Correlation between Haemoglobin A1c and Umbilical Artery Doppler as Predictors for Perinatal Outcome in Pregestational Diabetic Pregnancy and Pregestational Diabetic Pregnancy Complicated By Preeclampsia In Third Trimester
Journal Title: The Egyptian Journal of Hospital Medicine - Year 2018, Vol 71, Issue 7
Abstract
<span>Background: </span><span>Diabetes mellitus is one of the most common metabolic disorders that occur during pregnancy. It has two clinical patterns; either pregestational diabetes mellitus or gestational diabetes mellitus. Pregestational diabetes mellitus is associated with worse maternal and fetal outcomes compared to gestational diabetes mellitus. </span><span>Objectives: </span><span>To assess usefulness of using both heamoglobin A1C and umbilical artery Doppler velocity waveform analysis in predicting adverse perinatal outcomes for both pregestational diabetic pregnancies & pregestational diabetic pregnancies complicated by preeclampsia.<br /> </span><span>Methods</span><span>: </span><span>This comparative study was conducted on 150 pregnant women with gestational age 34 </span><span>– </span><span>40 weeks who were equally divided into 3 groups; 50 pregnant women with pregesational diabetes melleitus alone and 50 pregestional diabetes melleitus complicated with preeclampsia. These two groups were compared with 50 healthy pregnant women, free from medical disease, as control group. </span><span>Results: </span><span>In pregnant women with pregestational DM, HbA1c should be kept below 7% and it is better to be less than 6.5% by proper glycemic control, as higher levels of HbA1c were associated with bad perinatal outcomes in the forms of RDS, neonatal hypoglycemia, macrosomia, IUGR, Apgar score 1 & 5min and NICU24. In addition to, bad maternal outcomes in the forms of polyhyramnios, preterm labor, PROM, prolonged labor, mode of delivery, postpartum hemorrage, puerperal sepsis, pulmonary embolism, preeclampsia and its complications as eclampsia, HELLP syndrome, renal affection, hepatic affection and retinal affection. There was no significant relation between long term maternal glycemic control (HbA1c) & the changes of blood flow velocity in the umbilical artery in pregnancy complicated with diabetes mellitus unless the pregnancy is complicated with fetal growth restriction or preeclampsia. </span><span>Conclusion: </span><span>An increased pulsatility index of umbilical Doppler was found in our study to be the important predictor of perinatal outcome in diabetic pregnancies complicated by preeclampsia but not in uncomplicated diabetic pregnancy.<br /> </span>
Authors and Affiliations
Eman Helal
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