The influence of placental perfusion on birthweight in women with gestational diabetes.

OBJECTIVE: To evaluate the influence of both uterine and umbilical arteries Doppler pulsatility indexes (PI) and metabolic control on birthweight in pregnant women with gestational diabetes mellitus. METHODS: One hundred sixty-nine women with gestational diabetes were evaluated. Doppler measurements of umbilical artery and mean uterine arteries PI were recorded and the corresponding Z-score values by gestational age calculated. Maternal pregestational body mass index (BMI) and the levels of glycosylated hemoglobin were also recorded. The relationships between these studied variables and customised birthweight centiles according to sex and gestational age were analyzed using Spearman's correlation coefficient and linear regression. RESULTS: There was a significant correlation between birthweight centiles and Z-score values of the umbilical artery PI (r = -0.25, p = 0.001), but not with the Z-score values of the uterine artery PI (r = -0.12, p = 0.43). Third trimester maternal glycosylated hemoglobin was also positively correlated to birthweight (r = 0.29, p = 0.01). When using stepwise linear regression both maternal glycosylated hemoglobin and the Z-score of umbilical artery PI were included as independent variables in the predictive model of birthweight centile (p = 0.0002, p = 0.001 respectively, R(2)( )= 0.27). CONCLUSIONS: Umbilical artery PI predicts birthweight in women with gestational diabetes. However, metabolic control is the only important determinant of fetal macrosomia in these mothers.

Cardiac biometry and function in euploid fetuses with intracardiac echogenic foci.

OBJECTIVE: To compare cardiac biometry and function between fetuses with and without intracardiac echogenic foci (ICEF). METHODS: One hundred and fifty-two fetuses with ICEF were compared with 104 controls. Diastolic ventricular transverse diameters, systolic aortic and pulmonary diameters and interventricular septum were measured. Doppler measurements included pulmonary artery and aortic maximum systolic velocities, time to peak, velocity time integral and atrioventricular E/A ratios. RESULTS: Only A wave in the mitral valve was slightly but significantly higher in the ICEF group (0.45 ± 0.07 m/s vs 0.43 ± 0.08 m/s, p = 0.03), but mitral E/A ratio was similar in both groups (0.61 ± 0.06 vs 0.60 ± 0.07, p = 0.22). There were no statistically significant differences in the rest of the studied variables between the two groups. CONCLUSION: Fetuses with ICEF do not have relevant abnormalities in either cardiac biometry or function. We suggest the presence of an isolated ICEF should not be an indication for fetal echocardiography as long as fetal morphology scan had been performed and revealed no other findings.