Comparative analysis of carotid hemodynamics during second trimester in pregestational diabetic and non-diabetic pregnancies

초록

Objectives: Maternal hemodynamic adaptation is most prominentduring the second trimester of pregnancy. We investigated maternal hemodynamic changes during the second trimester using carotid ultrasonography and Doppler ultrasound in women with diabetes mellitus and compared with non-diabetic pregnancies. Methods: This prospective study included pregnant women who attended Korea University Ansan Hospital between March 2019 andMarch 2026. Women with multi fetal pregnancies, fetal anomalies,or chronic medical disorders were excluded. Ultrasound data including carotid and Doppler obtained at 20–24 weeks of gestation were analyzed. Adjusted analyses were controlled for chronic hypertension, maternal age, prepregnancy body mass index, parity,and gestational age at measurement. Results: Among 103 women, 19 had overt DM. In unadjusted analysis, overt DM was associated with lower common carotid artery peak systolic velocity (CCA PSV; p < 0.001), and higher externalcarotid artery intima-media thickness (ECA IMT; p = 0.034). After adjustment, lower CCA PSV (p = 0.003) and lower common carotid artery end-diastolic velocity (CCA EDV; p = 0.034)remained significant, whereas higher ECA IMT remained borderline(p = 0.082). In addition, overt DM was associated with higher fetalmiddle cerebral artery pulsatility index (MCA PI; p = 0.002) and resistance index (MCA RI; p = 0.002) Conclusions: Pregestational DM was independently associated with altered maternal carotid hemodynamics during the second trimester,suggesting impaired vascular responsiveness and an increased risk of maternal vascular complications and a less favorable fetoplacental hemodynamic profile in pregnant women with overt DM. Carotid Doppler parameters could serve as a useful non-invasive marker for early detection of vascular impairment in this population.