Uterine Artery Doppler in Pregnancy: Women with PCOS Compared to Healthy Controls

Solhild Stridsklev, Øyvind Salvesen, Kjell Åsmund Salvesen, Sven M Carlsen, Eszter Vanky, Solhild Stridsklev, Øyvind Salvesen, Kjell Åsmund Salvesen, Sven M Carlsen, Eszter Vanky

Abstract

The objective of this study was to investigate possible differences in uterine artery pulsatility index (UtAPI) between pregnant women with PCOS and healthy controls and to explore possible effects of metformin on UtAPI. Material and Methods. The study was conducted in a tertiary center. Forty-eight pregnant women diagnosed with PCOS before pregnancy and 124 healthy pregnant women were included. Women with PCOS were randomly assigned to metformin 2000 mg daily or a placebo. UtAPI was measured five times during 1st and 2nd trimesters of pregnancy in women with PCOS and four times in healthy controls. Results. There was no difference in UtAPI between PCOS women and healthy controls at any point in time (p = 0.34-0.77). In women with PCOS, randomly assigned to metformin 2000 mg or placebo, UtAPI was unaffected by metformin two hours after intake of the first dose of study medication (p = 0.34). All PCOS women, regardless of randomization, had higher UtAPI two hours after intake of study medication and a meal compared to before a meal (p = 0.02). Conclusions. In the first and second trimesters of pregnancy, there was no difference in UtAPI between women with PCOS and healthy controls. Metformin had no immediate effect on the UtAPI. Interestingly, blood flow decreased after a meal, suggesting that time since last meal should be taken into consideration when interpreting the results of UtAPI measurements in pregnancy. This trial is registered with ClinicalTrials.gov (NCT00466622) Metformin in Pregnant PCOS women (PregMet) (NCT00159536).

Figures

Figure 1
Figure 1
Participants and examinations. “+2 hours” is two hours after the first examination, and “+2 weeks” is 2 weeks after the first examination.
Figure 2
Figure 2
UtAPI percentile curve with 2.5, 50, and 97.5 percentiles. The lines are statistically calculated based on UtAPI measurements of the controls (gray rectangles) and PCOS women (black rectangles).

References

    1. Papageorghiou A. T., Yu C. K. H., Nicolaides K. H. The role of uterine artery Doppler in predicting adverse pregnancy outcome. Best Practice & Research Clinical Obstetrics & Gynaecology. 2004;18(3):383–396. doi: 10.1016/j.bpobgyn.2004.02.003.
    1. Gomez O., Figueras F., Martinez J. M., et al. Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome. Ultrasound in Obstetrics & Gynecology. 2006;28(6):802–808. doi: 10.1002/uog.2814.
    1. Kalache K. D., Duckelmann A. M. Doppler in obstetrics: beyond the umbilical artery. Clinical Obstetrics and Gynecology. 2012;55(1):288–295. doi: 10.1097/GRF.0b013e3182488156.
    1. Stampalija T., Gyte G. M. L., Alfirevic Z. Utero-placental Doppler ultrasound for improving pregnancy outcome. Cochrane Database of Systematic Reviews. 2010;(9, article CD008363) doi: 10.1002/14651858.CD008363.pub2.
    1. Alfirevic Z., Stampalija T., Gyte G. M. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane database of systematic reviews. 2013;(11, article CD007529) doi: 10.1002/14651858.CD007529.pub3.
    1. Eser A., Zulfikaroglu E., Eserdag S., Kilic S., Danisman N. Predictive value of middle cerebral artery to uterine artery pulsatility index ratio in preeclampsia. Archives of Gynecology and Obstetrics. 2011;284(2):307–311. doi: 10.1007/s00404-010-1660-5.
    1. Papageorghiou A. T., Yu C. K. H., Cicero S., Bower S., Nicolaides K. H. Second-trimester uterine artery Doppler screening in unselected populations: a review. The Journal of Maternal-Fetal & Neonatal Medicine. 2002;12(2):78–88. doi: 10.1080/jmf.12.2.78.88.
    1. Palomba S., de Wilde M. A., Falbo A., Koster M. P. H., La Sala G. B., Fauser B. C. J. M. Pregnancy complications in women with polycystic ovary syndrome. Human Reproduction Update. 2015;21(5):575–592. doi: 10.1093/humupd/dmv029.
    1. Goodman N. F., Cobin R. H., Futterweit W., Glueck J. S., Legro R. S., Carmina E. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome-part 2. Endocrine Practice. 2015;21(12):1415–1426. doi: 10.4158/EP15748.DSCPT2.
    1. Katulski K., Czyzyk A., Podfigurna-Stopa A., Genazzani A. R., Meczekalski B. Pregnancy complications in polycystic ovary syndrome patients. Gynecological Endocrinology. 2015;31(2):87–91. doi: 10.3109/09513590.2014.974535.
    1. Adali E., Kolusari A., Adali F., Yildizhan R., Kurdoglu M., Sahin H. G. Doppler analysis of uterine perfusion and ovarian stromal blood flow in polycystic ovary syndrome. International Journal of Gynaecology and Obstetrics. 2009;105(2):154–157. doi: 10.1016/j.ijgo.2008.12.023.
    1. Ajossa S., Guerriero S., Paoletti A. M., et al. Uterine perfusion and hormonal pattern in patients with polycystic ovary syndrome. Journal of Assisted Reproduction and Genetics. 2001;18(8):436–440. doi: 10.1023/A:1016686721307.
    1. Ozkan S., Vural B., Caliskan E., Bodur H., Turkoz E., Vural F. Color Doppler sonographic analysis of uterine and ovarian artery blood flow in women with polycystic ovary syndrome. Journal of Clinical Ultrasound. 2007;35(6):305–313. doi: 10.1002/jcu.20358.
    1. Resende A. V., Mendes M. C., Dias de Moura M., et al. Doppler study of the uterine arteries and ovarian stroma in patients with polycystic ovary syndrome. Gynecologic and Obstetric Investigation. 2001;52(3):153–157. doi: 10.1159/000052964.
    1. Palomba S., Falbo A., Russo T., et al. Uterine blood flow in pregnant patients with polycystic ovary syndrome: relationships with clinical outcomes. BJOG. 2010;117(6):711–721. doi: 10.1111/j.1471-0528.2010.02525.x.
    1. Tang T., Lord J. M., Norman R. J., Yasmin E., Balen A. H. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. The Cochrane Database of Systematic Reviews. 2010;(article Cd003053)
    1. Mohsen I. A., Elkattan E., Nabil H., Khattab S. Effect of metformin treatment on endometrial vascular indices in anovulatory obese/overweight women with polycystic ovarian syndrome using three-dimensional power doppler ultrasonography. Journal of Clinical Ultrasound. 2013;41(5):275–282. doi: 10.1002/jcu.22006.
    1. Salvesen K. A., Vanky E., Carlsen S. M. Metformin treatment in pregnant women with polycystic ovary syndrome—is reduced complication rate mediated by changes in the uteroplacental circulation? Ultrasound in Obstetrics & Gynecology. 2007;29(4):433–437. doi: 10.1002/uog.3965.
    1. Ozcimen E. E., Uckuyu A., Ciftci F. C., Zeyneloglu H. B. The effect of metformin treatment on ovarian stromal blood flow in women with polycystic ovary syndrome. Archives of Gynecology and Obstetrics. 2009;280(2):263–269. doi: 10.1007/s00404-008-0904-0.
    1. Stridsklev S., Carlsen S. M., Salvesen O., Clemens I., Vanky E. Midpregnancy Doppler ultrasound of the uterine artery in metformin-versus placebo-treated PCOS women: a randomized trial. The Journal of Clinical Endocrinology and Metabolism. 2014;99(3):972–977. doi: 10.1210/jc.2013-3227.
    1. Vanky E., Stridsklev S., Heimstad R., et al. Metformin versus placebo from first trimester to delivery in polycystic ovary syndrome: a randomized, controlled multicenter study. The Journal of Clinical Endocrinology and Metabolism. 2010;95(12):E448–E455. doi: 10.1210/jc.2010-0853.
    1. Stridsklev S., Salvesen O., Salvesen K. A., Carlsen S. M., Husoy M. A., Vanky E. Uterine artery Doppler measurements during first and second trimesters of normal pregnancy. Acta Obstetricia et Gynecologica Scandinavica. 2017;96(3):366–371. doi: 10.1111/aogs.13073.
    1. The Rotterdam ESHRE/ASRM‐sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS) Human Reproduction. 2004;19(1):41–47. doi: 10.1093/humrep/deh098.
    1. Salvesen K., Lees C., Abramowicz J., et al. ISUOG statement on the safe use of Doppler in the 11 to 13 +6-week fetal ultrasound examination. Ultrasound in Obstetrics & Gynecology. 2011;37(6):p. 628. doi: 10.1002/uog.9026.
    1. Hernandez-Andrade E., Brodszki J., Lingman G., Gudmundsson S., Molin J., Marsal K. Uterine artery score and perinatal outcome. Ultrasound in Obstetrics & Gynecology. 2002;19(5):438–442. doi: 10.1046/j.1469-0705.2002.00665.x.
    1. Mirghani H. M., Salem M., Weerasinghe S. D. Effect of maternal fasting on uterine arterial blood flow. The Journal of Obstetrics and Gynaecology Research. 2007;33(2):151–154. doi: 10.1111/j.1447-0756.2007.00500.x.
    1. Moradi M. The effect of Ramadan fasting on fetal growth and Doppler indices of pregnancy. Journal of Research in Medical Sciences. 2011;16(2):165–169.
    1. Jamal A., Milani F., Al-Yasin A. Evaluation of the effect of metformin and aspirin on utero placental circulation of pregnant women with PCOS. Iranian Journal of Reproductive Medicine. 2012;10(3):265–270.
    1. Sakar M. N., Gultekin H., Demir B., et al. Ramadan fasting and pregnancy: implications for fetal development in summer season. Journal of Perinatal Medicine. 2015;43(3):319–323. doi: 10.1515/jpm-2013-0289.
    1. El Hayek S., Bitar L., Hamdar L. H., Mirza F. G., Daoud G. Poly cystic ovarian syndrome: an updated overview. Frontiers in Physiology. 2016;7:p. 124. doi: 10.3389/fphys.2016.00124.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する