Determination of Three-Dimensional Ultrasound Measurement of Fetal Adrenal Gland and Maternal Serum Fructosamine Level in Gestational Diabetes Mellitus: A Prospective Cohort Study

This chapter evaluate the correlation between fetal adrenal gland size and volume observed using two-dimensional (2D) ultrasound measurement in transverse, coronal, and sagittal planes and three-dimensional (3D) ultrasound measurement using virtual organ computer-aided analysis (VOCAL) software and maternal serum fructosamine levels in GDM patients. Gestational diabetes mellitus (GDM) has an impact on fetal adrenal gland size and volume, which are greater in women with GDM compared to those without.

This prospective cohort study was performed at GDM clinic in Ramathibodi hospital, Mahidol University from January to December 2019. The foetal zone and overall adrenal gland volume in 3D ultrasonography were assessed using the virtual organ computer-aided analysis (VOCAL) software. Up until birth, all subjects were monitored. The link between foetal adrenal gland ultrasonography measures and the relevant parameters was investigated using Pearson's correlation analysis.

The study consisted of sixty-six (82.5%) pregnant women with diet-controlled GDM (GDMA1) and 14 (17.5%) with insulin-managed GDM (GDMA2). There was no difference in fetal adrenal gland measurements between the groups. In addition, all participants achieved optimal glucose levels at the time of ultrasound acquisition. The findings of this study indicate that fetal adrenal gland measurements using 2D and 3D ultrasonography in the third trimester can be visualized and measured adequately in 96.4%. The total adrenal gland length and fetal zone volume are correlated with EFW, maternal fructosamine, and HbA1c levels in well-controlled GDM. The total adrenal gland length and fetal zone volume had statistically significant positive correlations with EFW (r = 0.69, p = 0.02 and r = 0.84, p = 0.01, respectively). After adjusting for EFW, the relationships of total adrenal gland length with fructosamine levels (adjusted-OR = 0.4, 95% CI: 0.1, 0.7) and HbA1c levels (adjusted-OR = 0.3, 95% CI: 0.1, 0.6) were statistically significant (p < 0.05). Likewise, the relationship between fetal zone volume with fructosamine levels (adjusted-OR = 2.4, 95% CI: 1.5, 3.9) and HbA1c levels (adjusted-OR = 2.5, 95% CI: 1.6, 4.3) were statistically significant (p < 0.05).

The study also discovered a correlation between EFW, fructosamine levels, and HbA1c levels and total adrenal gland length and foetal zone volume. These non-invasive methods can be useful for GDM patients as glycemic monitoring indirect markers.