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Abstract
Objective:To investigate the relationship between utero-placental Doppler indices and detailed fetal neurosonographic findings in pregnancies complicated by pre-gestational and gestational diabetes mellitus (GDM).
Methods:A prospective cohort study was conducted on 150 diabetic pregnancies (75 pre- gestational, 75 GDM) and 75 matched healthy controls between 28-32 weeks of gestation. All participants underwent pulsed-wave Doppler assessment of the uterine arteries (UtA) to determine the pulsatility index (PI) and the presence of an early diastolic notch. Subsequently, a dedicated fetal neurosonography was performed to measure the transcerebellar diameter (TCD), Sylvian fissure depth, and lateral ventricle width, and to assess the development of the corpus callosum and cortical sulcation.
Results: The diabetic cohort, particularly the pre- gestational subgroup, demonstrated significantly higher mean UtA-PI values and a higher prevalence of bilateral notching compared to controls (p < 0.01). Neurosonography revealed significant alterations in the diabetic groups, including a larger transcerebellar diameter (p < 0.05), abnormal Sylvian fissure maturation, and delayed opercularization compared to the control group (p < 0.01). A significant inverse correlation was observed between UtA-PI and transcerebellar diameter (r = -0.45, p < 0.001), and a positive correlation with Sylvian fissure depth (r = 0.52, p < 0.001) in the pre-gestational diabetes group.
Conclusion: This study demonstrates a significant correlation between impaired utero-placental hemodynamics and alterations in fetal brain development in diabetic pregnancies, supporting the concept of a "placenta-brain unit". Integrated ultrasound assessment of this unit may serve as an early biomarker for identifying fetuses at risk for neurodevelopmental morbidity, enabling potential early intervention strategies.
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Copyright (c) 2025 Riyadh Adel Jaed (Author)

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References
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- Aslan Çetin B, Madazlı R. Assessment of normal fetal cortical sulcus development. Arch Gynecol Obstet. 2022;306(3):735-743. https://doi.org/10.1007/s00404-021-06334-x
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- Pooh RK, Machida M, Nakamura T, Uenishi K, Chiyo H, Itoh K, et al. Increased Sylvian fissure angle as an early sonographic sign of malformation of cortical development. Ultrasound Obstet Gynecol. 2019;54(2):199-206. https://doi.org/10.1002/uog.20171
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References
Meza-León A, Montoya-Estrada A, Reyes-Muñoz E, Romo-Yáñez J. Diabetes mellitus and pregnancy: an insight into the effects on the epigenome. Biomedicines. 2024;12(2):351. https://doi.org/10.3390/biomedicines12020351
Rodolaki K, Pergialiotis V, Iakovidou N, Boutsikou T, Iliodromiti Z, Kanaka-Gantenbein C. The impact of maternal diabetes on the future health and neurodevelopment of the offspring: a review of the evidence. Front Endocrinol (Lausanne). 2023;14:1125628. https://doi.org/10.3389/fendo.2023.1125628
Ye W, Luo C, Zhou J, Liang X, Wen J, Huang J, et al. Association between maternal diabetes and neurodevelopmental outcomes in children: a systematic review and meta-analysis of observational studies. Lancet Diabetes Endocrinol. 2025;13(6). https://doi.org/10.1016/S2213-8587(25)00036-1
Kramer AC, Jansson T, Bale TL, Powell TL. Maternal-fetal cross-talk via the placenta: influence on offspring development and metabolism. Development. 2023;150(20):dev202088. https://doi.org/10.1242/dev.202088
Tian Y, Yang X. A review of roles of uterine artery Doppler in pregnancy complications. Front Med (Lausanne). 2022;9:813343. https://doi.org/10.3389/fmed.2022.813343
Milani HJF, Barreto EQS, Araujo Júnior E, Peixoto AB, Nardozza LMM, Moron AF. Ultrasonographic evaluation of the fetal central nervous system: review of guidelines. Radiol Bras. 2019;52(3):176-181. https://doi.org/10.1590/0100-3984.2018.0056
Pogledic I, Mankad K, Severino M, et al. Prenatal assessment of brain malformations on neuroimaging: an expert panel review. Brain.2024;147(12):3982-4002. https://doi.org/10.1093/brain/awae253
Oikonomou E, Chatzakis C, Stavros S, Potiris A, Nikolettos K, Sotiriou S, et al. Impact of gestational diabetes on fetal brain development: an update on neurosonographic markers during the last decade. Life (Basel). 2025;15(2):210. https://doi.org/10.3390/life15020210
American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S20-S42.
Oloyede OA, Iketubosin F. Uterine artery Doppler study in second trimester of pregnancy. Pan Afr Med J. 2013;15:87. https://doi.org/10.11604/pamj.2013.15.87.2321
Malinger G, Monteagudo A, Pilu G, Timor-Tritsch I, Toi A. Sonographic examination of the fetal central nervous system: guidelines for performing the basic examination and the fetal neurosonogram. Ultrasound Obstet Gynecol. 2007;29(1):109-116. https://doi.org/10.1002/uog.3909
Aslan Çetin B, Madazlı R. Assessment of normal fetal cortical sulcus development. Arch Gynecol Obstet. 2022;306(3):735-743. https://doi.org/10.1007/s00404-021-06334-x
Denison FC, Macnaught G, Semple SIK, Terris G, Walker J, Anblagan D, et al. Brain development in fetuses of mothers with diabetes: a case-control MR imaging study. AJNR Am J Neuroradiol. 2017;38(5):1037-1044. https://doi.org/10.3174/ajnr.A5118
Zhi R, Tao X, Li Q, et al. Association between transabdominal uterine artery Doppler and small- for-gestational-age: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2023;23:659. https://doi.org/10.1186/s12884-023-05968-w
Zhu Y, Liu X, Xu Y, Lin Y. Hyperglycemia disturbs trophoblast functions and subsequently leads to failure of uterine spiral artery remodeling. Front Endocrinol (Lausanne). 2023;14:1060253. https://doi.org/10.3389/fendo.2023.1060253
Singh J, Thukral CL, Singh P, Pahwa S, Choudhary G. Utility of sonographic transcerebellar diameter in the assessment of gestational age in normal and intrauterine growth-restricted fetuses. Niger J Clin Pract. 2022;25(2):167-172. https://doi.org/10.4103/njcp.njcp_594_20
Pooh RK, Machida M, Nakamura T, Uenishi K, Chiyo H, Itoh K, et al. Increased Sylvian fissure angle as an early sonographic sign of malformation of cortical development. Ultrasound Obstet Gynecol. 2019;54(2):199-206. https://doi.org/10.1002/uog.20171
Siargkas A, Tsakiridis I, Kappou D, Mamopoulos A, Papastefanou I, Dagklis T. Association between uterine artery pulsatility index at mid-gestation and method of conception: a cohort study. Medicina (Kaunas). 2025;61(6):1093. https://doi.org/10.3390/medicina61061093
Andescavage N, duPlessis A, Metzler M, Bulas D, Vezina G, Jacobs M, et al. In vivo assessment of placental and brain volumes in growth-restricted fetuses with and without fetal Doppler changes using quantitative 3D MRI. J Perinatol. 2017;37(12):1278-1284. https://doi.org/10.1038/jp.2017.129
Glynn LM, Sandman CA. Prenatal origins of neurological development. Curr Dir Psychol Sci. 2011;20(6):384-389. https://doi.org/10.1177/0963721411422056
