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Doppler Sonography in Pregnancies Complicated by Pre-gestational Diabetes Mellitus

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Doppler Ultrasound in Obstetrics and Gynecology

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Abstract

Diabetes mellitus is one of the most common complications of pregnancy, with the global number of cases increasing each year. This has resulted in a higher prevalence of this condition in women of childbearing age. Although antenatal surveillance is warranted in these mothers given the well-known risk of complications that they may present, and Doppler studies provide a reliable assessment of the fetal and uterine hemodynamics, solid evidence regarding the utility of Doppler interrogation in the prediction of complications in pre-gestational diabetic pregnancies is still limited. The detrimental effects of maternal hyperglycemia and/or hypoglycemia in the maternal, fetal, and placental vasculatures have been well-studied in animals models and humans. Through different mechanisms described in this chapter, maternal hyperglycemia causes fetal oxidative stress, fetal hypoxia, acidemia, redistribution of the perfusion to fetal organs, and, ultimately, cardiac dysfunction and vascular injury. All these hemodynamic changes can be detected by the use of novel Doppler techniques.

In this chapter, we present some of the most relevant studies analyzing the relationship between umbilical artery Doppler studies and adverse perinatal outcomes as well as the association of the former with the level of maternal glycemia. Furthermore, we present the work of several authors who investigated the utility of the Doppler interrogation of other systems such as the middle cerebral artery, fetal venous system, fetal heart, uterine artery, and placenta in cases complicated by pre-gestational diabetes. Studies show that the applicability of these and other Doppler studies, although not yet supported by strong evidence, appears to yield promising results. Further studies to elucidate the real potential of the contribution of Doppler studies to pre-gestational diabetic mothers are warranted.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, UMKC School of Medicine/Truman Medical Center, UMKC School of Medicine, Kansas City, MO, USA

    Gustavo Vilchez & Dev Maulik

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  1. Gustavo Vilchez
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Correspondence to Gustavo Vilchez .

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  1. Department of Obstetrics and Gynecology, University of Missouri–Kansas City, Kansas City, MO, USA

    Dev Maulik

  2. Department of Metabolism, Digestion and Reproduction, Imperial College Healthcare NHS Trust, London, UK

    Christoph C. Lees

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Vilchez, G., Maulik, D. (2023). Doppler Sonography in Pregnancies Complicated by Pre-gestational Diabetes Mellitus. In: Maulik, D., Lees, C.C. (eds) Doppler Ultrasound in Obstetrics and Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-031-06189-9_22

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