Ductus Venosus Shunting in Pregnancies with Well-Controlled Gestational Diabetes Mellitus
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Abstract
Background: Gestational diabetes mellitus (GDM) is a common metabolic disorder in pregnancy, and it can be identified in 20% to 25% of Southeast Asian pregnancies. For GDM, fetal hypermetabolic rate due to hyperinsulinemia may cause an increase in hepatic blood flow from the UV, leading to a decrease in DV shunting. The objective of this study is to compare ductus venosus (DV) shunting between uncomplicated pregnancy and gestational diabetes mellitus.
Methods: A prospective cohort study was performed on 76 women with uncomplicated singleton pregnancies and 36 women with GDM. Ductus venosus flow (DVF) and umbilical venous flow (UVF) were measured to assess the degree of DV shunting at 28-32 weeks of gestation. Pregnancy and neonatal outcomes were also collected and analyzed, including antenatal complications, gestational age at delivery, birth weight, Apgar score, NICU admission, ventilator support, and neonatal morbidity.
Results: The baseline characteristics of both groups were not significantly different, except for mean maternal age. There was no difference in the degree of DV shunting between the GDM and the control groups after adjustment for maternal age and gestational age, 41.34 % vs. 40.18 %, respectively (P=0.70). After multiple linear regression analysis, DVF, UVF, and DV shunting with an adjustment for maternal age and gestational age (GA) did not show a statistically significant difference. No relationships were found between the hemodynamic variables and perinatal outcomes.
Conclusion: This study suggests that good control of maternal GDM may prevent an increase in fetal hepatic blood flow, as indicated by no significant change of DV shunting and UVF.
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