o_1977r8vv9vk1ts2ms0kd8pksa.pdf

336 D. Maulik et al.
Conclusion
Antepartum fetal surveillance constitutes an essential
component of the standards of care in managing
pregnancies complicated with pregestational diabetes
mellitus. Fetal hyperglycemia is associated with increased
oxidative metabolism, hypoxemia, and increased
brain and renal perfusion without any significant
changes in fetoplacental perfusion. Moreover, the
relationship between abnormal umbilical arterial
Doppler indices and the quality of glycemic control
remains unproven; however, observational studies
suggest significant diagnostic efficacy of the umbilical
arterial Doppler method in diabetic pregnancies complicated
with FGR or hypertension. Although there
are no randomized trials specifically addressing this
issue, existing evidence suggests that Doppler velocimetry
of the umbilical artery may be beneficial for
antepartum fetal surveillance in diabetic pregnancies
in the presence of these complications. Such utilization
should be integrated with the existing standards
of practice.
References
1. Garner P (1995) Type I diabetes mellitus and pregnancy.
Lancet 346:157±161
2. Crandell SS, Fisher DJ, Morriss FH Jr (1985) Effects of
ovine maternal hyperglycemia on fetal regional blood
flows and metabolism. Am J Physiol 249:E454±E460
3. Dickinson JE, Meyer BA, Palmer SM (1998) Fetal vascular
responses to maternal glucose administration in
streptozocin-induced ovine diabetes mellitus. J Obstet
Gynaecol Res 24:325±333
4. Philipps AF, Porte PJ, Stabinsky S, Rosenkrantz TS,
Raye JR (1984) Effects of chronic fetal hyperglycemia
upon oxygen consumption in the ovineuterus and conceptus.
J Clin Invest 74:279±286
5. Salvesen DR, Higueras MT, Mansur CA, Freeman J,
Brudenell JM, Nicolaides KH (1993) Placental and fetal
Doppler velocimetry in pregnancies complicated by
maternal diabetes mellitus. Am J Obstet Gynecol 168:
645±652
6. Harwell CM, Padbury JF, Anand RS, Martinez AM, Ipp
E, Thio SL, Burnell EE (1990) Fetal catecholamine
responses to maternal hypoglycemia. Am J Physiol.
259:R1126±R1130
7. Reece EA, Hagay Z, Roberts AB, DeGennaro N, Homko
CJ, Connolly-Diamond M, Sherwin R, Tamborlane WV,
Diamond MP (1995) Fetal Doppler and behavioral responses
during hypoglycemia induced with the insulin
clamp technique in pregnant diabetic women. Am J
Obstet Gynecol 172:151±155
8. Bjorklund AO, Adamson UK, Almstrom NH, Enocksson
EA, Gennser GM, Lins PE, Westgren LM (1996) Effects
of hypoglycaemia on fetal heart activity and umbilical
artery Doppler velocity waveforms in pregnant
women with insulin-dependent diabetes mellitus. Br J
Obstet Gynaecol 103:413±420
9. Maulik D, Yarlagadda P, Youngblood JP et al. (1990)
The diagnostic efficacy of the umbilical arterial systolic/diastolic
ratio as a screening tool: a prospective
blinded study: Am J Obstet Gynecol 162:1518±1523
10. Bracero L, Schulman H, Fleischer A, Farmakides G,
Rochelson B (1986) Umbilical artery velocimetry in
diabetes and pregnancy. Obstet Gynecol 68:654±658
11. Landon MB, Gabbe SG, Bruner JP, Ludmir J (1989)
Doppler umbilical artery velocimetry in pregnancy
complicated by insulin-dependent diabetes mellitus.
Obstet Gynecol 73:961±965
12. Johnstone FD, Steel JM, Haddad NG, Hoskins PR,
Greer IA, Chambers S (1992) Doppler umbilical artery
flow velocity waveforms in diabetic pregnancy. Br J
Obstet Gynaecol 99:135±140
13. Reece EA, Hagay Z, Assimakopoulos E, Moroder W,
Gabrielli S, DeGennaro N, Homko C, O'Connor T, Wiznitzer
A (1994) Diabetes mellitus in pregnancy and the
assessment of umbilical artery waveforms using pulsed
Doppler ultrasonography. J Ultrasound Med 13:73±80
14. Dicker D, Goldman JA, Yeshaya A, Peleg D (1990) Umbilical
artery velocimetry in insulin dependent diabetes
mellitus (IDDM) pregnancies. J Perinat Med 18:391±
395
15. Grunewald C, Divon M, Lunell NO (1996) Doppler
velocimetry in last trimester pregnancy complicated by
insulin-dependent diabetes mellitus. Acta Obstet Gynecol
Scand 75:804±808
16. Bracero LA, Figueroa R, Byrne DW, Han HJ (1996)
Comparison of umbilical Doppler velocimetry, nonstress
testing, and biophysical profile in pregnancies
complicated by diabetes. J Ultrasound Med 15:301±308
17. Fadda GM, D'Antona D, Ambrosini G, Cherchi PL, Nardelli
GB, Capobianco G, Dessole S (2001) Placental and
fetal pulsatility indices in gestational diabetes mellitus.
J Reprod Med 46:365±370
18. Van Bel F, Van de Bor M, Walther FJ (1991) Cerebral
blood flow velocity and cardiac output in infants of insulin-dependent
diabetic mothers. Acta Paediatr Scand
80:905±910
19. Salvesen DR, Higueras MT, Brudenell JM, Drury PL,
Nicolaides KH (1992) Doppler velocimetry and fetal
heart rate studies in nephropathic diabetics. Am J Obstet
Gynecol 167:1297±1303
20. Ishimatsu J, Matsuzaki T, Yakushiji M, Hamada T
(1995) Blood flow velocity waveforms of the fetal middle
cerebral artery in pregnancies complicated by diabetes
mellitus. Kurume Med J 42:161±166
21. Rizzo G, Arduini D, Romanini C (1991) Cardiac function
in fetuses of type I diabetic mothers. Am J Obstet
Gynecol 164:837±843
22. Rizzo G, Pietropolli A, Capponi A, Cacciatore C, Arduini
D, Romanini C (1994) Analysis of factors influencing
ventricular filling patterns in fetuses of type I diabetic
mothers. J Perinat Med 22:149±157
23. Miyake T (2001) Doppler echocardiographic studies of
diastolic cardiac function in the human fetal heart.
Kurume Med J 48:59±64
24. Rizzo G, Arduini D, Capponi A, Romanini C (1995)
Cardiac and venous blood flow in fetuses of insulin-dependent
diabetic mothers: evidence of abnormal hemodynamics
in early gestation. Am J Obstet Gynecol 173:
1775±1781