Diabetic fetopathy – pathogenesis, prognosis, perinatal and neonatal outcomes

Abstract. Diabetes mellitus (DM) during pregnancy is associated with an increased risk of complications for both the mother and the fetus, and may also have adverse long-term consequences for the newborn. The incidence of DM among pregnant women is steadily increasing, which emphasizes the relevance of this problem. Despite progress in diagnostic methods and glucose control in pregnant women with DM, complications during pregnancy remain common, occurring in 80% of women with this disease.

Objective: to study the clinical, laboratory and ultrasound features of patients with gestational diabetes mellitus to determine the risk factors for the development of this pregnancy complication.

Materials and methods. The study included 86 patients and their newborns, who were divided into two groups according to pregnancy outcomes. Group I (main) – 43 women whose pregnancy was complicated by the development of diabetic fetopathy, Group II (control) – 43 patients whose pregnancy ended with the birth of a live full-term baby without signs of diabetic fetopathy.

Results. The following features were identified in the group of women with gestational diabetes mellitus: obesity (53% vs 11%), chronic arterial hypertension (11% vs 2%), thyroid disease (13% vs 4%) (p < 0.05). The presence of obesity increases the chance of developing gestational diabetes mellitus by 8.7 times (OR = 8.7; 95% CI: 2.885–26.478; p = 0.001). Laboratory parameters demonstrated an increase in cholesterol levels (p = 0.04), while no differences in glucose and glycated hemoglobin levels were found between the groups. Ultrasound parameters of the fetus revealed significant differences between the groups: abdominal circumference exceeded the 75th percentile (p = 0.001), double contour of the head was observed (p = 0.044), subcutaneous fat thickness of the neck exceeded 0.32 cm (p = 0.014), and subcutaneous fat thickness of the chest and abdomen exceeded 0.5 cm (p = 0.007). In the control group, with a fetal weight of more than 3000 g, the subcutaneous fat thickness of the neck was more than 0,3 cm, while in the main group it was 0,35 cm, which indicates the need to revise the threshold values in order to increase the prognostic value of the current sign. Statistically significant differences in uteroplacental and fetal-placental blood flow between the groups were not found. Anthropometric parameters of newborns, such as height and weight, also did not show significant differences between the groups. In the main group, periventricular edema was more often recorded (p = 0.02), and laboratory parameters in newborns indicated a significant increase in the frequency of hypoglycemia (p = 0.0002).

Conclusion. The study revealed significant features in women with gestational diabetes mellitus, including an increased risk of comorbidities such as obesity and chronic arterial hypertension, which emphasizes the importance of careful monitoring of the health of pregnant women and regular ultrasound examinations to assess the condition of the fetus. Ultrasound parameters showed changes that require further study and possible revision of existing standards. In addition, due to the lack of significant differences in glucose and glycated hemoglobin levels, it is necessary to analyze glucose variability using a continuous monitoring system, which will provide more accurate glycemic control in patients and have a positive effect on their health. Key words: ultrasound diagnostics, diabetic fetopathy, metabolic disorders, obesity, gestational diabetes mellitus, pregnancy risks, perinatal outcomes, maternal diseases.

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