Monitoring fetal well-being and delivery outcomes in pregnancies complicated by gestational and pregestational diabetes

Abstract

Abstract Background diabetes is a very common pregnancy complication. This study aims to compare measurements taken during antenatal monitoring in the third trimester and delivery outcome data in pregnancies complicated by maternal diabetes with respect to healthy controls. Methods a prospective observational study included a total of 152 pregnant women. 25 had a diagnosis of pregestational diabetes mellitus (PGDM) and 61 were diagnosed with gestational diabetes mellitus (GDM). The remaining 66 were controls. Data collected antepartum for all pregnancies include ultrasound fetal biometry and amniotic fluid evaluation, Umbilical and Middle Cerebral Artery Pulsatility Index (UA-PI, MCA-PI) and computerized CTG (cCTG) monitoring. The mode of delivery and neonatal data, including umbilical cord gas values, were also obtained. The values collected were compared between groups. Results GDM and PGDM groups showed significantly lower values of UA-PI compared to Controls (p < 0.001) and GDMs assumed slightly lower values of MCA-PI compared to Controls (p = 0.028). Some cCTG parameters showed small but significant differences among groups. The analyzed groups presented significant differences in the umbilical artery gas analysis values at birth, which were affected by the mode of delivery. The pH was lower in PGDMs compared to both GDMs (p = 0.0279) and Controls (p < 0.0001), and spontaneous deliveries were associated with lower pH values (p = 0.008). pO2 significantly decreased from Controls to GDMs and PGDMs, respectively (Controls vs GDMs p = 0.0057, Controls vs PGDMs p < 0.001, GDMs vs PGDMs p = 0.0002) while pCO2 followed an opposite trend (Controls vs GDMs p < 0.001, Controls vs PGDMs p < 0.001, GDMs vs PGDMs p = 0.0014). Lactates were higher in PGDMs compared to both other groups (Controls vs PGDMs: p = 0.0128, GDMs vs PGDMs: p = 0.0161) and were higher in vaginal deliveries compared to cesarean sections (p = 0.017). Conclusions The results suggest that to date there are no antenatal monitoring methods that can accurately define the true well-being of the fetus in pregnancies complicated by diabetes. In fact, neonatal outcome data show greater differences between groups than those identified antepartum by the analyzed methods. We hypothesize that only a multi-parametric/multimodal approach can help in antepartum management.