COMPARISON OF UMBILICAL DOPPLER VELOCIMETRY, NONSTRESS TESTING, AND BIOPHYSICAL PROFILE IN PREGNANCIES COMPLICATED BY DIABETES

The purpose of this study was to determine which test is best for pred icting adverse outcomes in pregnancies complicated by diabetes: the no nstress test, biophysical profile, or umbilical artery velocimetry. We evaluated 207 singleton pregnancies complicated by diabetes within 1 week of delivery using the aforementioned pregnancy surveillance tests . Adverse pregnancy outcome was defined as delivery before 37 weeks of gestation or the occurrence of fetal growth restriction, hypocalcemia , hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, or fetal risk requiring cesarean delivery. The prognostic value of each o f the three tests was assessed, after controlling for the mothers' Whi te classification and third trimester glycosylated hemoglobin value. A mong the 207 pregnancies, 75 (36.2%) had an adverse outcome. In pregna ncies in which the umbilical artery systolic to diastolic ratio was gr eater than or equal to 3.0, the relative risk of adverse outcome was 2 .6 (95% confidence interval: 1.9-3.5, P < 0.001). For those with a bio physical profile less than or equal to 6 the relative risk was 1.7 (95 % confidence interval: 0.9-2.9, P = 0.109). Patients with a nonreactiv e nonstress test had a relative risk of 1.7 (95% confidence interval: 1.2-2.5, P = 0.009). Umbilical artery Doppler velocimetry was superior to either the nonstress test or the biophysical profile in identifyin g the subgroup of pregnancies complicated by diabetes that resulted in an adverse outcome.