Evaluation of placenta and fetal lung using shear wave elastography in gestational diabetes mellitus: An innovative approach

Abstract

Purpose This study aims to investigate placental and fetal lung stiffness in pregnant women with and without gestational diabetes, considering the well-established delay in fetal lung maturation associated with gestational diabetes.

Materials and Methods This prospective cohort study was conducted at a tertiary center and included pregnant women who underwent a 75-gram oral glucose tolerance test between 24–28 weeks of gestation. Elastography measurements were performed using point shear wave elastography (pSWE).

Results The study included 60 pregnant women diagnosed with gestational diabetes and 60 pregnant women in the control group. The SWE velocity of the peripheral placenta, central placenta, and lung was higher in the gestational diabetes group compared to the control group. Furthermore, the SWE velocity of the peripheral placenta, central placenta, and lung was higher in newborns with neonatal respiratory morbidity. Based on the ROC analysis of patients with gestational diabetes, the AUC for lung SWE velocity was 0.88 (cut-off 12.4 kPa, 95% CI: 0.77–0.99, p<0.001) with a sensitivity of 71.4% and specificity of 95.6% for predicting neonatal respiratory morbidity.

Conclusion Fetal placental and lung stiffness increase in fetuses of pregnant women with diabetes. Moreover, higher fetal lung stiffness during the fetal period is associated with increased neonatal respiratory morbidity.

Zusammenfassung

Zweck Diese Studie zielt darauf ab, die Lungensteifheit der Plazenta und des Fötus bei schwangeren Frauen mit und ohne Schwangerschaftsdiabetes zu untersuchen, wobei die bekannte Verzögerung der fetalen Lungenreifung im Zusammenhang mit Schwangerschaftsdiabetes berücksichtigt wird.

Materialien und Methoden Diese prospektive Kohortenstudie wurde an einem tertiären Zentrum durchgeführt und umfasste schwangere Frauen, die sich zwischen der 24. und 28. Schwangerschaftswoche einem oralen 75-Gramm-Glukose-Toleranztest unterzogen. Elastografiemessungen wurden mittels Punkt-Scherwellen-Elastografie (pSWE) durchgeführt.

Ergebnisse Die Studie umfasste 60 schwangere Frauen mit diagnostiziertem Schwangerschaftsdiabetes und 60 schwangere Frauen in der Kontrollgruppe. Die SWE-Geschwindigkeit der peripheren Plazenta, der zentralen Plazenta und der Lunge war in der Gruppe mit Schwangerschaftsdiabetes höher als in der Kontrollgruppe. Darüber hinaus war die SWE-Geschwindigkeit der peripheren Plazenta, der zentralen Plazenta und der Lunge bei Neugeborenen mit neonataler respiratorischer Morbidität höher. Basierend auf der ROC-Analyse von Patienten mit Schwangerschaftsdiabetes betrug die AUC für die Lungen-SWE-Geschwindigkeit 0,88 (Grenzwert 12,4 kPa, 95%-KI: 0,77–0,99, p < 0,001), mit einer Sensitivität von 71,4% und einer Spezifität von 95,6% bei der Vorhersage neonataler Atemwegsmorbidität.

Schlussfolgerung Die Steifheit der fetalen Plazenta und der Lunge nimmt bei Feten schwangerer Frauen mit Diabetes zu. Darüber hinaus ist eine höhere fetale Lungensteifheit während der Fetalperiode mit einer erhöhten Atemwegsmorbidität bei Neugeborenen verbunden.

Keywords

shear wave elastography - stiffness - fetal lung elastography - gestational diabetes - neonatal respiratory morbidity

Publication History

Received: 12 January 2024

Accepted after revision: 10 May 2024

Accepted Manuscript online:
10 May 2024

Article published online:
04 November 2024

• References

• 1 ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol 2018; 131: e49 DOI: 10.1097/AOG.0000000000002501. (PMID: 29370047)
• 2 Alorainy IA, Barlas NB, Al-Boukai AA. Pictorial Essay: Infants of diabetic mothers. Indian J Radiol Imaging 2010; 20: 174-181 DOI: 10.4103/0971-3026.69349. (PMID: 21042439)
• 3 Greenleaf JF, Fatemi M, Insana M. Selected Methods for Imaging Elastic Properties of Biological Tissues. Annu Rev Biomed Eng 2003; 5: 57-78 DOI: 10.1146/annurev.bioeng.5.040202.121623. (PMID: 12704084)
• 4 2 Principles of Elastography. 2017. Aufl. Thieme Verlag; 2017
• 5 Hamza A, Radosa J, Gerlinger C. et al. Cervical and Lower Uterine Parameter Ultrasound and Elastographic Parameters for the Prediction of a Successful Induction of Labor. Ultraschall in Med – Eur J Ultrasound 2021; 42: 520-528 DOI: 10.1055/a-1131-7736. (PMID: 32198732)
• 6 Issaoui M, Debost-Legrand A, Skerl K. et al. Shear wave elastography safety in fetus: A quantitative health risk assessment. Diagn Interv Imaging 2018; 99: 519-524 DOI: 10.1016/j.diii.2018.04.013. (PMID: 29934239)
• 7 International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care 2010; 33: 676-682 DOI: 10.2337/dc09-1848. (PMID: 20190296)
• 8 Suresh A, Liu A, Poulton A. et al. Comparison of maternal abdominal subcutaneous fat thickness and body mass index as markers for pregnancy outcomes: A stratified cohort study. Aust N Z J Obstet Gynaecol 2012; 52: 420-426 DOI: 10.1111/j.1479-828X.2012.01471.x. (PMID: 23045985)
• 9 Mottet N, Aubry S, Vidal C. et al. Feasibility of 2-D ultrasound shear wave elastography of fetal lungs in case of threatened preterm labour: a study protocol. BMJ Open 2017; 7: e018130 DOI: 10.1136/bmjopen-2017-018130. (PMID: 29282263)
• 10 Beck APA, Araujo Júnior E, Leslie ATFS. et al. Assessment of fetal lung maturity by ultrasound: objective study using gray-scale histogram. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet 2015; 28: 617-622 DOI: 10.3109/14767058.2014.927862.
• 11 Serizawa M, Maeda K. Noninvasive Fetal Lung Maturity Prediction Based on Ultrasonic Gray Level Histogram Width. Ultrasound Med Biol 2010; 36: 1998-2003 DOI: 10.1016/j.ultrasmedbio.2010.08.011. (PMID: 20950934)
• 12 Schenone MH, Samson JE, Jenkins L. et al. Predicting Fetal Lung Maturity Using the Fetal Pulmonary Artery Doppler Wave Acceleration/Ejection Time Ratio. Fetal Diagn Ther 2014; 36: 208-214 DOI: 10.1159/000358299. (PMID: 25139576)
• 13 Azpurua H, Norwitz ER, Campbell KH. et al. Acceleration/ejection time ratio in the fetal pulmonary artery predicts fetal lung maturity. Am J Obstet Gynecol 2010; 203: 40.e1-8 DOI: 10.1016/j.ajog.2010.01.075.
• 14 Acar Sirinoglu H, Uysal G, Nazik H. et al. Comparison of elasticity values in normal and gestational diabetic pregnancies in the third trimester. J Obstet Gynaecol J Inst Obstet Gynaecol 2022; 42: 842-847 DOI: 10.1080/01443615.2021.1945012.
• 15 Anuk AT, Tanacan A, Erol SA. et al. Evaluation of the relationship between placental stiffness measured by shear wave elastography and perinatal outcomes in women with gestational diabetes mellitus. Acta Radiol Stockh Swed 1987 2022; 63: 1721-1728 DOI: 10.1177/02841851211054255.
• 16 Mottet N, Cochet C, Vidal C. et al. Feasibility of two-dimensional ultrasound shear wave elastography of human fetal lungs and liver: A pilot study. Diagn Interv Imaging 2020; 101: 69-78 DOI: 10.1016/j.diii.2019.08.002. (PMID: 31447393)
• 17 Nallet C, Pazart L, Cochet C. et al. Prenatal quantification of human foetal lung and liver elasticities between 24 and 39 weeks of gestation using 2D shear wave elastography. Eur Radiol 2022; 32: 5559-5567 DOI: 10.1007/s00330-022-08654-1.
• 18 Yuksel MA, Kilic F, Kayadibi Y. et al. Shear wave elastography of the placenta in patients with gestational diabetes mellitus. J Obstet Gynaecol J Inst Obstet Gynaecol 2016; 36: 585-588 DOI: 10.3109/01443615.2015.1110120.
• 19 Lai HW, Lyv GR, Wei YT. et al. The diagnostic value of two-dimensional shear wave elastography in gestational diabetes mellitus. Placenta 2020; 101: 147-153 DOI: 10.1016/j.placenta.2020.08.024. (PMID: 32980791)
• 20 Yildiz Atar H, Baatz JE, Ryan RM. Molecular Mechanisms of Maternal Diabetes Effects on Fetal and Neonatal Surfactant. Children 2021; 8: 281 DOI: 10.3390/children8040281. (PMID: 33917547)
• 21 Du Y, Fang Z, Jiao J. et al. Application of ultrasound-based radiomics technology in fetal-lung-texture analysis in pregnancies complicated by gestational diabetes and/or pre-eclampsia. Ultrasound Obstet Gynecol 2021; 57: 804-812 DOI: 10.1002/uog.22037. (PMID: 32250510)
• 22 Jiao J, Du Y, Li X. et al. Prenatal prediction of neonatal respiratory morbidity: a radiomics method based on imbalanced few-shot fetal lung ultrasound images. BMC Med Imaging 2022; 22: 2 DOI: 10.1186/s12880-021-00731-z. (PMID: 34983431)