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| From
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Editorial
A. Abyad (Chief Editor) |
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Original contribution/Clinical Investigation
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Nazanin Farshchian, Farhad Naleini, Amir Masoud
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Anahid Maleki, Alireza Ebrahim Soltani, Alireza
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Faranak Behnaz, Mahshid Ghasemi , Gholamreza
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Prevalence
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Eideh Al-Shehhi, Hessa Al-Dhefairi, Kholoud
Abuasi, Noora Al Ali, Mona Al Tunaiji, Ebtihal
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Study and comparison
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Neda Ardestani-Samani, Mohammad Rabiei, Mohammad
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Dastras, Shirzad Arianmehr
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Ali-Asghar ValiPour, Azimeh Karimyan, Mahmood
Banarimehr, Marzieh Ghassemi, Maryam Robeyhavi,
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Family Stability and Conflict
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Zahra Pourmovahed , Seyed Saied Mazloomy Mahmoodabad
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A comparative
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and Islam
Simin Afrasibi, Zakieh Fattahi
The effectiveness
of cognitive - behavioral therapy in reducing
the post-traumatic stress symptoms in male students
survivors of earthquake in the central district
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Sakineh Salamat, Dr.Ahad Ahangar, Robab Farajzadeh
Reviews
Effects and mechanisms
of medicinal plants on stress hormone (cortisol):
A systematic review
Kamal Solati, Saeid Heidari-Soureshjani, Lesley
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Comparing Traditional
and medical treatments for constipation : A
Review Article
Mohammad Yaqub Rajput
A review of anti-measles
and anti-rubella antibodies in 15- 25 year old
women in Jahrom City in 2011
Ehsan Rahmania , Farideh Mogharab, Vahid Mogharab
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in Jahrom hospital, during 2010-2014
Ali Reza Yousefi , Reza Inaloo
Physical and
mental health in Islam
Bahador Mehraki, Abdollah Gholami
International Health Affairs
The Challenges of Implementation
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from the viewpoint of Nursing Students and Nurses
Saeedeh Elhami, Kambiz Saberi, Maryam Ban, Sajedeh
Mousaviasl, Nasim Hatefi Moadab, Marzieh Ghassemi
Cognitive Determinants
of Physical Activity Intention among Iranian Nurses:
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Arsalan Ghaderi, Firoozeh Mostafavi, Behzad Mahaki,
Abdorrahim Afkhamzadeh,
Yadolah Zarezadeh , Erfan Sadeghi
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Hossein Jafarizadeh, Ebrahim Zhiyani, Nader
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Calculation of Salaries
and Benefits of Faculty Members in the Ministry
of Health and Medical Education of Iran
Abdolreza Gilavand
The effect of education
on self-care behaviors of gastrointestinal side
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Shokoh Varaei, Ehsan Abadi Pishe, Shadan Pedram
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Homa Choheili, Reza Pasha, Gholam Hossein Maktabi,
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Abdolreza Gilavand, Jafar Fatahiasl
An Investigation
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Mahsa Boozaripour , Zanyar Karimi, Sima Zohari
Anbohi, Amir Almasi-Hashiani, Fariba Borhani
Clinical Research and Methods
Comparison of the
Antibacterial Effects of Chlorhexidine Mouth
washes with Jaftex Mouth wash on Some Common
Oral Microorganisms (An in Vitro Study)
Ebrahim Babadi, Zahra Bamzadeh, Fatemeh Babadi
Study of the effect
of plasma jet on Fusarium isolates with ability
to produce DON toxins
Elham Galin Abbasian, Mansour Bayat, Arash chaichi
Nosrati, Seyed Jamal Hashemi, Mahmood Ghoranneviss
The comparison of
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Sahar Zandi, Seyyed Muhammadreza Alavi, Kamran
Mirzaie, Ramin Seyedian, Narges Aria, Saman
Jokar
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|
|
| November 2017
- Volume 15, Issue 9 |
|
|
Comparison of the uterine
artery Doppler indices during pregnancy between
gestational diabetes and diabetes mellitus and
healthy pregnant women
Nazanin Farshchian
Farhad Naleini
Amir Masoud Jaafarnejhad
Parisa Bahrami Kamangar
Department of Radiology, Faculty of Medicine,
Kermanshah University of Medical Sciences, Kermanshah,
Iran
Corresponding Author:
Nazanin Farshchian,
Department of Radiology,
Faculty of Medicine,
Kermanshah University of Medical Sciences,
Kermanshah, Iran
Tel: 09123757729
Email: Nfarshchian@kums.ac.ir
|
Abstract
Introduction:
Diabetes can adversely affect the feto-placental
circulation. This can cause complications
such as congenital malformations of the
fetus, fetal demise, fetal growth abnormalities,
pre-eclampsia, and preterm labor. The
objective of this study was to compare
the uterine artery Doppler indices (resistance
index (RI), plasticity index (PI), and
peak systolic velocity (PSV)) among pregnant
women with diabetes mellitus and gestational
diabetes, with healthy pregnant women.
Methodology:
In this study, 60 pregnant women within
gestational age of 20 to 40 weeks were
consecutively selected. They were in three
groups: diabetes mellitus, gestational
diabetes, and healthy mothers. They were
examined by Doppler ultrasound of the
uterine artery and the RI, PI, and PSV
were recorded. The data were analyzed
using analysis of variance (ANOVA and
Kruskal-Wallis tests.
Results:
There was no significant difference in
terms of the uterine artery RI among the
three studied groups (P> 0.05). There
was a significant difference regarding
PI among the three groups (P< 0.05).
No significant difference existed with
regard to PSV among the three studied
groups (P> 0.05).
Conclusion:
There was a difference regarding PI between
mothers with diabetes mellitus and gestational
diabetes, and healthy mothers.
Key words: Diabetes
mellitus; gestational diabetes; uterine
artery; Doppler ultrasound
|
Diabetes mellitus (DM) is not a single disease;
rather it is a group of metabolic derangements
characterized by hyperglycemia. It is the result
of defect in insulin secretion, insulin function,
or a combination of these. Chronic hyperglycemia
causes damage to various organs including eyes,
kidneys, nervous system, and cardiovascular
system. According to the latest guidelines of
the American Diabetes Association (ADA), the
diagnosis of DM is made by any of the following:
one time glucose level of more than 200 mg/dL
associated with classic symptoms (polydipsia,
polyuria, and polyphagia); fasting plasma glucose
of > 126 mg/dL (fasting is defined as not
taking calories for at least 8 hours previously);
hemoglobin A1C (HbA1C) of > 6.5%, or 2-hour
75-g oral glucose tolerance test (OGTT) of >
200 mg (1). Gestational diabetes is defined
when hyperglycemia is detected for the first
time during pregnancy (2). It occurs in about
3 to 10% of pregnancies and its cause is not
well understood (3). In gestational diabetes,
if fasting plasma glucose is more than 126 mg/dL
or random plasma glucose is > 200 mg/dL,
the diagnosis is made and no challenge test
is required. In cases where that plasma glucose
is lower than the mentioned thresholds, glucose
challenge test is done (4, 5).
Early in pregnancy, diabetes can cause congenital
malformations and raises the risk of abortion.
It also has adverse effects on the fetal organs
such as brain and heart (6-8). Plus, maternal
diabetes can cause excessive growth of the fetus
and macrosomia (9). Macrosomia can result in
difficult labor and raises the likelihood of
cesarean section requirement. In case of natural
delivery, the risks of neonates’ shoulder
injury, hypoxia, and brain injury are increased
(10-12).
Considering the risks of diabetes during pregnancy,
this study was intended to examine the effect
of diabetes on uterine artery circulation and
compare this among three groups of mothers:
DM, gestational diabetes, and normal healthy
mothers. Here, we used Doppler ultrasound which
is a non-aggressive method to study the uterine
artery. This method has been shown to be able
to predict pregnancy loss, increased rate of
complications, and uterine perfusion disturbances
(13). This study aimed to compare the uterine
artery Doppler ultrasound indices among the
three groups of mothers: DM, gestational diabetes,
and normal healthy mothers.
In this analytic case-control study, 60 pregnant
women were selected and included consecutively.
They were within gestational age of 20 to 40
weeks. These presented to our medical center
in 2016. According to laboratory tests performed,
they were categorized as having DM, gestational
diabetes, or being normal healthy mothers without
hyperglycemia. The inclusion criteria were gestational
age from 20 to 40 weeks, no intrauterine growth
retardation, singleton pregnancy, no systemic
background diseases such as hypertension, and
not taking medications such as insulin. The
gestational age was calculated according to
the LMP. If the LMP was unreliable, the first
ultrasound examination (in the first trimester)
of the fetus was used to calculate the gestational
age. Mothers in the DM group had the condition
for less than 5 years, without vascular diseases,
and their blood glucose was under control.
The uterine artery color Doppler ultrasound
was done using Xmatrix iu22 (Philips) with CONVEX
3.5 to 5-MHz probe for the three groups. The
location of the uterine artery after separating
from the hypogastric artery and passing over
external iliac vessels was marked and RI, PI,
and PSV were measured. The three groups were
matched regarding maternal as well as gestational
age. In cases where the placenta was located
right-hand or left-hand of the uterus, the nearest
uterine artery was used for measurement of the
indices. In cases where the uterus was located
at the midline, the average of two measurements
made at the right and left uterine arteries
was recorded.
Data were expressed using descriptive indices
including mean and SD (standard deviation).
The data were analyzed using analysis of variance
(ANOVA) and Kruskal-Wallis tests. All analyses
were done using SPSS software (ver. 22.0, IBM,
US). A P value of less than 0.05 was considered
as statistically significant.
There
were
60
pregnant
women.
Each
group
contained
20
subjects.
Table
1
presents
demographic
characteristics
of
the
sample.
Table
1:
Demographic
characteristics
of
60
pregnant
women
Data
are
presented
as
mean
(±SD).
A
significant
difference
was
observed
regarding
the
uterine
artery
PI
among
the
three
studied
groups
(P<
0.05).
No
difference
was
observed
between
DM
and
gestational
diabetes
regarding
the
uterine
artery
PI.
However,
uterine
artery
PI
in
the
healthy
control
group
was
significantly
lower
compared
to
the
DM
and
gestational
diabetes
groups
(Table
2).
Table
2:
Comparison
of
uterine
artery
PI
(pulsatility
index),
RI
(resistance
index),
and
PSV
(peak
systolic
velocity)
among
diabetes
mellitus,
gestational
diabetes,
and
control
groups
Data
are
presented
as
mean
(±SD).
As
seen
in
Table
2,
the
uterine
artery
RI
did
not
reach
a
significant
difference
among
the
three
groups.
Likewise,
PSV
was
comparable
among
the
three
groups
(Table
2).
During
the
first
trimester,
trophoblasts
penetrate
into
the
uterine
arteries
and
cause
dilation
of
the
spiral
vessels
and
increased
uterine
blood
flow.
In
fact,
the
uterine
blood
flow
increased
from
50
cc
per
minute
in
non-pregnant
women
to
700
cc
per
min
in
pregnant
mothers
towards
the
end
of
the
pregnancy.
In
addition,
in
a
normal
pregnancy,
the
uterine
artery
RI
reduces
in
placental-fetal
circulation
(14).
In
a
previous
study,
no
difference
was
noted
regarding
Doppler
ultrasound
indices
of
the
fetal
spiral
vessels
and
umbilical
artery
among
DM,
gestational
diabetes,
and
healthy
mothers
(15).
In
agreement
with
what
we
observed
here,
a
former
study
noted
that
3D
Doppler
ultrasound
did
not
show
any
difference
between
DM
and
gestational
diabetes.
However,
all
indices
in
diabetic
mothers
showed
decreased
values
when
compared
to
healthy
mothers
and
fetal
and
uterine
blood
flow
had
significant
associations
with
3D
Doppler
indices
(16).
In
contrast
to
our
results,
a
previous
study
reported
that
although
no
difference
was
noted
regarding
mean
values
of
PI
of
the
uterine
artery
between
pre-eclampsia
and
gestational
diabetes,
with
worsening
of
gestational
diabetes,
the
uterine
artery
PI
values
were
higher
in
mothers
whose
pre-eclampsia
became
worse
compared
to
those
whose
pre-eclampsia
did
not
worsen.
This
discrepancy
can
be
due
to
difference
in
study
designs
(17).
In
another
study,
PI
of
fetuses
with
macrosomia
was
significantly
compared
to
normal
fetuses
(18).
It
has
been
shown
that
increased
uterine
artery
impedance
had
significant
association
with
vascular
disorders
before
pregnancy.
In
women
who
delivered
their
neonates
at
earlier
gestational
ages,
the
uterine
artery
PI
had
increased
significantly
which
is
compatible
with
our
study
(19).
The
uterine
artery
waveforms
and
the
systolic
to
diastolic
blood
pressure
ratio
did
not
show
difference
between
the
two
groups
(20).
Although
the
mentioned
studies
have
used
the
uterine
artery
Doppler
indices
in
early
diagnosis
of
uterine
artery
disturbances
due
to
diabetes
and
have
found
it
useful,
the
discrepancy
in
the
results
can
be
due
to
the
number
of
patients
studied
and
the
examined
vessel.
For
example,
in
a
previous
study,
placental
spiral
arteries
and
umbilical
artery
were
examined.
However,
here
we
examined
the
uterine
artery.
Based
on
the
obtained
findings,
in
absence
of
vascular
disorders
and
control
of
hyperglycemia,
uterine
artery
Doppler
indices
of
mothers
with
DM
and
gestational
diabetes
are
close
to
healthy
mothers.
Only
uterine
artery
PI
had
a
difference
among
the
groups.
But,
RI
and
PSV
were
comparable
among
the
three
groups.
One
of
the
limitations
we
had
was
the
low
sample
size.
Therefore,
we
recommend
performing
further
studies
with
larger
sample
sizes.
So
far,
no
study
has
examined
the
uterine
artery
Doppler
ultrasound
of
mothers
with
DM
and
gestational
diabetes.
Mothers
with
DM
and
gestational
diabetes
have
uterine
artery
RI
and
PSV
values
close
to
healthy
mothers
and
no
significant
difference
was
observed.
The
only
significant
difference
was
PI
of
the
uterine
artery
among
the
three
groups.
Acknowledgement
This
article
is
based
on
a
thesis
submitted
to
the
graduate
studies
office
in
partial
fulfillment
of
requirements
for
the
degree
of
Radiology
by
Amir
Masoud
Jaafarnejhad
in
Kermanshah
University
of
Medical
Sciences,
Faculty
of
Medicine.
Financial
support
by
the
Research
Council
of
Kermanshah
University
of
Medical
Sciences
(Grant
Number:
94211).
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