Skip to main content
SpringerLink
Log in

Fetal cerebral hemodynamic in gestational diabetic versus normal pregnancies: a Doppler velocimetry of middle cerebral and umbilical arteries

  • Original Article
  • Published:
Acta Neurologica Belgica Aims and scope Submit manuscript

Abstract

Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancies. Evaluating other conditions, including intra uterine growth restriction and pre-eclampsia, some studies have shown significant changes in blood flow velocity of fetal middle cerebral artery (MCA). Our study is one of the few that has aimed to assess the effects of GDM on Doppler parameters of the fetal MCA and umbilical artery (UA) and to compare with normal pregnancies. This cross-sectional study was performed on 66 pregnant women, including 33 women with GDM and the others without it, in Akbar-Abadi University Hospital in Tehran, Iran during 2010–2011. Peak systolic and diastolic velocities, pulsatility index (PI), resistance index (RI) and systolic diastolic ratio (SD) were recorded in UA as well as both right and left fetal MCAs for every recruited pregnant women by means of Doppler ultrasonography. The mean gestational age at the time of examination was 34.45 (SD = 2.62) weeks in GDM group. Although all of the measured Doppler parameters had higher values in GDM pregnancies, the differences were not significant between two groups of study; except for the left fetal MCA-PI, which was significantly higher in GDM group [2.07 (SD = 0.07) vs. 1.85 (SD = 0.74), P = 0.03]. Our results show that gestational diabetes may contribute to an elevated PI in the fetal MCA. Although there is not yet strong proof for the effect of GDM on the fetal brain hemodynamics, the significant higher MCA-PI warrants more attention towards better controlling of the hyperglycemia during pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lao TT, Tam KF (2001) Gestational diabetes diagnosed in third trimester pregnancy and pregnancy outcome. Acta Obstet Gynecol Scand 80:1003–1008

    Article  CAS  PubMed  Google Scholar 

  2. Khoshniat-Nikoo MAAS, Larijani B (2008) Evaluation of gestational diabetic prevalence studies around Iran. J Iran Diabetes Lipid 8:1–10

    Google Scholar 

  3. Pietryga M, Brazert J, Wender-Ozegowska E, Biczysko R, Dubiel M et al (2005) Abnormal uterine Doppler is related to vasculopathy in pregestational diabetes mellitus. Circulation 112:2496–2500

    Article  PubMed  Google Scholar 

  4. ACOG Practice Bulletin (2001) Clinical management guidelines for obstetrician-gynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational diabetes. Obstet Gynecol 98: 525–538

    Google Scholar 

  5. Asmussen I (1982) Vascular morphology in diabetic placentas. Contrib Gynecol Obstet 9:76–85

    CAS  PubMed  Google Scholar 

  6. Simanaviciute D, Gudmundsson S (2006) Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre-eclamptic pregnancies. Ultrasound Obstet Gynecol 28:794–801

    Article  CAS  PubMed  Google Scholar 

  7. Dubiel M, Gudmundsson S, Gunnarsson G, Marsal K (1997) Middle cerebral artery velocimetry as a predictor of hypoxemia in fetuses with increased resistance to blood flow in the umbilical artery. Early Hum Dev 47:177–184

    Article  CAS  PubMed  Google Scholar 

  8. Arduini D, Rizzo G (1992) Prediction of fetal outcome in small for gestational age fetuses: comparison of Doppler measurements obtained from different fetal vessels. J Perinat Med 20:29–38

    Article  CAS  PubMed  Google Scholar 

  9. Arduini D, Rizzo G, Romanini C, Mancuso S (1987) Utero-placental blood flow velocity waveforms as predictors of pregnancy-induced hypertension. Eur J Obstet Gynecol Reprod Biol 26:335–341

    Article  CAS  PubMed  Google Scholar 

  10. World Health Organization (1980) World health organization expert committee on diabetes mellitus: technical report series, vol 646. World Health Organization, Geneva, pp 8–12

  11. Ebbing C, Rasmussen S, Kiserud T (2007) Middle cerebral artery blood flow velocities and pulsatility index and the cerebroplacental pulsatility ratio: longitudinal reference ranges and terms for serial measurements. Ultrasound Obstet Gynecol 30:287–296

    Article  CAS  PubMed  Google Scholar 

  12. Sharma VK, Tsivgoulis G, Ning C, Teoh HL, Bairaktaris C et al (2008) Role of multimodal evaluation of cerebral hemodynamics in selecting patients with symptomatic carotid or middle cerebral artery steno-occlusive disease for revascularization. J Vasc Interv Neurol 1:96–101

    PubMed Central  PubMed  Google Scholar 

  13. Gosling R, King D (1975) Ultrasound angiology. In: Macus A, Adamson J (eds) Arteries and veins. Churchill-Livingstone, Edinburgh, pp 61–98

    Google Scholar 

  14. Piazze J, Padula F, Cerekja A, Cosmi EV, Anceschi MM (2005) Prognostic value of umbilical-middle cerebral artery pulsatility index ratio in fetuses with growth restriction. Int J Gynaecol Obstet 91:233–237

    Article  CAS  PubMed  Google Scholar 

  15. Bilardo CM, Nicolaides KH, Campbell S (1990) Doppler measurements of fetal and uteroplacental circulations: relationship with umbilical venous blood gases measured at cordocentesis. Am J Obstet Gynecol 162:115–120

    Article  CAS  PubMed  Google Scholar 

  16. Vyas S, Nicolaides KH, Bower S, Campbell S (1990) Middle cerebral artery flow velocity waveforms in fetal hypoxaemia. Br J Obstet Gynaecol 97:797–803

    Article  CAS  PubMed  Google Scholar 

  17. Bracero L, Schulman H, Fleischer A, Farmakides G, Rochelson B (1986) Umbilical artery velocimetry in diabetes and pregnancy. Obstet Gynecol 68:654–658

    CAS  PubMed  Google Scholar 

  18. Bracero LA, Jovanovic L, Rochelson B, Bauman W, Farmakides G (1989) Significance of umbilical and uterine artery velocimetry in the well-controlled pregnant diabetic. J Reprod Med 34:273–276

    CAS  PubMed  Google Scholar 

  19. 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

    Article  CAS  PubMed  Google Scholar 

  20. 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

    Article  CAS  PubMed  Google Scholar 

  21. Bracero LA, Schulman H (1991) Doppler studies of the uteroplacental circulation in pregnancies complicated by diabetes. Ultrasound Obstet Gynecol 1:391–394

    Article  CAS  PubMed  Google Scholar 

  22. Johnstone FD, Steel JM, Haddad NG, Hoskins PR, Greer IA et al (1992) Doppler umbilical artery flow velocity waveforms in diabetic pregnancy. Br J Obstet Gynaecol 99:135–140

    Article  CAS  PubMed  Google Scholar 

  23. 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

    CAS  PubMed  Google Scholar 

  24. Salvesen DR, Higueras MT, Mansur CA, Freeman J, Brudenell JM et al (1993) Placental and fetal Doppler velocimetry in pregnancies complicated by maternal diabetes mellitus. Am J Obstet Gynecol 168:645–652

    Article  CAS  PubMed  Google Scholar 

  25. Fadda GM, D’Antona D, Ambrosini G, Cherchi PL, Nardelli GB et al (2001) Placental and fetal pulsatility indices in gestational diabetes mellitus. J Reprod Med 46:365–370

    CAS  PubMed  Google Scholar 

  26. Ben-Ami M, Battino S, Geslevich Y, Shalev E (1995) A random single Doppler study of the umbilical artery in the evaluation of pregnancies complicated by diabetes. Am J Perinatol 12:437–438

    Article  CAS  PubMed  Google Scholar 

  27. To WW, Mok CK (2009) Fetal umbilical arterial and venous Doppler measurements in gestational diabetic and nondiabetic pregnancies near term. J Matern Fetal Neonatal Med 22:1176–1182

    Article  PubMed  Google Scholar 

  28. Wong SF, Petersen SG, Idris N, Thomae M, McIntyre HD (2010) Ductus venosus velocimetry in monitoring pregnancy in women with pregestational diabetes mellitus. Ultrasound Obstet Gynecol 36:350–354

    Article  CAS  PubMed  Google Scholar 

  29. Leung WC, Lam H, Lee CP, Lao TT (2004) Doppler study of the umbilical and fetal middle cerebral arteries in women with gestational diabetes mellitus. Ultrasound Obstet Gynecol 24:534–537

    Article  CAS  PubMed  Google Scholar 

  30. Bahado-Singh RO, Kovanci E, Jeffres A, Oz U, Deren O et al (1999) The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth restriction. Am J Obstet Gynecol 180:750–756

    Article  CAS  PubMed  Google Scholar 

  31. Gramellini D, Folli MC, Raboni S, Vadora E, Merialdi A (1992) Cerebral-umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol 79:416–420

    Article  CAS  PubMed  Google Scholar 

  32. Arbeille P, Roncin A, Berson M, Patat F, Pourcelot L (1987) Exploration of the fetal cerebral blood flow by duplex Doppler-linear array system in normal and pathological pregnancies. Ultrasound Med Biol 13:329–337

    Article  CAS  PubMed  Google Scholar 

  33. Arias F (1994) Accuracy of the middle-cerebral-to-umbilical-artery resistance index ratio in the prediction of neonatal outcome in patients at high risk for fetal and neonatal complications. Am J Obstet Gynecol 171:1541–1545

    Article  CAS  PubMed  Google Scholar 

  34. Ozeren M, Dinc H, Ekmen U, Senekayli C, Aydemir V (1999) Umbilical and middle cerebral artery Doppler indices in patients with preeclampsia. Eur J Obstet Gynecol Reprod Biol 82:11–16

    Article  CAS  PubMed  Google Scholar 

  35. McCowan LM, Naden RP (1992) Doppler ultrasound in pregnancies with hypertension. Aust N Z J Obstet Gynaecol 32:225–230

    Article  CAS  PubMed  Google Scholar 

  36. Rakoczi I, Tihanyi K, Gero G, Cseh I, Rozsa I et al (1988) Release of prostacyclin (PGI2) from trophoblast in tissue culture: the effect of glucose concentration. Acta Physiol Hung 71:545–549

    CAS  PubMed  Google Scholar 

  37. Kuhn DC, Crawford MA, Stuart MJ, Botti JJ, Demers LM (1990) Alterations in transfer and lipid distribution of arachidonic acid in placentas of diabetic pregnancies. Diabetes 39:914–918

    Article  CAS  PubMed  Google Scholar 

  38. Saldeen P, Olofsson P, Parhar RS, al-Sedairy S (1996) Prostanoid production in umbilical vessels and its relation to glucose tolerance and umbilical artery flow resistance. Eur J Obstet Gynecol Reprod Biol 68:35–41

    Article  CAS  PubMed  Google Scholar 

  39. Baschat AA, Gembruch U (2003) The cerebroplacental Doppler ratio revisited. Ultrasound Obstet Gynecol 21:124–127

    Article  CAS  PubMed  Google Scholar 

  40. Kelley RE, Chang JY, Scheinman NJ, Levin BE, Duncan RC et al (1992) Transcranial Doppler assessment of cerebral flow velocity during cognitive tasks. Stroke 23:9–14

    Article  CAS  PubMed  Google Scholar 

  41. Mari G, Hanif F, Kruger M, Cosmi E, Santolaya-Forgas J et al (2007) Middle cerebral artery peak systolic velocity: a new Doppler parameter in the assessment of growth-restricted fetuses. Ultrasound Obstet Gynecol 29:310–316

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Shaheed Akbar-Abadi University Hospital, Iran University of Medical Sciences, Tehran, Iran

    Mansoureh Shabani Zanjani & Roya Nasirzadeh

  2. Firoozgar Clinical Research Development Center (FCRDC), Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran

    Seyed-Mohammad Fereshtehnejad

  3. Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Novum 5th Floor, Stockholm, 14186, Sweden

    Seyed-Mohammad Fereshtehnejad

  4. Department of Radiology, Shaheed Akbar-Abadi University Hospital, Iran University of Medical Sciences, Tehran, Iran

    Ladan Yoonesi Asl

  5. Medical Student Research Committee (MSRC), Iran University of Medical Sciences, Tehran, Iran

    Seyed-Amir Pooya Alemzadeh & Sareh Askari

Authors
  1. Mansoureh Shabani Zanjani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roya Nasirzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seyed-Mohammad Fereshtehnejad
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ladan Yoonesi Asl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seyed-Amir Pooya Alemzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sareh Askari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seyed-Mohammad Fereshtehnejad.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shabani Zanjani, M., Nasirzadeh, R., Fereshtehnejad, SM. et al. Fetal cerebral hemodynamic in gestational diabetic versus normal pregnancies: a Doppler velocimetry of middle cerebral and umbilical arteries. Acta Neurol Belg 114, 15–23 (2014). https://doi.org/10.1007/s13760-013-0221-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13760-013-0221-7

Keywords

Search

Navigation