Predictive value of the modified myocardial performance index and the Cerebroplacental-Uterine ratio for adverse perinatal outcomes in late onset preeclampsia and diabetes mellitus: prospective cohort study

High-Risk Pregnancies complicated by gestational diabetes mellitus (GDM) and preeclampsia (PE) represent a significant global health challenge, affecting approximately 15-20% of all pregnancies. These conditions are major contributors to adverse perinatal outcomes, including respiratory distress, neonatal hypoglycemia, and NICU admission. Beyond these, growing evidence suggests that the fetal heart undergoes early structural and functional adaptations to the altered intrauterine environment . Current strategies for fetal surveillance mainly rely on conventional Doppler indices including umbilical artery, middle cerebral artery, and cerebroplacental ratio (CPR).Recently, interest has shifted toward combining cardiac functional assessment with placental Doppler parameters to improve prediction of adverse neonatal outcomes . The Modified Myocardial Performance Index has emerged as a sensitive Doppler-derived parameter for assessment of global fetal cardiac function through evaluation of systolic and diastolic time intervals. Several studies demonstrated elevated Mod-MPI values in fetuses affected by placental insufficiency and maternal metabolic disorders reflecting early fetal cardiac dysfunction . More recently, the cerebroplacental-uterine ratio (CPUR) has been introduced as a novel Doppler index that incorporates both fetal and maternal circulatory parameters. Therefore, further research is needed to evaluate advanced Doppler indices , particularly the cerebroplacental-uterine ratio (CPUR) and Mod-MPI in high risk pregnancy complicated by Diabetes mellitus and preeclampsia .This may enhance early detection of fetal compromise and improve prediction of neonatal morbidity. The rationale of the present study Is based on the need for a reliable, reproducible, and clinically applicable fetal cardiac assessment tool that can complement conventional Doppler surveillance and optimize perinatal management in high-risk pregnancies.