Fetal Cerebrovascular Flow Index from Three-Dimensional Power Doppler Ultrasonography in Gestational Diabetes Mellitus versus Low-Risk Pregnancy

Objective: To compare fetal cerebrovascular flow indices using three-dimensional power Doppler (3DPD) ultrasound between gestational diabetes mellitus (GDM) and low risk pregnancy. Additionally, these comparisons were made among GDM patients based on treatment methods and relationship between fetal cerebrovascular flow indices, HbA1C levels, and perinatal outcomes. Materials and Methods: The present study was a prospective cohort study comparing fetal cerebrovascular flow indices using 3DPD ultrasound between 80 low-risk pregnancies and 80 pregnancies complicated by GDM at Rajavithi Hospital. Participants underwent 3DPD ultrasound at 28 to 32 and 32 to 36 weeks of gestation to assess vascularization index (VI), flow index (FI), and vascularization flow index (VFI). The present study explored relationships between fetal cerebrovascular flow indices, maternal HbA1C levels, and neonatal outcomes. Results: FI and VFI were significantly elevated in the GDM group compared to the low-risk group (p≤0.01 and 0.03). Among GDM patients, those managed with dietary control had higher VFI compared to those treated with medication at 1.51 versus 1.09 (p=0.024). However, no significant differences in fetal cerebrovascular flow indices were observed between well-controlled and poorly controlled GDM groups at 32 to 36 weeks, and no correlation was found between these indices, HbA1C levels or perinatal outcomes. Conclusion: The 3DPD ultrasound provides a non-invasive method for assessing fetal cerebrovascular flow indices, particularly in GDM. The findings suggest that fetal brains in GDM cases adapt by increasing blood flow, as indicated by FI and VFI, while medication reduces pathological cerebral blood flow adaptation.