Resumo

NOMURA, Roseli Mieko Yamamoto et al. Fetal Surveillance In Pregnancies With Pregestational Diabetes Mellitus: A Longitudinal Study. Rev. Bras. Ginecol. Obstet. [online]. 2002, vol.24, n.2, pp. 113-120. ISSN 0100-7203.  http://dx.doi.org/10.1590/S0100-72032002000200007.

Purpose: to study fetal surveillance examinations in pregnancies complicated by pregestational diabetes mellitus, and to correlate them with large for gestational age (LGA) newborns. Methods: Between March 1999 and June 2001, 46 singleton pregnancies with pregestational diabetes mellitus without fetal anomalies were followed prospectively. From the 28^th gestational week on, the following examinations were performed weekly: fetal biophysical profile, amniotic fluid index (AFI), and dopplervelocimetry of umbilical and middle cerebral arteries. The newborns with birthweight above the 90^th percentile according to local standard values were characterized as LGA infants. Fisher's exact test and Student's t test were used for statistical analysis. Results: The mean gestational age at delivery was 37.6 weeks and 15 (32.6%) newborns were LGA. LGA fetuses showed significant increase in the AFI mean performed in the 32^nd (16.5 cm, p=0.02), 33^rd (16.7 cm, p=0.03), 34^th (17.0 cm, p=0.02), 35^th (17.9 cm, p=0.000), 36^th (15.8 cm, p=0.03) and 37^th (17.5 cm, p=0.003) weeks. Non-LGA fetuses presented the following mean AFI values: 13.5cm (32^nd week), 13.1cm (33^th week), 13.4 (34^th week), 12.8 (35^th week), 12.5 (36^th week) and 12.8cm (37^th week). AFI values equal to or above 18.0 cm were associated with the occurrence of LGA infants, when detected at the following gestational ages: 34^th (60%, p=0.03), 35^th (71.4%, p=0.01), 36^th (80%, p=0.02) and 37^th (66.7%, p=0.04) week. Non-LGA infants presented the following proportion of AFI values equal to or above 18.0 cm: 40.0% (34^th week), 28.6% (35^th week), 20.0% (36^th week), and 33.3% (37^th week). Conclusions: abnormal increase in AFI, mainly with values equal to or above 18.0 cm, is related to LGA infants at delivery. The maternal treatment should be adjusted to achieve the best result for maternal-fetal control, according to the AFI values during pregnancy.

Palavras-chave : Diabetes mellitus; Amniotic fluid index; Fetal biophysical profile; Dopplervelocimetry; Umbilical artery; Middle cerebral artery.