Gross patterns of umbilical cord coiling in pregnancies with and without gestational diabetes mellitus

Gestational diabetes mellitus (GDM) may influence the umbilical cord coiling index, but its effect on gross coiling patterns remains unclear. This study compared umbilical cord coiling patterns in pregnancies with GDM to those without and explored associations with placental pathology and adverse perinatal outcomes. The accuracy of antenatal ultrasound in detecting coil indentations and twist direction (sinistral or dextral) was also assessed.

In this prospective study, antenatal ultrasound and postpartum pathological examination were used to assess cord morphology in 200 women with GDM and 100 women without GDM. Ultrasound findings of coil indentations and twist direction were compared to postpartum diagnoses. Placental pathology, including fetal vascular malperfusion, and composite adverse outcomes-such as fetal heart rate decelerations, small-for-gestational-age neonates, low Apgar scores, and neonatal intensive care unit admissions-were analyzed.

Coiling patterns and twist direction were similar between groups and showed no association with fetal vascular malperfusion. However, dextral (right-twisting) umbilical cords were significantly associated with a higher risk of adverse outcomes, even after adjusting for GDM status, gestational age at delivery, coiling index, and gross coiling pattern (adjusted odds ratio = 2.67 [95 % confidence interval 1.34, 5.32]). Antenatal ultrasound accurately detected twist direction in 100 % of cases.

Although umbilical cord morphology does not significantly differ between pregnancies with and without GDM, dextral coiling may indicate an increased risk of adverse perinatal outcomes. Given the high accuracy of ultrasound in detecting twist direction, incorporating this assessment into routine prenatal care may help improve monitoring and outcomes.