Ultrasonic Doppler Technology Research Of Fetal Hemodynamics And Influence Factors Of Abnormal Glucose Metabolism During Pregnancy

Objectives To investigate the predictive value of hemodynamic parameters of fetal middle cerebral artery(MCA),umbilical artery(UA)and uterine artery(Ut-A)of pregnant women with abnormal glucose metabolism during pregnancy.To find out the influencing factors of abnormal pregnancy outcome in pregnancy with abnormal glycometabolism.Methods A total of 230 term pregnant women with singleton between October 2016 and September 2018 in the North China University of Science and Technology Affiliated Hospital were included in the present study.An ultrasound examination was performed 5 days before delivery.They were divided into group I,abnormal glucose metabolism in pregnancy,109 cases.and group II,normal control group,121 cases.Group I was divided into group IA1 of gestational diabetes mellitus,95 cases and group IA2 of pregestational diabetes mellitus,14 cases.Group I was divided into group IB1 of Poor prognosis,75 cases.and group IB2 of Good prognosis,34 cases.Including the ultrasound parameters: MCA-RI,MCA-PI,MCA-S/D,UA-RI,UA-PI,UA-S/D,Ut-A-RI,Ut-A-PI,Ut-A-S/D,biparietal diameter-BPD,head circumference-HC,abdominal circumference-AC,femur lengthFLwere collected.The clinical parameters included: maternal height,weight,gestational age,biochemical index,etc.Database was established by Excel 2013,SPSS 20 statistical software was uesd for statistical analysis.The measurement data are expressed in sx ±,Comparison of two sets of measured data obeying normal distribution using t test,Use of Wilcoxon symbol rank sum test for disobeying normal distribution.Comparison of three groups of measurement data by variance analysis.Count data are expressed in frequency or rate.Comparison using Pearson chi square test.ROC curve analysis was used to find the boundary value of the hemodynamic parameters to predict the adverse outcome of pregnancy.Two yuan Logistic stepwise regression method was used to analyze the factors affecting the outcome of pregnancy.Test level alpha P<0.05.Results 1 Comparison of hemodynamic parameters between group IA1,IA2 and group II:(1)the value of MCA-PI,MCA-RI and MCA-S/D in group IA1 and IA2 are less than group II,The difference was statistically significant(P<0.05),It showed that the blood flow resistance of MCA in group IA1 and IA2 were lower than that in group II.Group I ’s ratio of UA-PI,UA-RI,UA-S/D,Ut-A-PI,Ut-A-RI,Ut-A-S/D,PI’s ratio(Ut-A/MCA),RI’s ratio(Ut-A/MCA),S/D’s ratio(Ut-A/MCA)are larger than those of group II.(2)The difference was statistically significant(P<0.05),The results showed that the blood flow resistance of UA and Ut-A in group IA1 and IA2 were higher than that in group II,the changes of blood flow resistance in group IA1 and IA2,UA,MCA and Ut-A were larger than those in group II.(3)Comparison of hemodynamic parameters between group IA1 and group IA2,Results show,the hemodynamic parameters of the two groups of MCA,UA and Ut-A were not statistically significant(P>0.05),The results showed that the blood flow resistance of MCA,UA and Ut-A in group IA1 and group IA2 was not different.2 Comparison of hemodynamic parameters between group IB1 and group IB2,the ratio of MCA-PI,MCA-RI and RI(UA/MCA)in group IB1 was less than that of group IB2,The difference was statistically significant(P<0.05),The results showed that the fetal MCA blood flow resistance in group IB1 was lower than that in group IB2,The change degree of blood flow resistance of fetal UA and fetal MCA in group IB1 was smaller than that in group IB2,The UA-PI,UA-RI,UA-S/D,Ut-A-PI,PI ratio(Ut-A/MCA)and RI ratio(Ut-A/MCA)of the patients in group IB1 were higher than those of IB2.The difference was statistically significant(P<0.05),The results showed that the blood flow resistance of UA and Ut-A in group IB1 was higher than that in group IB2,The changes of blood flow resistance in Ut-A and MCA in group IB1 were larger than that in group IB2.3 The analysis of MCA,UA,and Ut-A hemodynamic parameters was used to predict the adverse outcome of pregnancy by ROC curve: When the value of MCA-PI was 1.56,the sensitivity and specificity of predicting the adverse outcome of pregnancy were 91.2% and 80%,When the value of the RI ratio(MCA/UA)was 0.84,the sensitivity of predicting the adverse outcome of pregnancy was 88.2% and the specificity was 92%,The results showed that the ratio of MCA-PI and RI(MCA/UA)had high sensitivity and specificity in predicting the adverse outcome of pregnancy.4 Analysis of factors related to adverse outcome of pregnancy: high altitude abdominal blood glucose(OR=2.802,95%CI 1.526~5.145,P<0.05),high levels of test OGTT one hour glucose(OR=538,95%CI 1.070~2.209,P<0.05),high weight gain index during pregnancy(OR=49.549,95%CI 3.581~637.506,P<0.05),family history of diabetes(OR=43.393,95%CI 1.464~1286.062,P<0.05)are the risk factors,pregnancy exercise(OR=0.068,95%CI 0.009~0.522,P<0.05)is a protective factor for the outcome.Conclusions 1 The blood flow resistance of MCA in pregnant women with abnormal glucose metabolism was lower than that of normal pregnant women,and the blood flow resistance of UA and Ut-A was higher than that of normal pregnant women.The changes of blood flow resistance in MCA,UA and Ut-A were greater than those of normal pregnant women.2 Abnormal glucose metabolism in late pregnancy,MCA blood flow resistance of pregnant women with poor prognosis is lower than that of pregnant women with good prognosis,Blood flow resistance of UA and Ut-A is higher than that of pregnant women with good prognosis,The change degree of blood flow resistance of Ut-A and MCA in pregnant women is greater than that of normal pregnant women.3 Prediction of abnormal pregnancy outcome by using the existing hemodynamic parameters in pregnancy,The single hemodynamic parameter MCA-PI has high sensitivity and specificity,The combined hemodynamic parameters RI ratio(MCA/UA)has high sensitivity and specificity,The hemodynamic parameters can be used to predict the adverse outcome of pregnancy,And the accuracy of the combined vascular flow resistance RI ratio(MCA/UA)is better than that of the single vascular blood flow resistance value MCA-PI.4 High altitude abdominal blood glucose,High OGTT experiment 1H blood glucose,BMI≥24.0kg/m2 and Family history of diabetes are the risk factors for abnormal pregnancy outcome.Pregnancy exercise is a protective factor for the outcome of abnormal pregnancy.