Sonographic Evaluation of Fetal Adrenal Gland in Gestational Diabetes: Relation to Fetal Growth and Maternal Biochemical Markers.
OBJECTIVE
To relate measurements and volume of the fetal adrenal gland in third trimester ultrasound in diabetic pregnancies (1) to birth weight; (2) to other sonographic markers of diabetic fetopathy (expected fetal weight, sectional area, and fractional volume in fetal limbs); and (3) to maternal biochemical markers of diabetes (HbA1c, leptin).


METHODS
Fetal adrenal gland measurements were obtained between 32 and 34 weeks. The gland length, width, depth, and volume (by Virtual Organ Computer-Aided Analysis [VOCAL]) were measured for total gland and fetal zone. Fetal total and fat sectional area and fractional volume were obtained in arm and thigh. A maternal blood sample was obtained. Univariate and multivariate models were used to assess the associations.


RESULTS
Thirty-nine diabetic pregnancies were included. Birth weight related significantly to total and fetal zone adrenal depth, and total adrenal volume in third trimester. Total adrenal length and corrected adrenal gland volume also showed a significant correlation to birth weight percentile in univariate and multivariate models. Total adrenal volume associated significantly to total and fat areas and volumes in fetal limbs. Both maternal leptin and HbA1c levels found a significant positive relation to fetal total adrenal volume and corrected adrenal gland volume. Total adrenal gland volume showed a significant association to maternal HbA1c level in multivariate model.


CONCLUSIONS
An enlargement of the fetal adrenal gland may be observed in gestational diabetes, not only related to birth weight, but also to distinctive features of diabetic pregnancies, such as fat tissue fetal deposits or maternal biochemical markers.
High-Risk Pregnancy Unit, Obstetrics & Gynecology Department, Hospital Universitario Quiron Madrid, Pozuelo de Alarcon (Madrid), Spain.
Jose
J
Garcia-Flores
High-Risk Pregnancy Unit, Obstetrics & Gynecology Department, Hospital Universitario Quiron Madrid, Pozuelo de Alarcon (Madrid), Spain.
Mireia
M
Cruceyra
High-Risk Pregnancy Unit, Obstetrics & Gynecology Department, Hospital Universitario Quiron Madrid, Pozuelo de Alarcon (Madrid), Spain.
Marina
M
Cañamares
High-Risk Pregnancy Unit, Obstetrics & Gynecology Department, Hospital Universitario Quiron Madrid, Pozuelo de Alarcon (Madrid), Spain.
Ainhoa
A
Garicano
High-Risk Pregnancy Unit, Obstetrics & Gynecology Department, Hospital Universitario Quiron Madrid, Pozuelo de Alarcon (Madrid), Spain.
Mercedes
M
Espada
High-Risk Pregnancy Unit, Obstetrics & Gynecology Department, Hospital Universitario Quiron Madrid, Pozuelo de Alarcon (Madrid), Spain.
Olga
O
Nieto
High-Risk Pregnancy Unit, Obstetrics & Gynecology Department, Hospital Universitario Quiron Madrid, Pozuelo de Alarcon (Madrid), Spain.
Ines
I
Tamarit
High-Risk Pregnancy Unit, Obstetrics & Gynecology Department, Hospital Universitario Quiron Madrid, Pozuelo de Alarcon (Madrid), Spain.
Ricardo
R
Sainz de la Cuesta
D000311:Adrenal Glands / Q000000981:diagnostic imaging* / Q000196:embryology / Q000473:pathology*; D000328:Adult; D001724:Birth Weight; D016640:Diabetes, Gestational / Q000503:physiopathology*; D005260:Female; D047109:Fetal Development / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D009929:Organ Size; D011247:Pregnancy; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*
birth weight; fetal adrenal gland; fractional limb volume; gestational diabetes; sectional area