Maternal glycemic control and umbilical artery Doppler velocimetry

To determine whether information from umbilical artery Doppler flow velocity waveforms significantly improves the prediction of adverse perinatal outcome, independently of maternal glycemic control, in pregnancies complicated by diabetes.

The medical records of 277 pregnant women with diabetes were reviewed. Glycemic control was determined by glycosylated hemoglobin concentration and umbilical artery Doppler velocimetry by using systolic/diastolic ratios (S:D), both obtained during the third trimester. Pregnancies with adverse perinatal outcome were compared to those with good outcome. Logistic regression analysis was used to adjust for glycemic control, and to test whether an elevated umbilical artery Doppler S:D ratio was independently associated with pregnancy outcome.

Adverse pregnancy outcome occurred in 51.6% of these pregnancies (143/277). The mean third-trimester glycosylated hemoglobin (7.7 +/- 1.9% vs. 6.7 +/- 1.3%, p < 0.001) and the umbilical artery S:D ratio were significantly higher (2.6 +/- 0.6 vs. 2.4 +/- 0.3, p < 0.001) in the pregnancies with adverse outcome. Logistic regression analysis showed that umbilical artery S:D ratio was an independent predictor of adverse perinatal outcome after adjusting for the third-trimester glycosylated hemoglobin level. Forty per cent of patients with normal Doppler findings (S:D ratio of < 3.0) and normal glycemic control values (glycosylated hemoglobin level of < 7.5%) had an adverse pregnancy outcome. Sixty-three per cent of patients with an abnormal result for one of these tests had an adverse pregnancy outcome. Ninety-six per cent of patients with both abnormal Doppler findings and abnormal glycemic control had an adverse pregnancy outcome.

Umbilical artery Doppler velocimetry improves the predictive value for adverse perinatal outcome, independently of glycemic control, in pregnancies complicated by diabetes. The combination of an abnormal umbilical artery S:D ratio and abnormal glycosylated hemoglobin was strongly associated with adverse pregnancy outcome.