The cerebro-placental-uterine ratio in predicting adverse perinatal outcomes in gestational diabetes: a prospective cohort study

Aims: The primary aim of the study was to evaluate Doppler parameters focusing on fetal cerebral and placental circulation in gestational diabetes mellitus (GDM) and to investigate their relationship with maternal glycemic profiles. Methods: A prospective cohort study was conducted involving 52 pregnant women diagnosed with GDM and 55 control participants. Doppler ultrasonography was performed between 34 and 37 weeks of gestation to evaluate key fetal hemodynamic parameters, including the umbilical artery (UA) systolic/diastolic (S/D) ratio, UA pulsatility index (PI), middle cerebral artery (MCA) S/D ratio and PI, uterine artery S/D ratio and PI, cerebro-placental ratio (CPR), and cerebro-placental uterine ratio (CPUR). Statistical analyses were performed to compare Doppler parameters between groups and to evaluate their predictive value for adverse perinatal outcomes. Results: Both the MCA PI (p=0.019) and MCA S/D (p=0.011) differed significantly between the GDM and control groups. The median MCA PI was 1.60 in the GDM group and 1.46 in the control group. No statistically significant differences were observed in other parameters, including UA PI, CPR, or CPUR. A positive correlation was found between the CPUR and the second hour 100-gram oral glucose tolerance test (OGTT) result (r=0.375; p=0.022). However, none of the Doppler parameters reliably predicted adverse perinatal outcomes. Conclusion: The st udy found that fetal Doppler parameters were significantly associated only with MCA S/D and MCA PI. Perinatal outcomes were not correlated with UA, CPR, or CPUR. A positive correlation was observed between CPUR and the second-hour glucose value from the 100 g OGTT.