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(Circulation. 2005;112:2496-2500.)
© 2005 American Heart Association, Inc.

Vascular Medicine

Abnormal Uterine Doppler Is Related to Vasculopathy in Pregestational Diabetes Mellitus

Marek Pietryga, MD, PhD; Jacek Brzert, MD, PhD; Ewa Wender-Ogowska, MD, PhD; Romuald Biczysko, MD, PhD; Mariusz Dubiel, MD, PhD; Saemundur Gudmundsson, MD, PhD

From the Division of Obstetrics and Maternal Diseases (M.P., J.B., E.W.-O., R.B.) and the Department of Perinatology and Gynecology (M.D.), Karol Marcinkowski University of Medical Sciences, Poznan, Poland; and the University of Lund, Department of Obstetrics and Gynecology (S.G.), University Hospital MAS, Malmö, Sweden.

Correspondence to Saemundur Gudmundsson, MD, PhD, Lund University, Department of Obstetrics and Gynecology, University Hospital MAS, S-205 02 Malmö, Sweden. E-mail saemundur.gudmundsson{at}obst.mas.lu.se

Received July 16, 2004; revision received July 2, 2005; accepted July 15, 2005.

Background— The aim of the study was to evaluate the relation between maternal placental Doppler velocimetry, levels of the maternal glucose, and clinical signs of vasculopathy in pregnancy complicated by pregestational diabetes mellitus.

Methods and Results— A retrospective study of 155 pregestational diabetic women between the 22nd and 40th weeks of pregnancy, categorized in White classification as B, 49; C, 40; D, 22; R, 20; F, 5; and RIF, 19. Cases in classes R, F, and R/F were defined as having vasculopathy. Doppler velocimetry of umbilical and uterine arteries was evaluated for vascular impedance, both in terms of pulsatility index (PI) for both arteries and a notch in early diastole in the uterine arteries. The last examination before delivery was used for analysis. Increased umbilical artery PI was seen in 19 and a uterine artery abnormality in 45 cases. There was a correlation between levels of HbA_lc and increased vascular impedance in the uterine and umbilical arteries. Signs of increased uterine artery vascular impedances were significantly related to pregestational vasculopathy. In cases of small-for-gestational-age newborn infants, PI was significantly increased in uterine and umbilical arteries. Furthermore, PI in macrosomic fetuses was significantly lower than in normal infants. Abnormal uterine artery Doppler was also strongly related to adverse outcome.

Conclusions— Abnormal uterine artery Doppler is related to pregestational vasculopathy and adverse outcome of pregnancy. The results suggest that the uterine arteries are affected in women with clinical signs of pregestational vasculopathy. This may influence placental perfusion and fetal well-being.

Key Words: diabetes mellitus • perfusion • pregnancy • vessels • vasculopathy