Gestasyonel ve pregestasyonel diyabette Caval Aort İndeksinin ultrasonografik değerlendirmesi: perinatal sonuçları öngörebilir mi?

Abstract

Amaç: Diabetes mellitus (DM), gebelik diyabeti (GDM) ve gebelik öncesi diyabeti (pre-GDM) içermekle beraber hiperglisemi ve vasküler değişiklikler nedeniyle maternal ve fetal sonuçları olumsuz etkileyebilir. Kaval aortik indeks, dolaşımdaki kan hacmini değerlendiren non-invaziv bir parametre olup, bu komplikasyonlar ile ilişkilendirilebilir. Biz de çalışmamızda diyabetli gebelerde inferior vena kava (IVC) ve aort (Ao) çaplarındaki fonksiyonel değişikliklerin yanı sıra kaval aort indeksinin perinatal sonuçları tahmin etmedeki önemini belirlemeyi amaçladık. Yöntemler: Bu prospektif vaka-kontrol çalışmasına 120 DM olan gebe ve 100 sağlıklı kontrol gebesi dahil edilmiştir. DM olan gebeler; pre-GDM, diyetle düzenlenen ve insülinle düzenlenen GDM olarak üç gruba ayrılmıştır. Ultrasonografi ile inferior vena kava ve aort çapları ölçülmüş ve Doppler değerlendirmeleri yapılmıştır. Bu parametrelerin olumsuz perinatal sonuçlarla ilişkisi istatistiksel analizlerle değerlendirilmiştir. Bulgular: DM olan gebelerin IVC ve aort çapları, kontrol grubuna kıyasla daha yüksek olup gruplar arasında istatistiksel olarak anlamlı fark (p<0.001) saptanmasına rağmen kaval aortik indeks gruplar arasında benzerdi. Olumsuz perinatal sonuçlar (APGAR 5. dakika <7, mekanik ventilasyon ihtiyacı, sürekli pozitif hava yolu basıncı ihtiyacı, solunum sıkıntısı sendromu, yenidoğanın geçici taşipnesi, yenidoğan yoğun bakım ünitesine yatış ve yenidoğanda düşük kordon kanı pH'ı) DM gruplarında daha yüksek bulunmasına rağmen, bu sonuçlar ile IVC veya aort çapı parametreleri arasında doğrudan bir korelasyon saptanmamıştır. DM olan gebelerde IVC çapı en anlamlı prediktif parametre olarak belirlenmiş ve >3.81 mm kesim noktası ile AUC: 0.674 olarak hesaplanmıştır. Sonuç: Ultrasonografik IVC ve aort çapları, diyabetik gebeliklerde vasküler adaptasyonları yansıtabilir ancak olumsuz perinatal sonuçları öngörmede sınırlı değere sahiptir. Kaval aortik indeksin prognostik değeri düşük olmakla birlikte, bu ölçümlerin kapsamlı risk değerlendirme modellerine entegre edilmesi, perinatal risk öngörüsünü artırabilir.

Keywords

• Gebelik diyabeti
• gebelik öncesi diyabet
• kaval aort indeks
• perinatal sonuçlar
• ultrasonografi
• vasküler adaptasyonlar

Ultrasonographic evaluation of Caval Aortic Index in gestational and pregestational diabetes: a predictor of perinatal outcomes?

Abstract

Aims: Diabetes mellitus (DM), including gestational (GDM) and pregestational diabetes (pre-GDM), adversely affects maternal and fetal outcomes due to hyperglycemia and vascular changes. The Caval Aortic Index, a non-invasive measure of blood volume, could provide insights into these complications. In our study, we aimed to determine the functional changes in inferior vena cava (IVC) and aorta (Ao) diameters as well as the importance of caval aortic index in predicting perinatal outcomes in diabetic pregnant women. Methods: This prospective case-control study included 120 DM patients and 100 controls. DM patients were divided into pre-GDM, diet-regulated GDM, and insulin-regulated GDM groups. Ultrasound measurements of inferior vena cava and aortic diameters were performed, alongside Doppler evaluations. Statistical analyses were conducted to assess the association of these parameters with adverse perinatal outcomes. Results: Although the IVC and aortic diameters of the pregnant women with DM were higher compared to the control group and a statistically significant difference (p<0.001) was found between the groups, the Caval-Aortic Index was similar between the groups. Adverse outcomes (APGAR 5 min <7, need for mechanical ventilation, need for continued positive airway pressure, respiratory distress syndrome, transient tachypnea of the newborn and neonatal intensive care unit admission and neonatal low cord blood pH) were higher in DM groups but showed no direct correlation with IVC or aortic parameters. IVC diameter was the most predictive parameter in DM patients and the cut-off was >3.81 mm (AUC: 0.674). Conclusion: Ultrasonographic IVC and aortic diameters reflect vascular adaptations in diabetic pregnancies but lack predictive value for adverse outcomes. While the Caval Aortic Index provides limited prognostic utility, integrating these measurements into comprehensive models may enhance perinatal risk assessment.

Keywords

• Gestational diabetes
• pregestational diabetes
• Caval Aortic Index
• perinatal outcomes
• ultrasonography
• vascular adaptations

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