Ultrasonographic Evaluation of Glycemic Control Effect on Placental Vascularization in Pregnancy with Type 1 Diabetes Mellitus

Zoltan Kozinszky; AbelT. Altorjay; Andras Molnar; Tibor Nyári; Sandor G. Vari; Gabor Nemeth; Andrea Suranyi

doi:10.1055/a-0824-6362

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

Exp Clin Endocrinol Diabetes 2020; 128(12): 788-795
DOI: 10.1055/a-0824-6362

Article

Ultrasonographic Evaluation of Glycemic Control Effect on Placental Vascularization in Pregnancy with Type 1 Diabetes Mellitus

Zoltan Kozinszky

¹Department of Obstetrics and Gynecology, Blekinge Hospital, Karlskrona, Sweden

,

AbelT. Altorjay

²Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary

,

Andras Molnar

²Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary

,

Tibor Nyári

³Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary

,

Sandor G. Vari

⁴International Research and Innovation in Medicine Program, Cedars - Sinai Medical Center, Los Angeles, CA, USA

,

Gabor Nemeth

²Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary

,

Andrea Suranyi

²Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary

› Author Affiliations

Abstract

Aims The aim of our study was to assess the effect of glycemic control on placental vascularization in pregnancies complicated by type 1 diabetes mellitus (T1DM) and to compare dataset of optimal/suboptimal glycemic control to normal placental 3-dimensional power Doppler (3-DPD) indices in 2^nd and 3^rd trimester.

Methods Placental vascularization of pregnant women was prospectively evaluated by 3-DPD ((vascularization-index (VI); flow-index (FI); vascularization-flow-index (VFI)) ultrasound technique. The normal pregnancies (n=214) were compared to those complicated by T1DM (n=53) with optimal (HbA1C≤6%;≤ 42 mmol/mol) and suboptimal (HbA1C>6%;>42 mmol/mol) glycemic control.

Results Pregnancies complicated by T1DM expressed lower placental vascularization indices as compared with normal pregnancies (adjusted odds ratio (AOR) for VI:0.86; FI:0.94; VFI:0.76). Placental 3-DPD indices have a significant correlation with HbA1C and optimal glycemic control is associated with lower placental perfusion (AOR for VI:1.64; FI:1.13; VFI:2.34). Short-term adverse neonatal outcome was predicted by lower 3-DPD indices (AOR_VI:0.83, AOR_FI:0.93, AOR_VFI:0.66, p<0.05 for each index). Besides the glycemic control, the pregestational body mass index (BMI), had significant influences on placental perfusion.

Conclusions VI displayed the best screening ability for suboptimal glycemic control with a sensitivity of 90.9%. The suboptimal glycemic control has a direct deteriorating effect on placental vasculature. Therefore the ultrasound examination could be an adjunct diagnostic modality for pregnant women with T1DM.

Key words

glycemic control - placental vascularization - type 1 diabetes mellitus - 3-dimensional power Doppler indices - ultrasound

Full Text

References

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