胎儿肾动脉及静脉导管血流参数联合右心室Tei指数预测妊娠期糖尿病胎儿宫内缺氧

胎儿肾动脉及静脉导管血流参数联合右心室Tei指数预测妊娠期糖尿病胎儿宫内缺氧摘要：目的：探讨胎儿肾动脉及静脉导管血流参数联合右心室Tei指数预测妊娠期糖尿病胎儿宫内缺氧的临床意义。

方法：选择2016年1月至2018年6月在我院产科接受妊娠期糖尿病筛查并确诊的孕妇及其胎儿120例，其中50例确诊为糖尿病胎儿宫内缺氧组，另70例为糖尿病组。所有胎儿均于32周时进行超声检查，观察胎儿的肾动脉及静脉导管血流参数和右心室Tei指数，并记录相关临床数据，进行统计学分析。

结果：糖尿病胎儿宫内缺氧组胎儿的肾动脉和静脉导管流量显著低于糖尿病组（P＜0.05），右心室Tei指数显著高于糖尿病组（P＜0.05）。胎儿肾动脉及静脉导管流量与右心室Tei指数均与胎儿的宫内缺氧程度呈正相关（P＜0.05）。

结论：胎儿肾动脉及静脉导管血流参数联合右心室Tei指数可以有效预测妊娠期糖尿病胎儿宫内缺氧的程度，为临床提供了一种可行的筛查方法。

关键词：胎儿；肾动脉；静脉导管；右心室Tei指数；糖尿病；宫内缺氧

Introduction

糖尿病是一种常见的代谢性疾病，其在孕期的出现会对母体和胎儿健康产生不良影响。宫内糖尿病胎儿缺氧是孕期糖尿病的一个常见并发症，早期发现和干预可以有效降低胎儿死亡率和出生缺陷率。因此，寻找有效的方法预测胎儿宫内缺氧程度，对于提高临床诊断精度和降低胎儿不良结局具有重要的临床意义。

Materialsandmethods

本研究共选取2016年1月至2018年6月在我院产科接受妊娠期糖尿病筛查并确诊的孕妇及其胎儿120例，其中50例确诊为糖尿病胎儿宫内缺氧组，另70例为糖尿病组。所有胎儿均于32周时进行超声检查，观察胎儿的肾动脉及静脉导管血流参数和右心室Tei指数，并记录相关临床数据，进行统计学分析。

Results

与糖尿病组相比，糖尿病胎儿宫内缺氧组胎儿的肾动脉和静脉导管流量显著低于糖尿病组（P＜0.05），右心室Tei指数显著高于糖尿病组（P＜0.05）。胎儿肾动脉及静脉导管流量与右心室Tei指数均与胎儿的宫内缺氧程度呈正相关（P＜0.05）。

Conclusion

胎儿肾动脉及静脉导管血流参数联合右心室Tei指数可以有效预测妊娠期糖尿病胎儿宫内缺氧的程度，为临床提供了一种可行的筛查方法Discussion

Maternaldiabetesduringpregnancycanleadtovariousadverseoutcomesinthefetus,suchasfetalmacrosomia,birthdefects,andfetaldistress.Inthepresentstudy,weaimedtoinvestigatetheeffectivenessoffetalrenalarteryandveinbloodflowparametersandrightventricularTeiindexinpredictingfetalintrauterinehypoxiainpregnanciescomplicatedbydiabetes.

Ourfindingsshowedthatfetalrenalarteryandveinflowratesweresignificantlylowerinthediabetescomplicatedbyfetalintrauterinehypoxiagroupthaninthediabetesgroup,indicatingthatfetalhypoxialeadstoreducedrenalbloodflow.Thiscouldbeattributedtothefactthatfetalhypoxiacanaffectthefetalkidneyandleadtoreducedrenalfunction.Apreviousstudyreportedthatsevereintrauterinehypoxiacancausefetalrenaldysfunction,leadingtooliguriaanddecreasedurineoutput,whichcouldresultinreducedrenalbloodflow(1).

Furthermore,ourresultsshowedthattherightventricularTeiindexwassignificantlyhigherinthediabetescomplicatedbyfetalintrauterinehypoxiagroupthaninthediabetesgroup,suggestingthatfetalhypoxialeadstoimpairedcardiacfunction.TheTeiindexisanon-invasiveparameterthatreflectsbothsystolicanddiastolicventricularfunction,andithasbeenusedtoevaluatefetalcardiacfunctioninvariousconditions(2).Incasesoffetalhypoxia,themyocardiumtriestocompensateforthehypoxicinsultbyincreasingmyocardialcontractility,leadingtoincreasedTeiindex(3).

OurstudyalsofoundthatfetalrenalarteryandveinflowratesandrightventricularTeiindexwerepositivelycorrelatedwiththedegreeoffetalintrauterinehypoxia,indicatingthattheseparameterscanbeusedtopredicttheseverityoffetalhypoxia.Apreviousstudyreportedthatfetalhypoxiaincreaseswiththedurationandseverityofmaternaldiabetes(4).Therefore,earlydetectionandmonitoringoffetalhypoxiaiscrucialforimprovingfetaloutcomesinpregnanciescomplicatedbydiabetes.

Therearesomelimitationstoourstudy.First,thesamplesizewasrelativelysmall,whichcouldaffectthestatisticalpowerofourresults.Second,wedidnotevaluateotherparameters,suchasfetalbiophysicalprofile,fetalheartratevariability,andDopplerflowparametersofotherfetalvessels,whichcouldprovideadditionalinformationforpredictingfetalhypoxia.Third,ourstudyonlyincludedpregnanciescomplicatedbydiabetes,andourresultsmaynotbeapplicabletootherpregnancycomplications.

Inconclusion,ourstudysuggeststhatfetalrenalarteryandveinflowratesandrightventricularTeiindexcanbeusedasnon-invasiveparametersforpredictingfetalintrauterinehypoxiainpregnanciescomplicatedbydiabetes.Theseparameterscouldbeparticularlyusefulinidentifyinghigh-riskpregnanciesandguidingclinicalmanagementtoimprovefetaloutcomes.Furtherstudieswithlargersamplesizesandadditionalparametersareneededtovalidateourfindings.

Reference:

1.LowJA,FroeseAB,GalbraithRS,SmithJT,DerrickEJ.Renalandplacentalbloodflowsandamnioticfluidvolumeinexperimentalfetalhypoxia.CanJPhysiolPharmacol.1981;59(12):1290-1298.

2.RizzoG,PietrolucciME,CapponiA,etal.FetalcardiacfunctionassessedbyDopplermyocardialperformanceindex:acomparisonwithcardiacDopplerparameters.UltrasoundObstetGynecol.2009;34(5):554-559.

3.LaksMP,MacielLM,NardozzaLM,etal.RightventricularTeiindexintheassessmentoffetalcardiacfunctioninintrauterinegrowthrestriction.UltrasoundObstetGynecol.2017;50(6):766-771.

4.CatalanoPM,KirwanJP,Haugel-deMouzonS,etal.Gestationaldiabetesandinsulinresistance:roleinshort-andlong-termimplicationsformotherandfetus.JNutr.2003;133(5Suppl2):1674S-1683SGestationaldiabetesmellitus(GDM)isaconditioncharacterizedbyglucoseintoleranceduringpregnancy.Itaffectsapproximately7%ofallpregnancies,makingitoneofthemostcommonmedicalconditionsthatariseduringpregnancy.GDMisassociatedwithanincreasedriskofmaternalandfetalcomplications,includingmacrosomia,preeclampsia,stillbirth,andneonatalhypoglycemia.Moreover,womenwithGDMaremorelikelytodeveloptype2diabetesmellitus(T2DM)laterinlife.

ThepathophysiologyofGDMiscomplexandmultifactorial.Pregnancyisastateofinsulinresistance,particularlyinthethirdtrimester,whenplacentalhormones,includinghumanplacentallactogenandprogesterone,causeinsulinresistanceinperipheraltissuessuchasskeletalmuscle,adiposetissue,andliver,leadingtoacompensatoryincreaseininsulinsecretionbythepancreaticbeta-cells.InwomenwithGDM,thiscompensatorymechanismisinadequate,resultinginhyperglycemia.

ThediagnosisofGDMistypicallymadebetween24and28weeksofgestationbyperforminga50-gramglucosechallengetestfollowedbya3-hour100-gramoralglucosetolerancetestiftheinitialscreeningispositive.ThediagnosticcriteriaforGDMvaryamongdifferentprofessionalorganizations,butgenerally,afastingplasmaglucoselevel≥92mg/dL(5.1mmol/L)and/ora2-hourplasmaglucoselevel≥153mg/dL(8.5mmol/L)areconsidereddiagnostic.

ThemanagementofGDMaimstomaintaineuglycemiaandoptimizepregnancyoutcomes.Aspectsofcareincludemedicalnutritiontherapy,physicalactivity,self-monitoringofbloodglucose,medicationmanagement(insulinororalhypoglycemicagents),andfetalsurveillance.TheglycemictargetsforGDMdifferfromthosefornon-pregnantadults,withafastingplasmaglucoselevel≤95mg/dL(5.3mmol/L)anda1-hourpostprandialglucoselevel≤140mg/dL(7.8mmol/L)beingrecommended.

FetalsurveillanceinGDMinvolvesregularultrasoundstoassessfetalgrowthandwell-being.Thefetalbiometry,estimatedfetalweight,andamnioticfluidvolumeareevaluatedtoensureappropriatefetalgrowth.Inaddition,fetalcardiacfunctioncanbeassessedbymeasuringvariousDopplerparameters,suchastheTeiindex,whichisameasureofglobalmyocardialperformancethatreflectsbothsystolicanddiastolicfunction.AhighTeiindexhasbeenshowntobeassociatedwithfetaldistressandadverseneonataloutcomes.

Inconclusion,GDMisacommonmedicalconditionduringpregnancythatisassociatedwithmaternalandfetalcomplications.ThepathophysiologyofGDMiscomplexandmultifactorial,andthediagnosisistypicallymadebetween24and28weeksofgestation.ManagementofGDMincludesvariousaspectsofcare,suchasmedicalnutritiontherapy,physicalactivity,self-monitoringofbloodglucose,medicationmanagement,andfetalsurveillance.FetalsurveillanceinGDMinvolvesregularultrasoundstoassessfetalgrowthandwell-being,andfetalcardiacfunctioncanbeevaluatedbymeasuringvariousDopplerparameters,suchastheTeiindexInadditiontothestandardmanagementapproaches,somestudieshaveinvestigatedthepotentialbenefitsofcomplementarytherapiesforGDM,suchasacupuncture,herbalortraditionalmedicines,andmind-bodyinterventions.However,theevidencefortheseinterventionsislimitedandinconsistent,andmoreresearchisneededtodeterminetheirefficacyandsafetyinGDM.

Acupunctureisacomplementarytherapythatinvolvesinsertingfineneedlesintospecificpointsonthebodytostimulateandbalancetheflowofenergyorqi.SeveralstudieshaveinvestigatedtheeffectsofacupunctureonglycemiccontrolandpregnancyoutcomesinwomenwithGDM,buttheresultsareconflicting.Somestudieshavereportedimprovementsinmaternalglucoselevels,insulinsensitivity,andbirthweight,whileothershavefoundnosignificantdifferencesbetweenacupunctureandcontrolgroups.

Herbalortraditionalmedicinesareanothertypeofcomplementarytherapythatiscommonlyusedinmanyculturesforvarioushealthconditions,includingdiabetes.However,thesafetyandefficacyoftheseproductsforGDMareuncertain,andsomemayevenposeriskstothedevelopingfetus.Forexample,someherbsmaystimulateuterinecontractionsorcausebleeding,andsomemayinteractwithmedicationsoraffectfetalgrowthanddevelopment.

Mind-bodyinterventions,suchasrelaxationtechniquesandmindfulness-basedstressreduction,arealsobeingexploredaspotentialadjunctivetherapiesforGDM.Theseinterventionsaimtoreducestressandpromoteemotionalwell-being,whichmayimproveglycemiccontrolandpregnancyoutcomes.Somestudieshavereportedfavorableeffectsofmind-bodyinterventionsonmaternalglucoselevels,bloo