DIABETES-MELLITUS IN PREGNANCY AND THE ASSESSMENT OF UMBILICAL ARTERYWAVE-FORMS USING PULSED DOPPLER ULTRASONOGRAPHY

The utility of Doppler ultrasonography as a means of assessing potenti al alterations of vascular resistance prior to fetal or maternal compr omise is very attractive. We investigated this relationship by prospec tively performing Doppler studies of the fetal umbilical artery in 56 diabetic patients, 14 of whom had varying degrees of vascular complica tions. When regression curves were established for the S/D ratio, the Pourcelot index, and the resistance index of the fetal umbilical arter y, the mean Doppler values were higher in diabetic patients with vascu lopathy than in nondiabetic control patients or in diabetic patients w ithout vasculopathy. The third trimester S/D ratio was greater than 3. 0 in almost 50% of patients with vasculopathy. A tendency toward adver se outcomes was observed at S/D ratios approaching 4.0. Statistically significant correlations were found between elevated Doppler indices a nd maternal vasculopathy associated with hypertension and worsening re nal insufficiency. Intrauterine growth retardation and neonatal metabo lic complications were also significantly correlated with elevated Dop pler indices. There was, however, no correlation between Doppler indic es and glucose values, although most were within a euglycemic range. T he aforementioned data indicate an increased resistance circuit among diabetics with vasculopathy, which may reflect a relative reduction in basal uteroplacental blood flow and the need for cautious interpretat ion of Doppler indices in these patients.