The University of Southampton
University of Southampton Institutional Repository

Altered development of fetal liver perfusion in pregnancies with pregestational diabetes

Altered development of fetal liver perfusion in pregnancies with pregestational diabetes
Altered development of fetal liver perfusion in pregnancies with pregestational diabetes

Background Pregestational diabetes is associated with fetal macrosomia, and umbilical perfusion of the fetal liver has a role in regulating fetal growth. We therefore hypothesized that pregestational diabetes alters fetal liver blood flow depending on degree of glycemic control. Methods In a prospective study, 49 women with pregestational diabetes underwent monthly ultrasound examinations during 24-36 gestational weeks. Blood flow was determined in the umbilical vein, ductus venosus and portal vein, and blood velocity was measured in the left portal vein, the latter reflecting the watershed between splanchnic and umbilical flow. The measurements were compared with reference values by z-score statistics, and the effect of HbA 1c assessed. Results The umbilical venous flow to the liver (z-score 0.36, p = 0.002), total venous liver flow (z-score 0.51, p<0.001) and left portal vein blood velocity (z-score 0.64, p<0.001), were higher in the study group. Normalized portal venous flow was lower (z-score -0.42, p = 0.002), and normalized total venous liver flow tended to be lower after 30 gestational weeks (z-score -0.54, p = 0.047) in the diabetic pregnancies compared with reference values from a low-risk population. The left portal vein blood velocity was positively, and the portal fraction of total venous liver flow negatively correlated with first trimester HbA 1C . Conclusions In spite of increased umbilical blood distribution to the fetal liver, graded according to glycemic control, the total venous liver flow did not match third trimester fetal growth in pregnancies with pregestational diabetes, thus contributing towards increased perinatal risks and possibly altered liver function with long-term metabolic consequences.

1932-6203
Lund, Agnethe
005617ac-cff8-427d-8c37-e262faf6ebdc
Ebbing, Cathrine
72ebfc05-95c6-4fea-a095-b9493c7e1ff5
Rasmussen, Svein
553e2196-bbb7-4a95-a583-792b2b5a65b9
Kiserud, Torvid
a7689962-989b-4f84-ae1a-dbc10b57c5f9
Hanson, Mark
1952fad1-abc7-4284-a0bc-a7eb31f70a3f
Kessler, Jörg
2112d15d-24b5-48c0-a800-40f1cd70a05b
Lund, Agnethe
005617ac-cff8-427d-8c37-e262faf6ebdc
Ebbing, Cathrine
72ebfc05-95c6-4fea-a095-b9493c7e1ff5
Rasmussen, Svein
553e2196-bbb7-4a95-a583-792b2b5a65b9
Kiserud, Torvid
a7689962-989b-4f84-ae1a-dbc10b57c5f9
Hanson, Mark
1952fad1-abc7-4284-a0bc-a7eb31f70a3f
Kessler, Jörg
2112d15d-24b5-48c0-a800-40f1cd70a05b

Lund, Agnethe, Ebbing, Cathrine, Rasmussen, Svein, Kiserud, Torvid, Hanson, Mark and Kessler, Jörg (2019) Altered development of fetal liver perfusion in pregnancies with pregestational diabetes. PLoS ONE, 14 (3). (doi:10.1371/journal.pone.0211788).

Record type: Article

Abstract

Background Pregestational diabetes is associated with fetal macrosomia, and umbilical perfusion of the fetal liver has a role in regulating fetal growth. We therefore hypothesized that pregestational diabetes alters fetal liver blood flow depending on degree of glycemic control. Methods In a prospective study, 49 women with pregestational diabetes underwent monthly ultrasound examinations during 24-36 gestational weeks. Blood flow was determined in the umbilical vein, ductus venosus and portal vein, and blood velocity was measured in the left portal vein, the latter reflecting the watershed between splanchnic and umbilical flow. The measurements were compared with reference values by z-score statistics, and the effect of HbA 1c assessed. Results The umbilical venous flow to the liver (z-score 0.36, p = 0.002), total venous liver flow (z-score 0.51, p<0.001) and left portal vein blood velocity (z-score 0.64, p<0.001), were higher in the study group. Normalized portal venous flow was lower (z-score -0.42, p = 0.002), and normalized total venous liver flow tended to be lower after 30 gestational weeks (z-score -0.54, p = 0.047) in the diabetic pregnancies compared with reference values from a low-risk population. The left portal vein blood velocity was positively, and the portal fraction of total venous liver flow negatively correlated with first trimester HbA 1C . Conclusions In spite of increased umbilical blood distribution to the fetal liver, graded according to glycemic control, the total venous liver flow did not match third trimester fetal growth in pregnancies with pregestational diabetes, thus contributing towards increased perinatal risks and possibly altered liver function with long-term metabolic consequences.

Text
journal.pone.0211788 - Version of Record
Available under License Creative Commons Attribution.
Download (1MB)

More information

Accepted/In Press date: 21 January 2019
e-pub ahead of print date: 13 March 2019

Identifiers

Local EPrints ID: 429624
URI: https://eprints.soton.ac.uk/id/eprint/429624
ISSN: 1932-6203
PURE UUID: dcdae83c-8257-4889-b895-25c91ec4bfdb
ORCID for Mark Hanson: ORCID iD orcid.org/0000-0002-6907-613X

Catalogue record

Date deposited: 02 Apr 2019 16:30
Last modified: 03 Apr 2019 00:35

Export record

Altmetrics

Contributors

Author: Agnethe Lund
Author: Cathrine Ebbing
Author: Svein Rasmussen
Author: Torvid Kiserud
Author: Mark Hanson ORCID iD
Author: Jörg Kessler

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×