Ductus Venosus Shunting in Pregnancies with Well-Controlled Gestational Diabetes Mellitus
Article Sidebar
Main Article Content
Abstract
Objectives: 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 umbilical venous (UV), leading to a decrease in ductus venosus (DV) shunting. The objective of this study was to compare DV shunting between uncomplicated pregnancy and gestational diabetes mellitus.
Materials and 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, neonatal intensive care unit (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 suggested 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.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: A global perspective. Curr Diab Rep 2016;16:7.
Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci 2018;19:3342.
Muche AA, Olayemi OO, Gete YK. Effects of gestational diabetes mellitus on risk of adverse maternal outcomes: a prospective cohort study in Northwest Ethiopia. BMC Pregnancy Childbirth 2020;20:73.
Pedersen J. Weight and length at birth of infants of diabetic mothers. Acta Endocrinol (Copenh) 1954;16:330-42.
Philipps AF, Porte PJ, Stabinsky S, Rosenkrantz TS, Raye JR. Effects of chronic fetal hyperglycemia upon oxygen consumption in the ovine uterus and conceptus. J Clin Invest 1984;74:279-86.
Depla AL, De Wit L, Steenhuis TJ, Slieker MG, Voormolen DN, Scheffer PG, et al. Effect of maternal diabetes on fetal heart function on echocardiography: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2021;57:539-50.
Boito SM, Struijk PC, Ursem NT, Stijnen T, Wladimiroff JW. Assessment of fetal liver volume and umbilical venous volume flow in pregnancies complicated by insulin-dependent diabetes mellitus. BJOG 2003;110:1007-13.
Lund A, Ebbing C, Rasmussen S, Kiserud T, Hanson M, Kessler J. Altered development of fetal liver perfusion in pregnancies with pregestational diabetes. PLoS One 2019;14:e0211788.
Lund A, Ebbing C, Rasmussen S, Kiserud T, Kessler J. Maternal diabetes alters the development of ductus venosus shunting in the fetus. Acta Obstet Gynecol Scand 2018;97:1032-40.
Dall’Asta A, Brunelli V, Prefumo F, Frusca T, Lees CC. Early onset fetal growth restriction. Matern Health Neonatol Perinatol 2017;3:2.
Haugen G, Kiserud T, Godfrey K, Crozier S, Hanson M. Portal and umbilical venous blood supply to the liver in the human fetus near term. Ultrasound Obstet Gynecol 2004;24:599-605.
Kessler J, Rasmussen S, Godfrey K, Hanson M, Kiserud T. Venous liver blood flow and regulation of human fetal growth: evidence from macrosomic fetuses. Am J Obstet Gynecol 2011;204:429.e1-7.
Kiserud T, Eik-Nes SH, Blaas HG, Hellevik LR, Simensen B. Ductus venosus blood velocity and the umbilical circulation in the seriously growth-retarded fetus. Ultrasound Obstet Gynecol 1994;4:109-14.
Stuart A, Amer-Wahlin I, Gudmundsson S, Marsal K, Thuring A, Kallen K. Ductus venosus blood flow velocity waveform in diabetic pregnancies. Ultrasound Obstet Gynecol 2010;36:344-9.
Committee on Obstetric Practice American Institute of Ultrasound in Medicine Society for Maternal–Fetal Medicine. Committee opinion no 700: Methods for estimating the due date. Obstet Gynecol 2017;129:e150-e154.16.
American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of obstetric ultrasound examinations. J Ultrasound Med 2013;32:1083-101.
Shang M, Lin L. IADPSG criteria for diagnosing gestational diabetes mellitus and predicting adverse pregnancy outcomes. J Perinatol 2014;34:100-4.
Hawkins JS, Lo JY, Casey BM, McIntire DD, Leveno KJ. Diet-treated gestational diabetes mellitus: comparison of early vs routine diagnosis. Am J Obstet Gynecol 2008;198:287.e1-6.
ACOG Practice Bulletin No. 190: Gestational diabetes mellitus. Obstet Gynecol 2018;131:e49-e64.
Marathe PH, Gao HX, Close KL. American Diabetes Association Standards of Medical Care in Diabetes 2017. J Diabetes 2017;9:320-4.
Lees CC, Stampalija T, Baschat A, da Silva Costa F, Ferrazzi E, Figueras F, et al. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol 2020;56:298-312.
Bhide A, Acharya G, Bilardo CM, Brezinka C, Cafici D, Hernandez-Andrade E, et al. ISUOG practice guidelines: use of Doppler ultrasonography in obstetrics. Ultrasound Obstet Gynecol 2013;41: 233-39.
Kiserud T, Rasmussen S. How repeat measurements affect the mean diameter of the umbilical vein and the ductus venosus. Ultrasound Obstet Gynecol 1998;11:419-25.
Acharya G, Wilsgaard T, Rosvold Berntsen GK, Maltau JM, Kiserud T. Reference ranges for umbilical vein blood flow in the second half of pregnancy based on longitudinal data. Prenat Diagn 2005;25:99-111.
Kiserud T, Eik-Nes SH, Blaas HG, Hellevik LR. Ultrasonographic velocimetry of the fetal ductus venosus. Lancet 1991;338:1412-4.
Kiserud T, Rasmussen S, Skulstad S. Blood flow and the degree of shunting through the ductus venosus in the human fetus. Am J Obstet Gynecol 2000;182: 147-53.
Kiserud T, Kessler J, Ebbing C, Rasmussen S. Ductus venosus shunting in growth-restricted fetuses and the effect of umbilical circulatory compromise. Ultrasound Obstet Gynecol 2006;28:143-9.
Lu JL, Capponi A, Mappa I, Maneschi F, Rizzo G. Effects of gestational diabetes mellitus on ductus venosus shunting during the third trimester. Prenat Cardio 2021;11:29-36.
Rizzo G, Mappa I, Bitsadze V, Khizroeva J, Makatsarya A, D’Antonio F. The added value of umbilical vein flow in predicting fetal macrosomia at 36 weeks of gestation: a prospective cohort study. Acta Obstet Gynecol Scand 2021;100:900-7.
Geurtsen ML, van Soest EEL, Voerman E, Steegers EAP, Jaddoe VWV, Gaillard R. High maternal early-pregnancy blood glucose levels are associated with altered fetal growth and increased risk of adverse birth outcomes. Diabetologia 2019;62:1880-90.
Hay WW, Jr. Care of the infant of the diabetic mother. Curr Diab Rep 2012;12:4-15.
Ebbing C, Rasmussen S, Kiserud T. Fetal hemodynamic development in macrosomic growth. Ultrasound Obstet Gynecol 2011;38:303-8.
Rizzo G, Mappa I, Bitsadze V, Słodki M, Khizroeva J, Makatsariya A, et al. Role of first-trimester umbilical vein blood flow in predicting large-for-gestational age at birth. Ultrasound Obstet Gynecol 2020;56:67-72.