Predicting adverse perinatal outcomes with fetal modified myocardial performance index and epicardial fat tissue thickness in diabetes-complicated pregnancies.

OBJECTIVE: The aim of this study was to evaluate fetal modified myocardial performance index (mod-MPI) and fetal epicardial fat tissue (EFT) thickness and its association with adverse perinatal outcomes in diabetic pregnant women. PATIENTS AND METHODS: This was a prospective case-control study including 90 gestational diabetes mellitus (GDM) and 45 pregestational diabetes mellitus (PGDM) and 90 healthy pregnant women (control group). Two-dimensional gray-scale and Doppler fetal echocardiography were used to calculate the mod-MPI. EFT thickness was measured in the hypoechogenic area between the myocardium and the visceral pericardium on the right ventricle by distinguishing it from the pericardial fluid by Doppler ultrasound. RESULTS: Both mod-MPI values and EFT thickness were significantly higher in diabetic pregnant women (p<0.001; for both). No significant differences were observed in mod-MPI values and EFT thickness between pregnant women with GDM and PGDM. In addition, there was no significant difference in fetal mod-MPI values and EFT thicknesses among diabetic pregnant women based on their treatment requirements. The receiver operating characteristic (ROC) curve revealed that mod-MPI value (cut-off 0.54, 95% CI: 0.629-0.837, p<0.001, sensitivity 64.6%, specificity 61.7%) and EFT thickness (cut-off 1.85 mm, 95% CI: 0.524-0.750, p=0.014, sensitivity 65.8%, specificity 63.9%) could predict adverse neonatal outcomes in diabetic pregnant women. Multivariate regression analysis revealed that both mod-MPI (p=0.003) and EFT thickness (p=0.008) were independently associated with adverse outcomes. CONCLUSIONS: Fetal mod-MPI values and EFT thickness increase in pregnancies complicated by diabetes, and these measurements may serve as valuable predictors of adverse perinatal outcomes.

Does detection of a large for gestational age (LGA) fetus in fetal anomaly scan (FAS) require an early oral glucose screening test (OGTT) and can LGA fetus be detected at birth?

OBJECTIVE: Gestational diabetes mellitus (GDM) complications increase with late diagnosis and late treatment, so early diagnosis and treatment is one of the most important factors in preventing complications. We tried to find an answer to the question of whether the detection of large for gestational age (LGA) fetus in fetal anomaly scan (FAS) requires earlier oral glucose screening test (OGTT) and predicts LGA fetus at birth. PATIENTS AND METHODS: Pregnant women who underwent fetal anomaly scan and gestational diabetes screening at the Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Training and Research Hospital between 2018 and 2020 were included in this large retrospective cohort study. FAS was routinely performed between 18-22 weeks in our hospital. 75 grams of OGTT was used for gestational diabetes screening and it was performed between 24-28 weeks. RESULTS: This large retrospective cohort study was performed on 3,180 fetuses, 2,904 appropriate for gestational age (AGA) and 276 LGA, in the second trimester. The prevalence of GDM was significantly higher in the LGA group (OR 2.44, 95% CI 1.66-3.58; p < 0.001). Insulin requirement for blood glucose regulation was significantly higher in the LGA group (OR 3.6, 95% CI 1.68-7.7; p = 0.001). Fasting and 1st hour OGTT values were similar between the groups, but 2nd hour OGTT values were significantly higher in the second trimester LGA group (p = 0.041). The prevalence of LGA newborns at birth was higher in second trimester LGA fetuses than in fetuses with AGA (21.1% vs. 7.1%, p < 0.001). CONCLUSIONS: The fact that the estimated fetal weight (EFW) measured in the second trimester FAS is LGA may be related to GDM in the future and LGA fetus at birth. A more detailed GDM risk questioning should be performed to these mothers and OGTT should be considered when additional risk factors are detected. In addition to all these, glucose regulation may not be possible with diet alone in mothers who have LGA in the second trimester ultrasound and who may have GDM in the future. These mothers should be monitored more closely and more carefully.