ROLE OF ULTRASOUND IN EVALUATING THE EFFECT OF GESTATIONAL DIABETIES MELLITUS & HYPERTENSION ON FETUS

Abstract

Background: Gestational diabetes mellitus (GDM) and gestational hypertension (GIH) are common pregnancy complications with opposing effects on fetal development: GDM results in fetal hyperinsulinemia leading to macrosomia, while GIH leads to placental insufficiency resulting in intrauterine growth restriction (IUGR). The aim of this study was to assess fetal outcome using ultrasonography in these high-risk pregnancies with particular focus on the Doppler-derived cerebroplacental ratio (CPR). Aim: The aim of this study was to assess the impact of GDM and GIH on fetal development using ultrasonography with special reference to Doppler velocimetry and to evaluate the role of CPR in the detection of fetal adaptive responses and prediction of adverse outcomes in high-risk pregnancies. Methods: A retrospective cross sectional study of 295 pregnant women was performed and the women were divided into three groups: GDM (n=36), GIH (n=107), and combined GDM/GIH (n=152). Full gray-scale ultrasonography and Doppler velocimetry of umbilical and middle cerebral arteries were carried out and fetal outcome classified according to growth patterns, CNS anomalies and fetal compromise. The statistical analysis used was Kruskal-Wallis tests and linear regression using SPSS Version 27.0. Results: There was an interesting contrast: macrosomia was seen in 63.9% of the GDM cases with universal polyhydramnios, while IUGR was seen in 43.9% of the GIH cases with 92.3% oligohydramnios. The positive association between DM and fetal growth (β = +0.0022, p = 0.011) and the negative association between blood pressure and fetal growth (β = −0.0558, p < 0.001) were confirmed by regression analysis. The brain sparing rate was highest in the hypoxia group (86.7%), and was significantly lower than in normal fetuses (1.15 ± 0.14 vs. 2.20 ± 0.37; p < 0.001). The 33 cases of intrauterine fetal death were all in pregnancies complicated by GIH.