Fetal Superior Mesenteric Artery Peak Systolic Velocity as a Marker of Prenatal Bowel Inflammation in Gastroschisis: A Case–Control Study

ABSTRACT Objective This study aimed to evaluate whether peak systolic velocity (PSV) in the fetal extra‐abdominal superior mesenteric artery (SMA) is a useful prenatal marker of bowel inflammation in gastroschisis (GS), which manifests postnatally as bowel matting. Methods This case–control study included 30 fetuses with gastroschisis who underwent standardized bowel assessment and Doppler measurement of the extra‐abdominal SMA‐PSV. Postnatal bowel status was classified as normal or inflamed. The primary analysis examined the association between fetal SMA‐PSV and bowel inflammation, using linear models and generalized estimating equations for repeated measurements. Results Among 30 fetuses, bowel matting was identified postnatally in 10 cases (33.3%). These neonates had significantly lower birthweight percentiles (5.5 vs. 50.5; p = 0.002) and more frequent ultrasound inflammatory signs such as bowel wall oedema (80% vs. 15%; p = 0.002), bowel wall stiffness (50% vs. 5%; p = 0.004), and corrugation wall (60% vs. 5%; p = 0.004). PSV was strongly correlated with bowel wall thickness ( r = 0.81) and significantly higher in fetuses with postnatally diagnosed bowel matting ( p < 0.001). GEE models showed that higher prenatal PSV independently predicted the later occurrence of bowel matting. Incorporating the time × bowel matting interaction significantly improved model fit (adjusted R 2 = 0.460). Conclusions Fetal SMA‐PSV is significantly associated with prenatal/ultrasound and postnatal signs of bowel inflammation in gastroschisis, such as bowel wall thickening and bowel matting. This association appears independent of the simple/complex GS surgical classification, suggesting PSV as a functional marker of intestinal compromise. Although technically demanding, SMA‐PSV assessment may aid prenatal evaluation and perinatal planning, particularly in detecting evolving intestinal inflammatory cases.