الفهرس 
AIM OF THE WORKOnly 14 pages are availabe for public view
 |  | from | 95 |  |  |
| | | from | 95 | | |
Abstract
This study aimed to evaluate the predictive role of first trimester fetal heart
rate for Gestational diabetes mellitus.
This cohort study was conducted at Menoufia University Hospitals and
Menouf General Hospital after obtaining approach of Menoufia University related
Ethics committees.
The study participant were 175 pregnant women at first trimester attended
outpatient clinic (prenatal care) chosen according the inclusion and exclusion
criteria of the study, conducted in the duration from March 2020 till January
2022.Explanation of the study protocol to each participant was done before her
inclusion in the study.
Singleton pregnancy, Non-diabetic pregnant women at 11-14 weeks, BMI
less than 30 kg\m2 were included in the study.
While patients more than 30 years, previous pregnancy with congenital
anomalies, positive consanguinity, Family history with congenital anomalies,
abnormal nuchal translucency, previously diagnosed diabetes, elevated lipid
profile, and any exposure to teratogenic risk during pregnancy were excluded.
For each patient, the following data were collected: maternal age, body
mass index, parity, general examination, NT, FHR, CRL, fasting plasma
glucose level, HbA1c and TG.
FHR was recorded by machine software using either m mode method or
Doppler method.
Patients were grouped i n t wo gro u p s according to the presence (cases)
or absence (controls) of GDM according to 75g OGTT at 24-28 weeks.
The follow up of the patient was up-to 24-28 weeks of gestation.
Maternal and ultrasound parameters were compared between cases and
controls groups.
The results of our study can be summarized as the following:
- The cutoff value of fetal heart rate in predicting GDM was ≥162 bpm, with
sensitivity of 76% and specificity of 78.9%. The PPV is 23.43 and NPV is
76.57 with AUC 0.853.
- The positive likelihood ratio was 3.6 which means that the probability to
develop GDM is increased 3.6 times when having first trimester FHR ≥ 162,
while negative likelihood ratio was 0.3 which means that the risk to develop
GDM is reduced to one third when first trimester FHR is less than 162.
- 134 participant out of 175 were non-diabetic (76.57%) while 41 (23.43%)
patients were diagnosed as GDM according to the 75g OGTT results done at
24-28 weeks of gestation.
- There were no statistically significant difference between the study groups
regarding to age, parity, BMI, vital signs (SPB, DPB, Pulse )
- There were no statistically significant difference between the study groups
regarding to first trimester laboratory investigations (FBS , HbA1c , TG ).
Summary
74
- There were no statistically significant difference between the study groups
regarding to CRL and NT. While first trimester FHR was significantly
increased among the GDM group than the control group.
- Some antenatal maternal and fetal outcomes were recorded during the study
such as polyhydramnious, large for gestational age and gestational
Hypertension.
- The statistical analysis showed that there were no statistically significant
correlation between fetal heart rate and these recorded complications between
the two groups.
- The multinomial logistic regression analysis of variables of associated with
GDM showed that maternal age and parity have a predictive value for GDM.
According the results of our study:
First trimester FHR is a reasonable tool for early prediction of Gestational
diabetes mellitus that can be used specially in low resources settings where there
is no general screening for GDM. Also to select women who may benefit the
OGTT.