Research Value Of MRI In Fetal Brain Development Of Pregnant Women With Gestational Diabetes Mellitus

Objective:To assess fetal brain development between the the second and third trimesters of pregnant women with gestational diabetic and normal using magnetic resonance imaging.Materials and Methods:A total of 68 pregnant women were enrolled in the third affiliated hospital of Guangzhou Medical University from July 2018 to February 2020.All underwent 75 g OGTT between 24 to 28 pregnancy weeks and performed fetal brain MRI before delivery.Five were excluded from this study due to the poor images quality of fetal artifact,63 pregnant women and their fetuses were included in study(gestational weeks(GWs)26.143 ~ 39.143 weeks).According to the 75 g OGTT diagnostic criteria,they were divided into 2 groups: group A had 27 cases(any plasma glucose levels reached or exceed the above standard)and group B had 36 cases(all three plasma glucose levels were lower than the above standard).We measured following parameters:the skull fronto-occipital diameter(SFOD),skull biparietal diameter(SBD),brain fronto-occipital length(BFOL),brain biparietal diameter(BBD),transverse cerebellar diameter(TCD),vermis height(VH),width of trigonal area of bilateral lateral ventricles,width of bilateral anterior frontal space,width of bilateral anterior temporal space and the whole brain volume.Independent sample t test,paired t test,pearson correlation analysis and variance analysis were used to analyze the the differences in the left and right hemispheres,gender differences and age-related changes.We considered the differences to be statistically significant if P<0.05.Results:1.(1)The widths of left and right lateral ventricle in group A were statistically significant(P<0.05),the widths of left ventricle were higher than the right;the bilateral anterior frontal spaces and anterior temporal spaces had no statistical significance(P>0.05).(2)The widths of left and right lateral ventricle and anterior temporal space in group B were statistically significant(P<0.05),the widths of left ventricle and anterior temporal space were higher than the right;the bilateral anterior frontal spaces had no statistical significance(P>0.05).2.(1)The differences of values of BFOL and VH had statistical significance between group A and group B(P < 0.05),and the mean values of group A were lower than group B.The differences of values of SFOD,SBD,BBD,TCD had no statistical significance between group A and group B(P > 0.05).(2)The differences of widths of bilateral lateral ventricles and anterior frontal spaces had statistical significance between group A and group B(P < 0.05),and the mean values of group A were higher than group B.The differences of values of bilateral anterior temporal spaces had no statistical significance between group A and group B(P > 0.05).3.(1)The BFOL,SFOD,SBD,BBD,TCD and VH in group A were positively correlated with GWs(P<0.05).The bilateral lateral ventricles,anterior frontal spaces and anterior temporal space weres not correlated with GWs(P > 0.05).(2)The BFOL,SFOD,SBD,BBD,TCD,VH and the bilateral lateral ventricles in group B were positively correlated with GWs(P<0.05).The anterior frontal space and anterior temporal space were not correlated with GWs(P > 0.05).4.The volumes of the whole brain had no statistical different between group A and group B(P > 0.05).The whole brain volume in group A and group B were positively correlated with GWs(P<0.05).5.All MRI values of fetal brain had no statistic differences between males and females(P>0.05).6.The growth speed of skull and brain parenchyma was different in group A and group B,and the development speed of various parts of brain parenchyma was also different.Conclusion:1.The structural asymmetry of cerebral hemisphere during development possibly related to their functional asymmetry.2.The brain parenchyma of gestational diabetic fetuses were smaller than that of normal fetus,but the lateral ventricle widths and extracerebral spaces were opposite.3.The linear measurements of fetal skull and brain parenchyma and the whole brain volume were positively correlated with gestational weeks,and the development speed of skull was less than that of brain parenchyma.4.Gestational diabetes mellitus had a certain suggestive effect on fetal intrauterine brain injury.Normal routine MRI may have abnormal microstructure,but it basically conformed to the normal development.5.There was no gender difference in fetal brain measurements based on MRI.