Role of fetal pulmonary artery Doppler in prediction of neonatal respiratory distress in neonates of diabetic mothers


  • Hager Mamdouh G. Taha Department of Obstetrics and Gynecology, Tanta University, Tanta, Egypt
  • Nagwa Mahmoud Al Ghorab Department of Obstetrics and Gynecology, Tanta University, Tanta, Egypt
  • Mohammed Mohsen Al-Namory Department of Obstetrics and Gynecology, Tanta University, Tanta, Egypt
  • Naglaa Ali Hussein Department of Obstetrics and Gynecology, Tanta University, Tanta, Egypt



Fetal pulmonary artery, Doppler neonatal respiratory distress, Diabetic mothers


Background: Newborn respiratory complication is one of the most prevalent and life-threatening disorders. The clinical indications of early newborn respiratory distress with consistent radiologic features. The Doppler examination of the primary pulmonary artery in the foetus has been proven to be beneficial. The foetal pulmonary artery At/Et ratio is linked to foetal gestational age and amniotic fluid foetal lung maturity (FLM) tests. The aim of the study was to assess the accuracy of foetal main pulmonary artery (MPA) Doppler indices in prediction of the development of neonatal respiratory distress syndrome (RDS) in diabetic mothers.

Methods: This was a prospective observational study carried out on 100 cases of diabetic mothers in obstetrics and gynecology department, Tanta University during one year from the approval of the university counsel. The physician evaluated the foetal heart in a methodical manner after a regular ultrasound assessment that included foetal biometry, anomaly scan, measured foetal weight, and amniotic fluid index. Classic chest radiological features include reticulogranular patterns, air bronchogram and ground glass look, as well as the need for surfactant.

Results: PI and RI were significantly higher in newborns with RDS than those without RDS (p=0.025 and 0.036 respectively) PSV and At/Et ratio were significantly reduced in neonates with RDS compared with RDS free ones (p=0.004 and <0.001 respectively). RI was significantly higher in neonates with RDS than those without RDS (P = 0.048) PSV and At/Et ratio were significantly reduced in newborns with RDS compared to RDS free ones (p=0.008 and <0.001 respectively). The ROC curve displayed that the cut off value of ≤0.25 for At/Et ratio was associated with a sensitivity of 76.92%, a specificity of 100.0%, a PPV of 100.0% and a NPV of 96.7% for prediction of neonatal RDS with AUC of 0.925 and p≤0.001.

Conclusions: development of neonatal RDS in foetus of diabetic mothers with a cut off value of ≤0.25, a sensitivity of 76.92%, a specificity of 100.0%, a PPV of 100.0%, a NPV of 96.7% and AUC of 0.925 The usage of corticosteroids improved the Doppler indices of main pulmonary artery and is accompanied by less morbimortality related to RDS.


Cummings JJ, Gerday E, Minton S, Katheria A, Albert G, Flores-Torres J, et al. Aerosolized Calfactant for Newborns With Respiratory Distress: A Randomized Trial. Pediatrics. 2020;146(5):e20193967.

Parimi M, Nitsch D. A Systematic Review and Meta-Analysis of Diabetes During Pregnancy and Congenital Genitourinary Abnormalities. Kidney Int Rep. 2020;5(5):678-93.

Khattab M, Mahmoud K, Shaltout I. Effect of Vildagliptin Versus Sulfonylurea in Muslim Patients with Type 2 Diabetes Fasting During Ramadan in Egypt: Results from VIRTUE Study. Diabetes Ther. 2016;7(3):551-60.

AlSawahli H, Mpyet CD, Ezzelarab G, Hassanin I, Shalaby M, Safa O, et al. Population-based cross-sectional prevalence survey of diabetes and diabetic retinopathy in Sohag-Egypt, 2019. BMJ Open. 2021;11(6):e047757.

Haleluya N, Wainstock T, Landau D, Sheiner E. Maternal gestational diabetes mellitus and the risk of subsequent pediatric cardiovascular diseases of the offspring: a population-based cohort study with up to 18 years of follow up. Acta Diabetol. 2018;55(10):1037-42.

Sampson S, Paradis G, Healy-Profitós J, St-Pierre F, Auger N. Gestational diabetes and risk of cardiovascular disease up to 25 years after pregnancy: a retrospective cohort study. Acta Diabetol. 2018;55(4):315-22.

Li Y, Wang W, Zhang D. Maternal diabetes mellitus and risk of neonatal respiratory distress syndrome: a meta-analysis. Acta Diabetol. 2019;56(7):729-40.

Miakotina OL, Goss KL, Snyder JM. Insulin utilizes the PI 3-kinase pathway to inhibit SP-A gene expression in lung epithelial cells. Respir Res. 2002;3(1):27.

Schenone MH, Samson JE, Jenkins L, Suhag A, Mari G. Predicting fetal lung maturity using the fetal pulmonary artery Doppler wave acceleration/ejection time ratio. Fetal Diagn Ther. 2014;36(3):208-14.

Granstam SO, Björklund E, Wikström G, Roos MW. Use of echocardiographic pulmonary acceleration time and estimated vascular resistance for the evaluation of possible pulmonary hypertension. Cardiovasc Ultrasound. 2013;11:7.

Kim SM, Park JS, Norwitz ER, Hwang EJ, Kang HS, Park CW, et al. Acceleration time-to-ejection time ratio in fetal pulmonary artery predicts the development of neonatal respiratory distress syndrome: a prospective cohort study. Am J Perinatol. 2013;30(10):805-12.

Guan Y, Li S, Luo G, Wang C, Norwitz ER, Fu Q, et al. The role of doppler waveforms in the fetal main pulmonary artery in the prediction of neonatal respiratory distress syndrome. J Clin Ultrasound. 2015;43(6):375-83.

Moety GA, Gaafar HM, El Rifai NM. Can fetal pulmonary artery Doppler indices predict neonatal respiratory distress syndrome? J Perinatol. 2015;35(12):1015-9.

Koivisto M, Marttila R, Kurkinen-Räty M, Saarela T, Pokela ML, Jouppila P, et al. Changing incidence and outcome of infants with respiratory distress syndrome in the 1990s: a population-based survey. Acta Paediatr. 2004;93(2):177-84.

Bouziri A, Ben SS, Hamdi A, Menif K, Belhadj S, Khaldi A, et al. Acute respiratory distress syndrome in infants at term and near term about 23 cases. Tunis Med. 2007;85(10):874-9.

Menon R. Spontaneous preterm birth, a clinical dilemma: etiologic, pathophysiologic and genetic heterogeneities and racial disparity. Acta Obstet Gynecol Scand. 2008;87(6):590-600.

Tita AT, Landon MB, Spong CY, Lai Y, Leveno KJ, Varner MW, et alk. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med. 2009;360(2):111-20.

Kemp MW, Jobe AH, Usuda H, Nathanielsz PW, Li C, Kuo A, et al. Efficacy and safety of antenatal steroids. Am J Physiol Regul Integr Comp Physiol. 2018;315(4):825-39.

Akella A, Deshpande SB. Pulmonary surfactants and their role in pathophysiology of lung disorders. Indian J Exp Biol. 2013;51(1):5-22.

Chaoui R, Taddei F, Rizzo G, Bast C, Lenz F, Bollmann R. Doppler echocardiography of the main stems of the pulmonary arteries in the normal human fetus. Ultrasound Obstet Gynecol. 1998;11(3):173-9.

Lindsley W, Hale R, Spear A, Adusumalli J, Singh J, DeStefano K, et al. Does corticosteroid therapy impact fetal pulmonary artery blood flow in women at risk for preterm birth? Med Ultrason. 2015;17(3):280-3.






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