E-ISSN: 2619-9467

Contents    Cover    Publication Date: 06 Jun 2023
Year 2023 - Volume 33 - Issue 2

Open Access

Peer Reviewed

ORIGINAL RESEARCH
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Altered Right Portal and Umbilical Vein Doppler Parameters in Fetal Macrosomia Resulting from Pregestational andGestational Diabetic Mothers: A Prospective Case-Control Study

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JCOG. 2023;33(2):88-94
DOI: 10.5336/jcog.2022-93879
Article Language: EN
Copyright Ⓒ 2024 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: To evaluate the blood flow of the umbilical vein and right portal vein in macrosomic fetuses of diabetic mothers and investigate the effect of maternal insulin treatment on these blood flows. Material and Methods: This prospective case-control study was conducted between March 2019 and December 2019. Fetuses of the 49 pregestational and gestational diabetic mothers who had an abdominal circumference percentile above 97% were evaluated as macrosomic and formed the study group. The study group was divided into two subgroups: patients treated with insulin and those who did not. In the control group, 48 non-diabetic pregnant women with matched gestational weeks whose fetuses are at the 10-90% percentile were included. Time-averaged maximum blood velocity (TAMXV) values of the right portal vein and the free loop of the umbilical vein were measured. Results: The median right portal vein TAMXV value and umbilical vein TAMXV value were found to be significantly higher in diabetic pregnancies (16.25 cm/s, and 15.28 cm/s, respectively) than in the control group (12.76 cm/s, and 13.38 cm/s, respectively, p<0.001). Umbilical and right portal vein flows were similar in macrosomic fetuses of diabetic mothers who were treated with insulin or those who did not. While umbilical vein flow in macrosomic fetuses increased as the gestational age progressed (p=0.028), it was observed steadily in normally growing fetuses. Conclusion: The umbilical and right portal vein flows are higher in macrosomic fetuses of diabetic mothers than in appropriately grown fetuses. Maternal insulin treatment does not affect fetal umbilical vein and right portal vein blood flow in macrosomic fetuses.
REFERENCES:
  1. Kessler J, Rasmussen S, Kiserud T. The fetal portal vein: normal blood flow development during the second half of human pregnancy. Ultrasound Obstet Gynecol. 2007;30(1):52-60. [Crossref]  [PubMed] 
  2. Kessler J, Rasmussen S, Kiserud T. The left portal vein as an indicator of watershed in the fetal circulation: development during the second half of pregnancy and a suggested method of evaluation. Ultrasound Obstet Gynecol. 2007;30(5):757-64. [Crossref]  [PubMed] 
  3. Haugen G, Kiserud T, Godfrey K, Crozier S, Hanson M. Portal and umbilical venous blood supply to the liver in the human fetus near term. Ultrasound Obstet Gynecol. 2004;24(6):599-605. [Crossref]  [PubMed] 
  4. Kessler J, Rasmussen S, Godfrey K, Hanson M, Kiserud T. Venous liver blood flow and regulation of human fetal growth: evidence from macrosomic fetuses. Am J Obstet Gynecol. 2011;204(5):429.e1-7. [Crossref]  [PubMed] 
  5. Ebbing C, Rasmussen S, Kiserud T. Fetal hemodynamic development in macrosomic growth. Ultrasound Obstet Gynecol. 2011;38(3):303-8. [Crossref]  [PubMed] 
  6. Lund A, Ebbing C, Rasmussen S, Kiserud T, Hanson M, Kessler J. Altered development of fetal liver perfusion in pregnancies with pregestational diabetes. PLoS One. 2019;14(3):e0211788. [Crossref]  [PubMed]  [PMC] 
  7. Ebbing C, Rasmussen S, Godfrey KM, Hanson MA, Kiserud T. Redistribution pattern of fetal liver circulation in intrauterine growth restriction. Acta Obstet Gynecol Scand. 2009;88(10):1118-23. [Crossref]  [PubMed] 
  8. Jokkaew N, Pleankong M, Smanchat B, Prommas S, Bhamarapravatana K, Suwannarurk K. Nomogram of fetal right portal vein diameter at gestational age 30 to 35 weeks and prediction of small for gestational age at birth. J Obstet Gynaecol Res. 2021;47(9):3084-90. [Crossref]  [PubMed] 
  9. Vedmedovska N, Rezeberga D, Teibe U, Zodzika J, Donders GG. Adaptive changes in the splenic artery and left portal vein in fetal growth restriction. J Ultrasound Med. 2012;31(2):223-9. [Crossref]  [PubMed] 
  10. Kessler J, Rasmussen S, Godfrey K, Hanson M, Kiserud T. Fetal growth restriction is associated with prioritization of umbilical blood flow to the left hepatic lobe at the expense of the right lobe. Pediatr Res. 2009;66(1):113-7. [Crossref]  [PubMed] 
  11. International Association of Diabetes and Pregnancy Study Groups Consensus Panel; Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676-82. [Crossref]  [PubMed]  [PMC] 
  12. Ölmez F, Oğlak SC, Gedik Özköse Z. Increased maternal serum aquaporin-9 expression in pregnancies complicated with early-onset preeclampsia. J Obstet Gynaecol Res. 2022;48(3):647-53. [Crossref]  [PubMed] 
  13. Behram M, Oğlak SC. The expression of angiogenic protein Cyr61 significantly increases in the urine of early-onset preeclampsia patients. Journal of Contemporary Medicine. 2021;11(5):605-9. [Crossref] 
  14. Oğlak SC, Bademkıran MH, Obut M. Predictor variables in the success of slow-release dinoprostone used for cervical ripening in intrauterine growth restriction pregnancies. J Gynecol Obstet Hum Reprod. 2020;49(6):101739. [Crossref]  [PubMed] 
  15. Can E, Oğlak SC, Ölmez F. Maternal and neonatal outcomes of expectantly managed pregnancies with previable preterm premature rupture of membranes. J Obstet Gynaecol Res. 2022;48(7):1740-9. [Crossref]  [PubMed] 
  16. Lund A, Ebbing C, Rasmussen S, Qvigstad E, Kiserud T, Kessler J. Pre-gestational diabetes: Maternal body mass index and gestational weight gain are associated with augmented umbilical venous flow, fetal liver perfusion, and thus birthweight. PLoS One. 2021;16(8):e0256171. [Crossref]  [PubMed]  [PMC] 
  17. Opheim GL, Henriksen T, Haugen G. The effect of a maternal meal on fetal liver blood flow. PLoS One. 2019;14(6):e0216176. [Crossref]  [PubMed]  [PMC] 
  18. Kessler J, Rasmussen S, Godfrey K, Hanson M, Kiserud T. Longitudinal study of umbilical and portal venous blood flow to the fetal liver: low pregnancy weight gain is associated with preferential supply to the fetal left liver lobe. Pediatr Res. 2008;63(3):315-20. [Crossref]  [PubMed] 
  19. Haugen G, Bollerslev J, Henriksen T. Human fetoplacental and fetal liver blood flow after maternal glucose loading: a cross-sectional observational study. Acta Obstet Gynecol Scand. 2014;93(8):778-85. [Crossref]  [PubMed] 
  20. Spurway J, Logan P, Pak S. The development, structure and blood flow within the umbilical cord with particular reference to the venous system. Australas J Ultrasound Med. 2012;15(3):97-102. [Crossref]  [PubMed]  [PMC] 
  21. Oğlak SC, Obut M. Expression of ADAMTS13 and PCNA in the placentas of gestational diabetic mothers. Int J Morphol. 2021;39(1):38-44. [Crossref] 
  22. Akgöl S, Budak MŞ, Oğlak SC, Ölmez F, Dilek ME, Kartal S. Can maternal abdominal fat thickness predict antenatal insulin therapy in patients with gestational diabetes mellitus? J Obstet Gynaecol Res. 2022;48(3):634-9. [Crossref]  [PubMed] 
  23. Oğlak SC, Yavuz A, Olmez F, Gedik Özköse Z, Süzen Çaypınar S. The reduced serum concentrations of β-arrestin-1 and β-arrestin-2 in pregnancies complicated with gestational diabetes mellitus. J Matern Fetal Neonatal Med. 2022;35(25):10017-24. [Crossref]  [PubMed] 
  24. Tunc S, Oglak SC, Olmez F, Ozkose ZG. The value of first-trimester maternal abdominal visceral adipose tissue thickness in predicting the subsequent development of gestational diabetes mellitus. J Coll Physicians Surg Pak. 2022;32(6):722-7. [Crossref]  [PubMed] 
  25. Grindheim S, Ebbing C, Karlsen HO, Skulstad SM, Real FG, Lønnebotn M, et al. Metformin exposure, maternal PCOS status and fetal venous liver circulation: a randomized, placebo-controlled study. PLoS One. 2022;17(1):e0262987. [Crossref]  [PubMed]  [PMC]