妊娠期糖尿病孕妇胎儿大脑沟回发育的超声评价

Ultrasonic evaluation of fetal cerebral sulci and gyrus development in pregnant women with gestational diabetes mellitus

目的分析妊娠期糖尿病(GDM)孕妇晚孕期胎儿大脑沟回超声特征及血流灌注情况。方法前瞻性选取2022年1-10月河南省人民医院进行中晚孕系统筛查的孕28~34周孕妇1540例,纳入GDM孕妇100例为GDM组,根据控制血糖效果将GDM组分为控制血糖效果满意组(GDM 1组)、控制血糖效果不满意组(GDM 2组),每组各50例。同时纳入妊娠28~34周的50例健康孕妇作为对照组。比较三组胎儿外侧裂、顶枕沟、距状沟以及扣带沟的深度之间差异,分析大脑沟回测量值与控制后血糖水平的相关性,并对三组间胎儿脐动脉搏动指数(MCPI)、大脑中动脉搏动指数(UAPI)、静脉导管搏动指数(DVPI)进行比较,以评估三组胎儿血流灌注情况的差异。结果GDM 1组与对照组外侧裂、顶枕沟、扣带沟、距状沟深度测值之间差异无统计学意义(均P>0.05),但均大于GDM 2组(P<0.05)。外侧裂、顶枕沟、扣带沟及距状沟深度与空腹血糖、餐后1 h血糖、餐后2 h血糖呈负相关(均P<0.05)。对照组与GDM 1组MCAPI、UAPI、DVPI差异无统计学意义(均P>0.05),GDM 2组MCAPI小于对照组及GDM 1组,UAPI及DVPI大于对照组及GDM 1组(均P<0.05)。结论GDM孕妇的胎儿大脑沟回发育成熟度与孕妇血糖控制情况有关,孕妇持续高血糖状态,胎儿血流灌注改变可能引起大脑沟回发育迟缓。

Objective To evaluate the development of fetal cerebral sulci and gyrus and the blood perfusion in pregnant women with gestational diabetes mellitus(GDM)by ultrasound.Methods A total of 1540 pregnant women with 28-34 weeks of pregnancy who underwent systematic screening in Henan Provincial People′s Hospital from January 2022 to October 2022 were prospectively selected,100 pregnant women with GDM were selected as the GDM group.According to the effect of blood glucose control,the GDM group was divided into 2 groups:the satisfied control group(GDM group 1),and the dissatisfied control group(GDM group 2),with 50 cases in each group.At the same period,50 healthy pregnant women at 28-34 weeks of gestation were enrolled as the control group.The differences of the sylvian fissure,parietooccipital sulci,calcarine sulci and cinguli sulci among the 3 groups were statistically analyzed.And the correlations between the deep of the brain cerebral sulci and gyrus and controlled blood glucose levels were evaluated.The umbilical artery pulsation index(UAPI),middle cerebral artery pulsation index(MCAPI)and ductus venosus pulsation index(DVPI)among the 3 groups were compared,and the differences in fetal blood perfusion among the 3 groups were evaluated.Results There were no significant differences in the depths of the sylvian fissure,parietooccipital sulci,calcarine sulci and cinguli sulci between the control group and the GDM group 1(all P>0.05),and they were larger than those of the GDM group 2(all P<0.05).The depths of lateral fissure,parieto-occipital sulcus,cingulate sulcus and calcarine sulcus were negatively correlated with fasting blood glucose,1 h and 2 h postprandial blood glucose(all P<0.05).There were no significant differences in MCAPI,UAPI and DVPI between the control group and GDM1 group(all P>0.05).The MCAPI in GDM 2 group was lower than that in the control group and GDM 1 group,and the UAPI and DVPI values were higher than those in the control group and GDM1 group(all P<0.05).Conclusions The maturity of fetal cerebral sulci and gyrus in GDM pregnant women is related to the blood glucose control of pregnant women.The change of blood perfusion caused by persistent hyperglycemia in pregnant women and intrauterine hypoxia may cause the development retardation of cerebral sulci and gyrus.