Abstract
Purpose
Gestational diabetes mellitus (GDM) is one of the most common morbidities of pregnancy. The impact of increased maternal blood glucose on fetoplacental hemodynamics is not fully elucidated, especially in patients with uncontrolled GDM necessitating insulin therapy. The objective of this study was to assess the impact of insulin therapy on the umbilical artery dopplers in GDM pregnancies with adequate for gestational age fetuses.
Methods
Retrospective observational study among 447 GDM pregnant women, divided according to their treatment: nutritiona therapy (NT), long acting (LA) insulin and combined insulin. The umbilical artery pulsatility index (UA-PI) was recorded at 28, 32 and 36 weeks.
Results
UA-PI values declined in both GDM and healthy controls at all 3 time interval. The combined insulin group showed always a reduced UA-PI values in comparison to LA insulin group but the difference never reached statistical significance. The combined insulin group exhibited significant reduced UA-PI values at 32 and 36-weeks’ gestation compared to the NT groups.
Conclusion
A decreased impedence to blood flow in the umbilical artery of diabetic mothers on insulin therapy was observed, more pronounced during the final stage of pregnancy. Maternal hyperglycemia could have a worsening effect on fetal vasculature. Nevertheless, the extent to which umbilical artery PI can predict unfavorable outcomes associated with maternal hyperglycemia has yet to be determined. Further additional prospective studies are necessary to confirm the precise impact of glucose levels and medical interventions on the circulation of both the fetus and the mother.