目的:本研究旨在评估多普勒超声测量在预测妊娠合并既往或妊娠期糖尿病的不良围产期结局方面的预后准确性。
方法:MEDLINE的在线数据库搜索,科克伦,Embase,CINAHL,Scopus,和Emcare从成立到2022年4月进行。
方法:报告单例的研究,本研究纳入了妊娠期间曾患有(1型或2型糖尿病)或妊娠期糖尿病的女性的非异常胎儿.此外,纳入的研究评估了脑胎盘比率和大脑中动脉和/或脐动脉搏动指数在预测早产剖宫产胎儿窘迫,APGAR(外观,脉搏,鬼脸,活动,和呼吸)在5分钟时得分<7,新生儿重症监护病房(>24小时),急性呼吸窘迫综合征,黄疸,低血糖,低钙血症,或新生儿死亡。
方法:遵循PRISMA(系统评价和荟萃分析的首选报告项目)指南,共确定了610篇文章,其中包括15个。两位作者从每篇文章中独立提取预后数据,并使用QUADAS-2(诊断准确性研究质量评估-2)评分标准评估研究适用性和偏倚风险。
结果:共有15项研究纳入综述,包括前瞻性(n=10;66%)和回顾性(n=5;33%)队列。在每次多普勒测量中,灵敏度和阳性预测值差异很大。脐动脉对低血糖的敏感性高于脑胎盘比率和大脑中动脉,黄疸,新生儿重症监护病房入院,呼吸窘迫,和早产。脑胎盘比率是报道最多的指标测试;然而,在所有不良围产期结局中,预后准确性均低于脐动脉和大脑中动脉多普勒.在14项(94%)研究中存在显著的偏倚风险,在研究设计和评估结果方面,在研究中观察到大量异质性。
结论:脐动脉搏动指数异常在预测糖尿病妊娠不良围产结局方面可能比脑胎盘比率和大脑中动脉搏动指数更有临床价值。为了更广泛的临床应用,需要使用跨研究的标准化变量进一步评估糖尿病妊娠的脐动脉多普勒测量。多普勒测量异常与低血糖之间的显着关联可能需要进一步研究。
OBJECTIVE: This study aimed to assess the prognostic accuracies of Doppler ultrasound measures in predicting adverse perinatal outcomes for pregnancies complicated with preexisting or gestational diabetes mellitus.
METHODS: An online database search of MEDLINE, Cochrane, Embase, CINAHL, Scopus, and Emcare from inception to April 2022 was conducted.
METHODS: Studies reporting singleton, nonanomalous fetuses of women with either preexisting (type 1 or 2 diabetes mellitus) or gestational diabetes mellitus during pregnancy were included. In addition, the included studies assessed cerebroplacental ratio and middle cerebral artery and/or umbilical artery pulsatility index in the prediction of either: preterm birth, cesarean delivery for fetal distress, APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score <7 at 5 minutes, neonatal intensive care unit admission (>24 hours), acute respiratory distress syndrome, jaundice, hypoglycemia, hypocalcemia, or neonatal death.
METHODS: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed and 610 articles were identified, of which 15 were included. Two authors independently extracted prognostic data from each article and assessed the study applicability and risk of bias using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) scoring criteria.
RESULTS: A total of 15 studies were included in the review and comprised prospective (n=10; 66%) and retrospective (n=5; 33%) cohorts. Sensitivity and positive predictive values varied widely across each Doppler measurement. Umbilical artery sensitivities were higher than those of cerebroplacental ratio and middle cerebral artery for hypoglycemia, jaundice, neonatal intensive care unit admission, respiratory distress, and preterm birth. Cerebroplacental ratio was the most reported index test; however, prognostic accuracy was worse than that of umbilical artery and middle cerebral artery Doppler across all adverse perinatal outcomes. Significant risk of bias was present in 14 (94%) studies, with substantial heterogeneity observed across studies in terms of study design and outcomes assessed.
CONCLUSIONS: Abnormal umbilical artery pulsatility index may be of more clinical value in predicting adverse perinatal outcomes compared with cerebroplacental ratio and middle cerebral artery pulsatility index in diabetic pregnancies. Further evaluation of umbilical artery Doppler measurements in diabetic pregnancies using standardized variables across studies is required for broader clinical application. The significant association between abnormal Doppler measurement and hypoglycemia may warrant further investigation.