ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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Gestational Diabetes Mellitus: Predicting Diabetic Fetopathy

DOI:10.31550/1727-2378-2020-19-6-45-49
For citation: Remnyova O.V., Rozhkova O.V., Trukhacheva N.V., Brusentsov I.G. Gestational Diabetes Mellitus: Predicting Diabetic Fetopathy. Doctor.Ru. 2020; 19(6): 45–49. (in Russian) DOI: 10.31550/1727-2378-2020-19-6-45-49
23 July 15:48

Study Objective: To identify the most significant and least variable ultrasound markers of diabetic fetopathy (DF) in fetuses of patients with gestational diabetes mellitus (GDM) and create a mathematical model for predicting DF.

Study Design: This was a retrospective, comparative study.

Materials and Methods: One hundred and eighteen patients with GDM who gave birth to full-term babies after a singleton pregnancy were included in the study and divided into two groups. Group I consisted of 39 pregnant women whose fetuses met typical ultrasound criteria of DF, and Group II was made up of 79 pregnant women whose fetuses did not meet these criteria. Ultrasound data on fetuses in the full-term stage were thoroughly evaluated and the sensitivity and specificity of certain ultrasound markers of DF were assessed in order to create a mathematical model for predicting this condition.

Study Results: Different combinations of ultrasound markers of DF (macrosomia, hepatomegaly, cardiomegaly/cardiomyopathy, edema and thickening of the subcutaneous fat, double contour of the fetal skull, and polyhydramnios) were found in 33.1% of the patients with GDM; in the postnatal period, however, DF was confirmed only in 12 (10.2%) newborns. Diet has been proven to reduce the risk of DF in patients with GDM (odds ratio [OR] 0.151; 95% confidence interval [CI]: 0.004–0.4; р = 0.02). When hyperglycemia is left untreated, the risk of fetal macrosomia and DF increases: OR 3.86 (95% CI: 1.07–13.97; р = 0.04) for fetal macrosomia and 4.98 (95% CI: 1.26–19.8; р = 0.03) for DF.

The regression mathematical model created in this study includes six ultrasound markers of DF, with asymmetric fetal macrosomia being the most significant (45 points). This model is highly sensitive (100%) and specific (93.7%), and has a high prognostic value (96.9%) for a negative result.

Conclusion: Analysis of the predictive capacity of this regression prognostic model for DF showed that it is quite effective for predicting both DF (83.3%) and its absence (true negatives in 96.9% of cases). The overall percentage of accurate results was 95.4%.

Contributions: Dr. O.V. Remnyova was responsible for design of the study, scientific guidance, and writing and approving the manuscript. Dr. O.V. Rozhkova collected clinical material, selected patients, performed ultrasonography, and analyzed and interpreted study data. N.V. Trukhacheva did statistical analysis and developed the mathematical prognostic model for DF. Dr. I.G. Brusentsov reviewed relevant publications.

Conflict of interest: The authors declare that they do not have any conflict of interests.

O.V. Remnyova (Corresponding author) — Altai State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Federation Ministry of Health; 40 Lenin Prospect, Barnaul, Russian Federation 656038. DAR, Altai Territorial Perinatal Clinical Center (a Territorial Government-funded Healthcare Institution); 154 Fomin St., Barnaul, Russian Federation 656048. eLIBRARY.RU SPIN: 7338-2147. ORCID: http//orcid.org/0000-0002-5984-1109. E-mail: rolmed@yandex.ru

O.V. Rozhkova — Altai State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Federation Ministry of Health; 40 Lenin Prospect, Barnaul, Russian Federation 656038. DAR, Altai Territorial Perinatal Clinical Center (a Territorial Government-funded Healthcare Institution); 154 Fomin St., Barnaul, Russian Federation 656048. ORCID: http//orcid.org/0000-0002-9985-4078. E-mail: rojkovaov@mail.ru

N.V. Trukhacheva — Altai State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Federation Ministry of Health; 40 Lenin Prospect, Barnaul, Russian Federation 656038. eLIBRARY.RU SPIN: 3515-5231. ORCID: http//orcid.org/0000-0002-7894-4779. E-mail: tn10@mail.ru

I.G. Brusentsov — Altai State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Federation Ministry of Health; 40 Lenin Prospect, Barnaul, Russian Federation 656038. eLIBRARY.RU SPIN: 7220-9782. E-mail: surb22@mail.ru

Доктор.ру

Table 1
Predictive value of ultrasound markers of diabetic fetopathy in patients with gestational diabetes mellitus, %

t7_1.jpg

Table 2
Frequency of diabetic fetopathy (DF) in newborns by treatment given to their mothers, n (%)

t7_2.jpg 

Table 3
Diagnostic scale for diabetic fetopathy

t7_3.jpg

Figure. ROC curve for a mathematical prognostic model for diabetic fetopathy

r7_1.jpg

Received: 07.11.2019
Accepted: 09.12.2019

23 July 15:48
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