http://www.lifesciencesite.com ) 2013;10(3 Life Science Journal, 2371 Role of middle cerebral artery, umbilical artery resistance indices and middle cerebral artery to umbilical artery resistance index ratio in predicting unfavorable perinatal outcomes of normotensive and hypertensive diabetic pregnancies Usama M. Fouda *, Mohamed M. Abou ElKassem, Shamel M. Hefny, Ahmed T. Hashem Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt. umfrfouda@yahoo.com Abstract: Objective: To evaluate the role of middle cerebral artery (MCA), umbilical artery (UA)resistance indices (RI) and middle cerebral artery / umbilical artery resistance index ratio(MCA/UA RI) in predicting unfavorable perinatal outcomes in pregnancies complicated with diabetes mellitus. Methods: This prospective study included 96 women divided into 4 groups. Group 1 included 23 pregnant patients with preexisting diabetes, group 2 included 22 patients with gestational diabetes, group 3 included 24 diabetic pregnancies associated with hypertension and group 4 was a control group which included 27 patients with uncomplicated pregnancies. The umbilical artery and middle cerebral artery resistance indices were measured weekly starting from the 34 th till the 38 th week of pregnancy. Results: Abnormal UA RI (≥ 95 th centile) had 78.57% sensitivity in detecting adverse perinatal outcomes in group 3 compared with 16.67 % and 0% sensitivity in group 1 and group 2 respectively. Abnormal MCA RI (≤ 5 th centile) had 50% sensitivity in detecting adverse perinatal outcomes in group 3 compared with 0% sensitivity in groups 1 and 2. Abnormal MCA/UA RI (< 1) had 71.43 % sensitivity in detecting adverse perinatal outcomes in group 3 compared with 0 % sensitivity in groups 1 and 2. Conclusion: The abnormal UA RI, MCA RI and MCA/UA RI may be useful parameters in predicting adverse perinatal outcomes in diabetic pregnancies associated with hypertension. On the other hand, there were weak correlations between abnormal UA RI, MCA RI, MCA/UA RI and adverse perinatal outcomes of diabetic pregnancies not associated with hypertension. Therefore the results of the UA RI, MCA RI and MCA/UA RI should be interpreted with caution in the management of diabetic pregnancies, especially those not associated with hypertension, as adverse perinatal outcomes frequently occur in patients with normal Doppler indices. [Usama M. Fouda, Mohamed M. Abou ElKassem, Shamel M. Hefny and Ahmed T. Hashem. Role of middle cerebral artery, umbilical artery resistance indices and middle cerebral artery to umbilical artery resistance index ratio in predicting unfavorable perinatal outcomes of normotensive and hypertensive diabetic pregnancies. Life Sci. J. 2013;10(3):2371-2377]. (ISSN: 1097-8135). http://www.lifesciencesite.com . 345 Keywords: Diabetes mellitus, hypertension, Doppler ultrasound, Resistance index, Pregnancy 1. Introduction Diabetes mellitus (DM) is a common medical disorder which complicates 7 % of all pregnancies (1). The prevalence of diagnosed diabetes among adults has increased from 4.9% in 1990 to 6.9% in 1999 (2). It is expected that the incidence of diabetes mellitus will increase by another 165% by 2050. This increase in the prevalence of diabetes (especially in young population) will consequently increase the prevalence of diabetic pregnancies. Diabetes with pregnancy leads to an increase in maternal and fetal complications such as preeclampsia, prematurity, malformations, macrosomia and perinatal morbidity and mortality. Although, the rates of perinatal mortality and morbidity associated with diabetic pregnancies have shown a progressive decline(mainly due to better preconceptional, antenatal, and neonatal care), these rates are still higher than that of the general pregnant population (3). During the past three decades, the protocols of antepartum fetal surveillance(non stress test, contraction stress test and Doppler) for high risk pregnancies became a part of routine obstetric practice. Although several studies showed that Doppler ultrasound can be used to assess fetal wellbeing in high-risk pregnancies complicated with chronic placental insufficiency, such as in pregnancies complicated with preeclampsia and intrauterine growth restriction. It remains uncertain whether Doppler ultrasound can be used to monitor pregnancies complicated with diabetes mellitus especially in the absence of hypertension or fetal growth restriction(4,5). The purpose of this study was to evaluate the role of middle cerebral artery (MCA), umbilical artery (UA) resistance indices (RI) and middle cerebral artery/ umbilical artery resistance index ratio (MCA/UA RI) in predicting unfavorable perinatal outcomes in pregnancies complicated with diabetes mellitus. 2. Patients and methods This prospective study included 82 diabetic pregnancies and 30 uncomplicated pregnancies. The