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Diabetes concurrent with pregnancy is a high-risk condition associated with risks for adverse pregnancy outcomes. These risks were unacceptably high and a policy of late preterm delivery induction was the rule. With the advent of improved glycemic management and the introduction of antenatal fetal testing and surveillance, the perinatal risks have dropped significantly such that a healthy pregnancy is expected.
Diabetic pregnancies have risk of developing maternal complications like hypertension, pre-eclampsia, polyhydramnios and post-partum hemorrhage and also fetal complications like intrauterine growth restriction, macrosomia, stillbirth and respiratory distress syndrome.
The delivery of a macrosomic infant has potentially severe consequences for both the newborn and the mother. Maternity care professionals continue to search for accurate methods of predicting fetal weight in an effort to ameliorate the adverse outcomes that are associated with traumatic delivery.
The clinician’s intention in anticipating macrosomia is not only to employ cut-offs of estimated fetal weight for selecting cases in which the risk of birth trauma is high enough to warrant delivery by cesarean section, but also to adapt the usual intrapartum management and to plan for induction of labour, at least in diabetic pregnancies.
The purpose of this study was to evaluate the effect of diabetes mellitus on fetal outcome and to assess the role of ultrasound in prediction of fetal complications in late pregnancy. Comparison between diabetic and non-diabetic women was done regarding ultrasonographic fetal measurements and occurrence of maternal and fetal complications.
Eighty two (82) diabetic and 156 non-diabetics pregnant women were included in this study and considered as diabetic and non-diabetic groups respectively. All patients in both group were subjected to ultrasonographic examination at 27-28 weeks and at 36-37 weeks of gestation.
Ultrasonography was used to detect fetal growth indices and consequently early prediction of abnormal fetal growth patterns (either intrauterine growth restriction or occurrence of macrosomia) was identified.
Fetal abdominal circumference, estimated fetal body weight and Wharton’s Jelly area which was an estimate of umbilical cord thickness were used as ultrasonographic parameters for prediction of macrosomia and fetal birth weight.
The color flow pattern was selected to measure hemodynamic parameters of umbilical artery. Women were followed till the time of delivery to observe maternal and neonatal outcomes. Types of delivery was registered and birth weight of the baby was measured.
Results of the present study revealed that, there was significant difference between both groups of the study regarding their age, parity. No of abortions and still birth and family history of diabetes and all these criteria were considered as risk factors for diabetic pregnancy.
There was significant difference between both groups regarding umbilical cord thickness and estimated fetal weight measurements at both ultrasonographic examinations. While fetal abdominal circumference measurements were significantly different only at 36-37 weeks and consequently these parameters were considered as sonographic predictors for fetal macrosomia.
There was significant difference between both groups regarding resistance index and systolic/diastolic of fetal umbilical artery Doppler indices.
Results of this study also revealed that incidence of macrosomia and low birth weight of neonates among diabetic women was higher than non-diabetic group.
There was significant difference between macrosomic and non-macrosomic fetuses among diabetic group regarding maternal HbA1c and consequently maternal glycated hemoglobin was considered as risk factor for development of macrosomia among diabetic women.
Regarding feto-maternal complications, results of this study revealed that incidence of intrauterine fetal death and occurrence of pre-eclampsia was higher among diabetic group especially those with pregestational diabetes mellitus.
There was significant difference between diabetic and non-diabetic group regarding type of delivery as incidence of cesarean section increased among diabetic women while vaginal delivery increased among non-diabetic group.
1- In conclusion, the results of the present study suggest the possibility of using ultrasonographic parameters (fetal abdominal circumference, estimated fetal weight and Wharton’s Jelly area which is an estimate of umbilical cord thickness) as predictors of macrosomia and neonatal birth weight among diabetic pregnant women. These parameters can be used to identify patients at risk of giving birth to macrosomic or low birth weight infants consequently tight glycemic control is particularly important in these patients.
2- Assessing these parameters could enable real time detection of abnormal fetal growth and disproportion, potentially resulting in early detection and reducing fetal morbidity.
3- Ultrasonographic evaluation in diabetic pregnancy, however, can be considered as an effective, non-invasive, easily reproducible and cost effective method for predicting fetal consequences of maternal hyperglycemia. Such pregnancies should be closely followed up for successful perinatal outcome.
4- Maternal age, parity, family history of diabetes and No. of still birth and abortions were considered as risk factors for diabetic pregnancy in this study.
5- Maternal HbA1c levels could be used to predict pregnancy outcomes, especially fetal macrosomia among diabetic women.
6- Further studies are needed to evaluate the clinical value of incorporating umbilical cord thickness as an ultrasonographic soft tissue measurement for prediction of fetal weight specially in diabetic pregnancy.
7- The importance of diabetic control before conception should be stressed and each woman is advised to have a comprehensive medical assessment, instructions and treatment to improve the future perinatal outcome.
8- Effective antenatal care of pre-existing as well as gestational diabetes mellitus and early prediction of fetal complications will improve outcomes.
9- Egyptian authorities are striving to improve diabetes care, but many strategies and guidelines for standard of care especially for diabetic pregnant women are still needed to augment this effort.