Evaluation of fetal diaphragm excursion and thickness in term pregnancies complicated with pre-gestational and gestational diabetes mellitus

Background Both pre-gestational (PGDM) and gestational diabetes mellitus (GDM) make pregnancy complicated. Moreover in the literature GDM and PGDM have been held responsible for respiratory morbidity in newborns. Diaphragm ultrasound (DUS) is a valuable and noninvasive method that provides an opportunity to examine the diaphragmatic morphology and function. This study examined the quality of fetal diaphragmatic contractions in pregnant women complicated with GDM and PGDM. Methods A total of 105 volunteers who were separated into three groups; (1) A GDM group (n = 35), (2) a PGDM group (n = 35), and (3) a healthy non-diabetic control group (n = 35). All volunteers with the cephalic presentation and only male fetuses were examined in the 37th week of gestation. This cross sectional and case controlled study was performed at the perinatology clinic of the Erciyes University School of Medicine between 15.01.2020 and 01.08.2021. The thickness of fetal diaphragm (DT), diaphragmatic excursion (DE), diaphragm thickening fraction (DTF) and costodiaphragmatic angle (CDA) was measured and recorded by ultrasound and examined on the video frame during the inspiration and expiration phases of respiration. Results Especially the PGDM group represented adversely affected diaphragm function parameters. DT inspiration, DT expiration, DE, CDA inspiration and DTF values were significantly different between PGDM and the control group. Neonatal intensive care unit (NICU) admission was high among babies who were born to pregnancies complicated with PGDM or GDM. Conclusions The quality of fetal diaphragm movements is affected in pregnancies complicated with GDM and PGDM. The prolonged duration of diabetes may have additional adverse effects on diaphragm morphology and its function. Plain language summary The percentage of pre-gestational diabetes mellitus (PGDM) in pregnancy is 13-21% and the remaining part of diabetes is gestational diabetes mellitus (GDM). Both of the complications are related to respiratory problems at birth. Until now, it was known that this situation was due to the lack of surfactant, which has a facilitating effect on the participation of the lungs in respiration. However, in this study, the diaphragm of the babies of patients with PGDM and GDM was examined. The thickness of fetal diaphragm, movements and function were evaluated via using ultrasound. As a result, it was determined that the diaphragm movements were impaired and the babies born from these patients needed more pediatric care. This study will open horizon on new studies examining the functional capacity of the diaphragm in the future. In the future, it may be possible to decide which baby will need intensive care by examining the diaphragm.