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November 2017 -
Volume 15, Issue 9

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From the Editor



Original contribution/Clinical Investigation
Diabetes Mellitus - Knowledge, Management and Complications: Survey report from Faisalabad-Pakistan
Ijaz Anwer, Ahmad Shahzad, Kashmira Nanji, Farah Haider, Muhammad Masood Ahmad

Alanine aminotransferase indicates excess weight and dyslipidemia
Mehmet Rami Helvaci, Orhan Ayyildiz* Mustafa Cem Algin, Yusuf Aydin, Abdulrazak Abyad, Lesley Pocock

Comparative Analysis of Antimicrobial Peptides Gene Expression in Susceptible/Resistant Mice Macrophages to Leishmania major Infection

Hamid Daneshvar, Iraj Sharifi, Alireza Kyhani, Amir Tavakoli Kareshk, Arash Asadi

Does socio-economic status of the patients have effect on clinical outcomes after coronary artery bypass grafting surgery?
Forough Razmjooei, Afshin Mansourian, Saeed Kouhpyma

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

Survey single dose Gentamicin in treatment of UTI in children with range of 1 month to 13 years old in Jahrom during 2015
Ehsan Rahmanian, Farideh Mogharab,
Vahid Mogharab

Evaluation of control of bleeding by electro cauterization of bleeding points of amplatz sheath tract after percutaneous nephrolithotomy (PCNL) in Jahrom Peymanieh hospital during year 2015-2016
Ali Reza Yousefi , Reza Inaloo

Comparison of the three-finger tracheal palpation technique with triple ID formula to determine endotracheal tube depth in children 2-8 years in 2016-2017
Anahid Maleki, Alireza Ebrahim Soltani, Alireza Takzare, Ebrahim Espahbodi,
Mehrdad Goodarzi , Roya Noori

Effect of Sevoflurane and Propofol on pulmonary arterial pressure during cardiac catheterization in children with congenital heart diseases
Faranak Behnaz, Mahshid Ghasemi , Gholamreza Mohseni, Azim Zaraki
Population and Community Studies

Prevalence and risk factors of obesity in children aged 2-12 years in the Abu Dhabi Islands
Eideh Al-Shehhi, Hessa Al-Dhefairi, Kholoud Abuasi, Noora Al Ali, Mona Al Tunaiji, Ebtihal Darwish

Study and comparison of psychological disorders in normal students and students with multiple sclerosis in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Comparative study of self-concept, physical self-concept, and time perspective between the students with multiple sclerosis and healthy students in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Relationship between Coping Styles and Religious Orientation with Mental Health in the Students of the Nursing-Midwifery Faculty of Zabol
Nasim Dastras, Mohsen Heidari Mokarrar, Majid Dastras, Shirzad Arianmehr

Tuberculosis in Abadan, Iran (2012-2016): An Epidemiological Study
Ali-Asghar ValiPour, Azimeh Karimyan, Mahmood Banarimehr, Marzieh Ghassemi, Maryam Robeyhavi, Rahil Hojjati,
Parvin Gholizadeh

Family Stability and Conflict of Spiritual Beliefs and Superstitions among Yazdi People in Iran: A Qualitative Study
Zahra Pourmovahed , Seyed Saied Mazloomy Mahmoodabad ; Hassan Zareei Mahmoodabadi ; Hossein Tavangar ; Seyed Mojtaba Yassini Ardekani ; Ali Akbar Vaezi

A comparative study of the self-actualization in psychology 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 of Varzeghan
Sakineh Salamat, Dr.Ahad Ahangar, Robab Farajzadeh


Effects and mechanisms of medicinal plants on stress hormone (cortisol): A systematic review
Kamal Solati, Saeid Heidari-Soureshjani, Lesley Pocock

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

Review of percutaneous nephrolithotomy in children below 12 years old 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 of Professional Ethics Standards in Clinical Care 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: An Application of Integrative Model of Behavior Prediction
Arsalan Ghaderi, Firoozeh Mostafavi, Behzad Mahaki, Abdorrahim Afkhamzadeh,
Yadolah Zarezadeh , Erfan Sadeghi

Effect of resilience-based intervention on occupational stress among nurses
Hossein Jafarizadeh, Ebrahim Zhiyani, Nader Aghakhani, Vahid Alinejad, Yaser Moradi

Education and Training

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 effects on patients undergoing chemotherapy
Shokoh Varaei, Ehsan Abadi Pishe, Shadan Pedram Razie, Lila Nezam Abadi Farahani

Creating and Validating the Faith Inventory for Students at Islamic Azad University of Ahvaz
Solmaz Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Creating and Validating the Adjustment Inventory for the Students of Islamic Azad University of Ahvaz
Homa Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Evaluating the Quality of Educational Services from the Viewpoints of Radiology Students of Ahvaz Jundishapur University of Medical Sciences
Abdolreza Gilavand, Jafar Fatahiasl

An Investigation of Psychosocial aspect of Iranian Nursing Students' Clinical Setting
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 anti-inflammatory effect in two methods of topical dexamethasone injection and topical application of ginger alcoholic extract after removing mandibular wisdom teeth
Sahar Zandi, Seyyed Muhammadreza Alavi, Kamran Mirzaie, Ramin Seyedian, Narges Aria, Saman Jokar

The effect of curcumin on growth and adherence of major microorganisms causing tooth decay
Leila Helalat, Ahmad Zarejavid, Alireza Ekrami, Mohammd Hosein Haghighizadeh, Mehdi Shiri Nasab

Middle East Quality Improvement Program

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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


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.

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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