The relationship between abnormal fetoplacental Dopplers, angiogenic markers of placental dysfunction and adverse perinatal outcomes in diabetic pregnancies with small fetuses – A prospective study

IF 3 2区医学 Q2 DEVELOPMENTAL BIOLOGY

Placenta Pub Date : 2025-02-01 DOI:10.1016/j.placenta.2024.12.025

Jesrine Hong , Kylie Crawford , Erika Cavanagh , Vicki Clifton , Fabricio da Silva Costa , Anthony V. Perkins , Sailesh Kumar

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引用次数: 0

Abstract

Introduction

The aim of this study was to evaluate differences in circulating maternal placental biomarkers and fetoplacental Dopplers in women with diabetes mellitus in pregnancy (DIP) with prenatally identified small fetuses (defined as <20th centile for gestational age) compared to women with small fetuses without DIP.

Methods

This was a prospective cohort study of women with DIP with small infants compared to a non-diabetic cohort with similarly small fetuses. Multivariable logistic regression was used to evaluate the effect of DIP on placental biomarkers, fetoplacental Dopplers, and adverse perinatal outcomes.

Results

There were 447 pregnancies in this study – 117 (26.2 %) had DIP and 330 (73.8 %) did not have diabetes. Of the DIP cohort, 57 (48.7 %) had early-onset and 27 (23.1 %) had late-onset FGR. Higher rates of low PlGF levels<100 ng/L (42.1 % vs. 25.7 %,p = 0.002), high sFlt-1/PlGF ratio (39.6 % vs. 25.4 %,p = 0.006), low MCA PI < 5th centile at recruitment (18.8 % vs. 7.6 %,p < 0.001, OR 2.37 95%CI 1.25, 4.46,p = 0.008), abnormal UA Doppler before delivery (OR 1.63 95%CI 1.00, 2.66,p = 0.048) were seen in the DIP cohort. DIP was associated with higher rates of emergency cesarean section (43.6 % vs. 26.7 %,p = 0.001) and lower birthweight (2300 (1558, 2610g) vs. 2447 (2050, 2690g),p = 0.003). The odds of early FGR (OR 1.90 95%CI 1.20, 2.98,p = 0.006), PTB<37 weeks (OR 1.66 95%CI 1.02, 2.70,p = 0.039), PTB<34 weeks’ gestation (OR 3.00 95%CI 1.51, 5.96,p = 0.002), composite non-neurological neonatal morbidity (OR 1.86 95%CI 1.04, 3.33,p = 0.037), and hypoglycemia (OR 3.69 95%CI 1.59, 8.54,p = 0.002) were significantly higher in DIP.

Conclusions

DIP is associated with increased risks of early-onset FGR, PTB, composite severe non-neurological neonatal morbidity, and neonatal hypoglycemia in women with small infants. DIP was significantly associated with increased odds of MCA PI < 5th centile at diagnosis and abnormal UA Doppler before birth.

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糖尿病妊娠伴小胎的胎儿胎盘多普勒异常、胎盘功能障碍血管生成标志物与不良围产期结局的关系——一项前瞻性研究

本研究的目的是评估妊娠期糖尿病（DIP）伴有小胎（定义为胎龄第20百分位）的妇女与无DIP的小胎妇女相比，循环母体胎盘生物标志物和胎胎盘多普勒的差异。方法：这是一项前瞻性队列研究，将有小婴儿的DIP妇女与有类似小胎儿的非糖尿病队列进行比较。采用多变量logistic回归评估DIP对胎盘生物标志物、胎胎盘多普勒和不良围产期结局的影响。结果447例妊娠患者中，117例（26.2%）患有糖尿病，330例（73.8%）未患糖尿病。在DIP队列中，57例（48.7%）为早发性FGR， 27例（23.1%）为晚发性FGR。低PlGF水平和100 ng/L(42.1%比25.7%,p = 0.002)，高sFlt-1/PlGF比率（39.6%比25.4%,p = 0.006），低MCA PI和lt；招聘时第5百分位数(18.8% vs. 7.6%,p <；产前UA多普勒异常（OR 1.63 95%CI 1.00, 2.66,p = 0.048）出现在DIP队列中。DIP与较高的紧急剖宫产率（43.6%对26.7%,p = 0.001）和较低的出生体重（2300 （1558,2610g）对2447 (2050,2690g),p = 0.003）相关。DIP患者早期FGR （OR 1.90 95%CI 1.20, 2.98,p = 0.006）、pttb lt；37周（OR 1.66 95%CI 1.02, 2.70,p = 0.039）、pttb lt；34周妊娠（OR 3.00 95%CI 1.51, 5.96,p = 0.002）、新生儿非神经性并发症（OR 1.86 95%CI 1.04, 3.33,p = 0.037）、低血糖（OR 3.69 95%CI 1.59, 8.54,p = 0.002）的几率显著增高。结论dip与小婴儿妇女早发性FGR、PTB、复合严重非神经性新生儿发病率和新生儿低血糖的风险增加有关。DIP与MCA PI <的发生率增加显著相关；诊断时5百分位，出生前UA多普勒异常。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Placenta 医学-发育生物学

CiteScore

6.30

自引率

10.50%

发文量

391

审稿时长

78 days

期刊介绍： Placenta publishes high-quality original articles and invited topical reviews on all aspects of human and animal placentation, and the interactions between the mother, the placenta and fetal development. Topics covered include evolution, development, genetics and epigenetics, stem cells, metabolism, transport, immunology, pathology, pharmacology, cell and molecular biology, and developmental programming. The Editors welcome studies on implantation and the endometrium, comparative placentation, the uterine and umbilical circulations, the relationship between fetal and placental development, clinical aspects of altered placental development or function, the placental membranes, the influence of paternal factors on placental development or function, and the assessment of biomarkers of placental disorders.