title: Novel placental ultrasound assessment: potential role in pre-gestational diabetic pregnancy.
abstract: OBJECTIVE
  Management of women with pre-gestational diabetes continues to be challenging for clinicians. This study aims to determine if 3D power Doppler (3DPD) analysis of placental volume and flow, and calculation of placental calcification using a novel software method, differ between pregnancies with type 1 or type 2 diabetes and normal controls, and if there is a relationship between these ultrasound placental parameters and clinical measures in diabetics.
  
  
  METHODS
  This was a prospective cohort study of 50 women with diabetes and 250 controls (12-40 weeks gestation). 3DPD ultrasound was used to evaluate placental volume, vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI). Placental calcification was calculated by computer analysis. Results in diabetics were compared with control values, and correlated with early pregnancy HbA1c, Doppler results and placental histology.
  
  
  RESULTS
  Placental calcification and volume increased with advancing gestation in pre-gestational diabetic placentae. Volume was also found to be significantly higher than in normal placentae. VI and VFI were significantly lower in diabetic pregnancies between 35 and 40 weeks gestation. A strong relationship was seen between a larger placental volume and both increasing umbilical artery pulsatility index and decreasing middle cerebral artery pulsatility index. FI was significantly lower in cases which had a booking HbA1c level ≥6.5%. Ultrasound assessed placental calcification was reduced with a histology finding of delayed villous maturation. No other correlation with placental histology was found.
  
  
  CONCLUSIONS
  This study shows a potential role for 3D placental evaluation, and computer analysis of calcification, in monitoring pre-gestational diabetic pregnancies.
authors.affiliation: Diagnostic Imaging, School of Medicine and Medical Science, University College Dublin, Ireland. Electronic address: moran.mary@ucd.ie.
authors.forename: M
authors.initials: M
authors.lastname: Moran
authors.affiliation: UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland. Electronic address: cmulcahy@nmh.ie.
authors.forename: C
authors.initials: C
authors.lastname: Mulcahy
authors.affiliation: Centre for Support and Training in Analysis and Research, UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Ireland. Electronic address: leslie.daly@ucd.ie.
authors.forename: L
authors.initials: L
authors.lastname: Daly
authors.affiliation: Diagnostic Imaging, School of Medicine and Medical Science, University College Dublin, Ireland. Electronic address: zomboir@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Zombori
authors.affiliation: Department of Pathology, National Maternity Hospital, Dublin, Ireland. Electronic address: pdowney@nmh.ie.
authors.forename: P
authors.initials: P
authors.lastname: Downey
authors.affiliation: UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland. Electronic address: fionnuala.mcauliffe@ucd.ie.
authors.forename: F M
authors.initials: FM
authors.lastname: McAuliffe
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose; D002114:Calcinosis; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging*; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D009929:Organ Size; D010920:Placenta / Q000000981:diagnostic imaging* / Q000473:pathology / Q000502:physiology; D021041:Placental Circulation; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D001786:Blood Glucose
keywords: Novel ultrasound placental assessment; Pre-gestational diabetes