Utility of In Vivo Magnetic Resonance Imaging Is Predictive of Gestational Diabetes Mellitus During Early Pregnancy.
Utility of In Vivo Magnetic Resonance Imaging Is Predictive of Gestational Diabetes Mellitus During Early Pregnancy.
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DOI：
10.1210/clinem/dgac602
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发表时间：
2023-01-17
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--
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妊娠期糖尿病（GDM）对母亲和胎儿造成长期的不良健康影响。磁共振成像（MRI）在妊娠早期GDM中的作用尚未得到充分研究。探讨定量MRI测量胎盘体积和灌注的作用，以及孕妇肥胖的分布，在妊娠早期GDM。在加州大学洛杉矶分校的产前产科门诊，在妊娠早期招募了10200名孕妇，对她们进行了整个妊娠期直至分娩的临时随访。在14至16周和19至24周胎龄（GA）时前瞻性地进行了两次胎盘MRI扫描。胎盘体积和血流量（PBF）计算从胎盘的利益区域;母亲的肥胖分布进行了评估皮下脂肪面积比（SFAR）和内脏脂肪面积比（VFAR）。使用双尾t检验进行统计学比较。通过曲线下面积（AUC）评价预测性logistic回归模型。在总计186例受试者中，21例受试者（11.3%）发生GDM。在两个时间点，GDM组的VFAR均高于对照组（P < 0.001）。妊娠19 ~ 24周时，GDM组胎盘体积大于对照组（P = 0.01）。结合VFAR、胎盘体积和灌注，在14至16周时将AUC提高至0.83（阳性预测值[PPV] = 0.77，阴性预测值[NPV] = 0.83），在19至24周GA时提高至0.81（PPV = 0.73，NPV = 0.86）。基于MRI的胎盘体积、灌注和内脏脂肪在妊娠早期的组合显示了GDM的显著变化，并为预测GDM的后续发展提供了概念证据。
Gestational diabetes (GDM) imposes long-term adverse health effects on the mother and fetus. The role of magnetic resonance imaging (MRI) during early gestation in GDM has not been well-studied. To investigate the role of quantitative MRI measurements of placental volume and perfusion, with distribution of maternal adiposity, during early gestation in GDM. At UCLA outpatient antenatal obstetrics clinics, ∼200 pregnant women recruited in the first trimester were followed temporally through pregnancy until parturition. Two placental MRI scans were prospectively performed at 14 to 16 weeks and 19 to 24 weeks gestational age (GA). Placental volume and blood flow (PBF) were calculated from placental regions of interest; maternal adiposity distribution was assessed by subcutaneous fat area ratio (SFAR) and visceral fat area ratio (VFAR). Statistical comparisons were performed using the two-tailed t test. Predictive logistic regression modeling was evaluated by area under the curve (AUC). Of a total 186 subjects, 21 subjects (11.3%) developed GDM. VFAR was higher in GDM vs the control group, at both time points (P < 0.001 each). Placental volume was greater in GDM vs the control group at 19 to 24 weeks GA (P = 0.01). Combining VFAR, placental volume and perfusion, improved the AUC to 0.83 at 14 to 16 weeks (positive predictive value [PPV] = 0.77, negative predictive value [NPV] = 0.83), and 0.81 at 19 to 24 weeks GA (PPV = 0.73, NPV = 0.86). A combination of MRI-based placental volume, perfusion, and visceral adiposity during early pregnancy demonstrates significant changes in GDM and provides a proof of concept for predicting the subsequent development of GDM.
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