in the GDM group (P<0.01).
There was a highly statistically significant difference
between group I and group II as regard BPD, HC, AC and FL
(P<0.01) showing that the BPD, HC, AC and FL were higher in
diabetic group.Among all included women, there was a highly
statistically insignificant difference between group I and Group
II as regard all ultrasound indices including UA_S/D, UA_RI,
UA_PI, MCA_S/D, MCA_RI, MCA_PI, RA_S/D, RA_RI and
RA_PI (P>0.05).
Among all included women, there was a highly
statistically significant positive correlation between birth
weight and fetal growth indices (BPD, HC, AC and FL) in
group I and group II (P<0.01).
As regard correlation between birth weight and
ultrasound indices results showed that in group I there was a
highly statistically significant negative correlation between
birth weight and the following ultrasound indices: (UA_RI,
UA_S/D, UA_PI MCA_RI and MCA_PI) and that there was a
statistically significant positive correlation between birth
weight & RA_RI (P<0.01).
As regard group II there was a highly statistically
significant negative correlation between birth weight and the
following ultrasound indices: (UA_S/D, UA_RI, UA_PI and
MCA_PI) (P<0.01). But no correlation was found between
birthweight and any of reanl artery indices.
Thus fetal hemodynamic indices in late pregnancy might
be helpful for estimating newborn birth weight in women with
GDM.