Prediction of postnatal abnormal coiling of the umbilical cord in gestational diabetes mellitus: a diagnostic accuracy study

Abstract

Objective: To investigate whether evaluations of antenatal umbilical coiling index (aUCI) could predict postnatal umbilical coiling index (UCI) (pUCI) in people with gestational diabetes mellitus (GDM) compared with normal pregnancy independent of maternal demographic and reproductive characteristics.

Method: In this prospective study, 105 women with normal pregnancy, and 117 women with pregnancy complicated by GDM were recruited. Ultrasound scan of umbilical cord was performed at 18–23 and 37–41 weeks of gestation (WG). Evaluation of pUCI, as the reference standard, was performed within 24 hours after delivery.

Findings: There was no significant relationship between aUCI and maternal demographic and reproductive characteristics. The mean for pUCI was 0.21 ± 0.12 in the GDM group, and 0.21 ± 0.09 in the normal pregnancy (p = .61). In the GDM group, a significant association was found between aUCI and pUCI categories (p = .004). The area under curve (AUC) was less than 0.5 for hypocoiling in both groups. For hypercoiling it was 0.84 ± 0.04 in the GDM group and 0.75 ± 0.06 in the normal pregnancy group (18–23 WG). In the GDM group the cutoff points that predict hypercoiling were 0.28 (18–23WG), and 0.21 (37–41WG). These were 0.35 (18–23WG), and 0.33 (37–41WG) in the normal pregnancy group. Diagnostic accuracy analysis revealed that in the GDM group, the sensitivity and specificity of hypercoiling for prediction of pUCI were 0.94 and 0.70 respectively at 18–23 WG.

Conclusions: Antenatal hypercoiling at the second trimester of pregnancy strongly predict postnatal hypercoiling in pregnancies complicated by GDM.

Keywords:

• Antenatal
• diagnostic accuracy study
• gestational diabetes mellitus
• postnatal
• umbilical coiling index

Acknowledgments

The authors wish to thank the staff who greatly helped us to complete the project especially Noohi, Sadeghipour, Alikhani, Taghipour, Fatahi, Tahlavi, Seif, Kia, Mohamadizadeh, Mahmoudi, Amiri, Yadegari, and Madani.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The study protocol was approved by the local ethical committee of Iran University of Medical Sciences (IR.IUMS.REC.1393.24991) at 12/29/2014. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained and signed by all the individual parturients and their spouses included in the study.