Comparison of cerebro-placental-uterine ratio between patients with gestational diabetes mellitus and healthy pregnant women: A prospective tertiary center observational study.

OBJECTIVE

The aim of this study was to evaluate the cerebroplacental ratio (CPR) and the cerebroplacental-uterine ratio (CPUR) in pregnancies complicated by gestational diabetes mellitus (GDM) and to determine the role of these indices in predicting adverse perinatal outcomes.

METHODS

This prospective, single-center observational study was conducted at a tertiary care institution between August 2024 and January 2025. A total of 117 pregnant women were enrolled, including 64 with GDM (group 1) and 53 without GDM (group 2). The GDM group was further subdivided according to treatment modality (diet-controlled vs. insulin-treated). Doppler parameters, as well as maternal and fetal outcomes, were compared between the groups.

RESULTS

In the GDM group, body mass index (BMI) (P < 0.001), cesarean delivery rate (P = 0.037), and neonatal intensive care unit (NICU) admissions (P = 0.010) were significantly higher, whereas gfestational age at delivery (P = 0.016), first and fifth minute Apgar scores, and umbilical cord PH were significantly lower (P < 0.05). The umbilical artery pulsatility index (UA-PI) was significantly elevated in the GDM group, while CPR (P < 0.001) and CPUR (P < 0.001) were significantly lower. Both CPR and CPUR were significant predictors of adverse fetal outcomes. In the study group, the receiver operating characteristic analysis for CPR predicting NICU admission yielded an optimal cut-off value of 1.45 (area under the curve [AUC] = 0.725; P = 0.001), with 69.2% sensitivity and 69.2% specificity. For CPUR, the optimal cut-off was 1.37 (AUC = 0.761; P = 0.001), with 73.1% sensitivity and 72.5% specificity.

CONCLUSION

In patients with GDM, both CPR and CPUR were significantly lower compared to healthy pregnancies, and CPUR was shown to be a clinically useful predictor of adverse fetal outcomes.