J. Perinat. Med. 2017; 45(6): 711–715 Panagiotis Antsaklis*, Selma Porovic, George Daskalakis and Asim Kurjak 4D assessment of fetal brain function in diabetic patients DOI 10.1515/jpm-2016-0394 Received December 4, 2016. Accepted January 30, 2017. Previously published online March 17, 2017. Abstract Objective: To assess whether there is a difference in the behavior of fetuses of pregnant women with diabetes under treatment with insulin, compared to fetuses of pregnant women without diabetes. Materials and methods: Kurjak’s antenatal neurodevel- opmental test (KANET) – a method that, by application of four-dimensional (4D) ultrasound, assesses fetal behavior in a similar way that neonatologists perform a neurological assessment in newborns – was applied from 28 to 38 weeks of gestation to 40 pregnancies with pre-existing diabetes mellitus or gestational diabetes mellitus (GDM) requiring insulin (diabetic group) and to 40 non-diabetic cases, with otherwise low-risk pregnancies (non-diabetic group). Results: There were no statistically significant differences regarding maternal age (30.5  ± 5.1 years for diabetic group vs. 29.8  ± 6.2 years for non-diabetic group) and gestational age (32  ± 1.6 weeks for the diabetic group compared to 33  ± 1.2 weeks for the non-diabetic group). After analysis of the results obtained from application of KANET to each group, results of KANET had higher scores in the non-diabetic group. Conclusion: It appears that there are differences in the fetal behavior between diabetic and non-diabetic fetuses, and also the specific parameters – movements that were different between the two groups were identified. Keywords: Diabetes; fetal neurobehavior; KANET. Introduction Assessment of fetal behavior in utero has been one of the greatest obstetrical challenges for many years. Advances of ultrasound technology allowed a more comprehensive and realistic evaluation of the fetus, with direct observa- tion of real time fetal movements and activities, including facial expressions and delicate movements of legs, hands and even fingers, mainly due to the excellent views offered by three- (3D) and four-dimensional (4D) ultrasound [1–3]. The fetal behavioral pattern that correspond to the differ- ent gestational ages has been described and it has been shown that each behavioral pattern reflects the corre- sponding fetal brain maturation [4, 5]. Kurjak’s antenatal neurodevelopmental test (KANET) is a recognized method that by application of 4D ultrasound assesses a combina- tion of parameters of fetal behavior and forms a scoring system, that assesses the fetus in a comprehensive and systematic approach, in the same way that neonatologists perform a neurological assessment in newborns, during the first days of their life, in order to determine their neu- rological status [6]. Human brain development is a very structured and detailed procedure, but as such it is at the same time very sensitive and susceptible to a wide variety of factors and defects, that may occur during any of the phases of intrauterine life. One of the most common conditions that affect preg- nancy is gestational diabetes. Diabetes has been related with several complications of pregnancy, affecting both the mother and the fetus. Early identification of ges- tational diabetes mellitus (GDM) and better control of glucose levels in all forms of gestational diabetes, has been related to a decreased incidence of these complica- tions. The information given from the literature regarding the effect of glucose control on fetal behavior and mainly the fetal neurobehavior is limited. The aim of this study was to apply KANET to both diabetic and non-diabetic patients and identify possible differences in their fetal neurobehavior. Materials and methods This study included 80 women in total ranging from 28 to 38 weeks of pregnancy. The women were divided into two groups. The frst group (diabetic group) included 40 pregnancies with pre-existing diabe- tes mellitus or GDM requiring insulin and the second group (non- diabetic group) included 40 non-diabetic patients, with otherwise low-risk pregnancies. The study was performed in two university *Corresponding author: Panagiotis Antsaklis, 1 st Department of Obstetrics and Gynecology, “Alexandra” Maternity Hospital, University of Athens, 11 Lampsakou str, Athens 11528, Greece, E-mail: panosant@gmail.com Selma Porovic and Asim Kurjak: Department of Obstetrics and Gynecology, Sveti Duh Clinical Hospital, Zagreb, Croatia George Daskalakis: 1 st Department of Obstetrics and Gynecology, “Alexandra” Maternity Hospital, University of Athens, Greece