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Sabir MS, Hassan MM, Malik M, Saleem R, Tariq Z, Zohaib K, Javaid M, Malik AY, Saleem A. Diagnostic Accuracy of Fetal Anterior Abdominal Wall Thickness as an Early Sonographic Sign for Diagnosing Gestational Diabetes. Cureus 2023; 15:e46538. [PMID: 37927742 PMCID: PMC10625453 DOI: 10.7759/cureus.46538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Traditionally, different fetal variable measurements are used in ultrasound to assess fetal growth. Ultrasound can detect abnormal fetal growth. Gestational diabetes mellitus (GDM) is linked to higher fetal obesity as early as 20 weeks of pregnancy. The amount of fetal adipose tissue may be measured by measuring the thickness of the anterior abdominal wall. Measuring the thickness of the fetus's anterior abdominal wall (AAWT) is a straightforward procedure that may be performed alongside standard abdominal circumference measurements. Objectives To check the diagnostic accuracy of fetal AAWT as an early sonographic sign for diagnosing GDM, keeping oral glucose tolerance test as the gold standard. Study design This research was conducted using a cross-sectional analysis. Study place and duration The study was conducted in the Radiology Department at Rawalpindi Medical University and Allied Hospitals from July 10, 2019 to January 9, 2020. Materials and methods Women between the ages of 18 and 45 who had a family history of type 2 diabetes and were at risk for developing GDM were recruited. Exclusions were made for diabetic women, those carrying multiples, and those with autoimmune diseases. The AAWT measurement of the fetus, which included the skin and subcutaneous tissue, was acquired using the traditional anterior cranial view, 2-3 cm lateral to cord insertion. Pregnant patients at risk for GDM underwent screening using an oral glucose tolerance test. Those exhibiting any two abnormal values were diagnosed with GDM. Results The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of fetal AAWT as an early sonographic sign for diagnosing GDM, with the oral glucose tolerance test as the gold standard, were 93.14%, 82.65%, 84.82%, 92.05%, and 88.0%, respectively. Conclusion The study concludes that the diagnostic accuracy of fetal AAWT as an early sonographic indicator for identifying gestational diabetes is notably high.
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Affiliation(s)
| | | | - Moeena Malik
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Rabia Saleem
- Obstetrics and Gynecology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Zartasha Tariq
- General Medicine, Holy Family Hospital Rawalpindi, Rawalpindi, PAK
| | - Khurram Zohaib
- Internal Medicine, Benazir Bhutto Hospital, Rawalpindi, PAK
| | - Maham Javaid
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Adnan Younas Malik
- Internal Medicine and Nephrology, District Headquarter Hospital, Rawalpindi, PAK
| | - Amna Saleem
- Pediatrics and Child Health, Islamic International Medical College Trust (IIMCT)Pakistan Railways Hospital, Rawalpindi, PAK
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Seth I, Aiyappan RK, Singh S, Seth A, Sharma D, K JM, Krishnan V, Seth A, Yadav CM, Jain H. Mid-Trimester Fetal Anterior Abdominal Wall Subcutaneous Tissue Thickness: An Early Ultrasonographic Predictor of Gestational Diabetes Mellitus. Cureus 2023; 15:e34610. [PMID: 36891019 PMCID: PMC9985981 DOI: 10.7759/cureus.34610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Background This study aimed to determine whether mid-trimester fetal anterior abdominal wall subcutaneous tissue thickness (FASTT) is an early sonographic predictor of gestational diabetes mellitus (GDM), as well as to study its correlation with maternal glycemic values on GDM screening at 24-28 weeks. Methodology We conducted a prospective, case-control study. FASTT was assessed at anomaly scan in 896 uncomplicated singleton pregnancies. The 75-gram oral glucose tolerance test (OGTT) was done for all included patients at 24-28 weeks. Women diagnosed with GDM were taken as cases and appropriately matched in equal numbers as controls. Statistical analysis was done using SPSS version 20 (IBM Corp., Armonk, NY, USA). Independent-samples t-test, chi-square test, receiver operating characteristic curve, and Pearson's correlation coefficient (r) were performed wherever applicable. Results A total of 93 cases and 94 controls were included. Fetuses of women with GDM had significantly higher mean FASTT at 20 weeks (1.605 ± 0.328 mm vs. 1.222 ± 0.121 mm; p < 0.001). The FASTT cut-off obtained was 1.35 mm (sensitivity = 79.6%, specificity = 87.2%, positive predictive value = 86%, negative predictive value = 81.2%). There was a moderate positive correlation between fasting blood sugar (FBS) and two-hour OGTT values and FASTT (r = 0.332, p < 0.001 and r = 0.399, p < 0.001, respectively). FASTT >1.35 mm had an independent predictive value for GDM and was associated with a 19.608-fold increased risk of GDM. Conclusions FASTT values greater than 1.35 mm at 20 weeks are associated with a significantly increased risk of GDM. In addition, FASTT correlates with FBS and two-hour OGTT at 24-28 weeks and is a simple predictor of GDM at 18-20 weeks.
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Affiliation(s)
- Isha Seth
- Obstetrics and Gynaecology, Amrita Hospital, Faridabad, IND
| | | | - Sunayana Singh
- Obstetrics and Gynaecology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Aditya Seth
- Orthopaedics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Deepti Sharma
- Obstetrics and Gynaecology, Amrita Hospital, Faridabad, IND
| | - Janu M K
- Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Kochi, IND
| | - Vivek Krishnan
- Perinatology and Foetal Medicine, Amrita Institute of Medical Sciences, Kochi, IND
| | - Arushi Seth
- Medicine, Jawaharlal Nehru Medical College, Belgaum, IND
| | - Chander Mohan Yadav
- Orthopaedics and Rehabilitation, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Harsh Jain
- Orthopaedics and Rehabilitation, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
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Tutus S, Asal N, Uysal G, Şahin H. Is there a relationship between high birth weight and umbilical vein diameter? J Matern Fetal Neonatal Med 2020; 34:3609-3613. [PMID: 33081536 DOI: 10.1080/14767058.2020.1814247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the associations between sonographical measurements of the umbilical cord and birth weight in 20-24 weeks of gestations. METHODS This cross-sectional study was conducted with the participation of 220 low-risk pregnant women between 20-24 gestational weeks. Biparietal diameter, head and abdominal circumference, and femur length were measured for anthropometric calculations. Umbilical cord including umbilical vein diameters, placental thickness, umbilical artery. Doppler measurements (RI, PI) were recorded. RESULTS In accordance with the results of statistical computations, an inverse relationship was found between umbilical vein diameter and birth weight of a large gestational age (LGA) newborn in 20-24 gestational weeks (p < .05). There was no significant relationship between other parameters and birth weight of LGA newborns. CONCLUSION There is an inverse relationship between birth weights of newborns with LGA and umbilical vein diamater at 20-24 weeks of pregnancy. The umbilical vein diameter in the second trimester may be a promising measurement on predicting LGA fetus. The researches have not confirmed the physiopathology of this finding yet, but it is paving the path for future studies.
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Affiliation(s)
- Sadan Tutus
- Department of Radiology, Kayseri Training and Research Hospital, Şeker Mahallesi, Kayseri, Turkey
| | - Neşe Asal
- Kirikkale Universitesi Tip Fakultesi, Kirikkale, Turkey
| | - Gulsum Uysal
- Department of Obstetrics and Gynecology, Adana City Education and Research Hospital, Adana, Turkey
| | - Hatice Şahin
- Ege University Faculty of Medicine, Izmir, Turkey
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Araujo Júnior E, Peixoto AB, Zamarian ACP, Elito Júnior J, Tonni G. Macrosomia. Best Pract Res Clin Obstet Gynaecol 2017; 38:83-96. [DOI: 10.1016/j.bpobgyn.2016.08.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 01/05/2023]
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Aksoy H, Aksoy Ü, Yücel B, Saygi Özyurt S, Aydın T, Alparslan Babayiğit M. Fetal anterior abdominal wall thickness may be an early ultrasonographic sign of gestational diabetes mellitus. J Matern Fetal Neonatal Med 2015; 29:2028-32. [DOI: 10.3109/14767058.2015.1072164] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Deter RL, Lee W, Sangi-Haghpeykar H, Tarca AL, Yeo L, Romero R. Individualized fetal growth assessment: critical evaluation of key concepts in the specification of third trimester size trajectories. J Matern Fetal Neonatal Med 2013; 27:543-51. [PMID: 23962305 DOI: 10.3109/14767058.2013.833904] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To characterize second and third trimester fetal growth using Individualized Growth Assessment methods in a larger cohort of fetuses with normal neonatal growth outcomes. METHODS A prospective longitudinal study of 119 pregnancies was performed from 18 weeks, MA, to delivery. Measurements of several 1D and 3D fetal size parameters were obtained from 3D volume data sets at 3-4 week intervals. Regression analyses were used to determine Start Points (SP) and Rossavik model (P = c {t} (k + st)) coefficients c. k and s for each parameter in each fetus. Second trimester growth velocity reference ranges were determined and size model specification functions re-established, the latter used to generate individual size models. Actual measurements were compared to predicted third trimester size trajectories using Percent Deviations. New age-specific reference ranges for the Percent Deviations of each parameter were defined using 2-level statistical modeling. RESULTS Rossavik models fit the data for all parameters very well (R(2): 99%), with SP's and k values similar to those found in much smaller cohorts. The c* values were strongly related to the second trimester slope (R(2): 97%), as was predicted s* to estimated c* (R(2): 54--95%). Rossavik models predicted third trimester growth with systematic errors close to 0%; random errors (95% range) ranged between 5.7 and 10.9% and 20.0 and 24.3% for 1D and 3D parameters, respectively. CONCLUSIONS IGA procedures for evaluating second and third trimester growth are now established based on a larger cohort (4-6 fold larger). New, more rigorously defined, age-specific standards for the evaluation of third trimester size deviations are now available for nine anatomical parameters and a weight estimation procedure that incorporates a soft tissue parameter (fractional thigh volume). These results provide a means for more reliably assessing fetal growth on an individualized basis, thus minimizing the effect of biological differences in growth.
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Affiliation(s)
- Russell L Deter
- Department of Obstetrics and Gynecology, Baylor College of Medicine , Houston, TX , USA
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Kang JY, Park EJ, Yang YS, Park M, Park WI. Crown-rump length measured in the early first trimester as a predictor of low birth weight. Yonsei Med J 2013; 54:1049-52. [PMID: 23709444 PMCID: PMC3663218 DOI: 10.3349/ymj.2013.54.4.1049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study is to assess the association between crown-rump length (CRL) measured before the 10th gestational week and birth weight. Results from 316 transvaginal ultrasonography scans at the 46th, 53rd, 60th, 67th, and 74th days of pregnancy were compared in low birth weight (LBW) versus normal birth weight groups. A positive correlation between CRL and birth weight was observed when CRL was measured at days 60, 67, and 74. CRL measured on the 67th day of pregnancy was significantly smaller in the LBW group than in the normal birth weight group. A cut-off value of CRL=26.5 mm measured at day 67 has the highest power to predict LBW.
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Affiliation(s)
- Jae-Yul Kang
- Department of Obstetrics and Gynecology, School of Medicine, Eulji University, Seoul, Korea
| | - Eun-Ju Park
- Department of Obstetrics and Gynecology, School of Medicine, Eulji University, Seoul, Korea
| | - Yun-Suk Yang
- Department of Obstetrics and Gynecology, School of Medicine, Eulji University, Seoul, Korea
| | - Mira Park
- Department of Preventive Medicine, School of Medicine, Eulji University, Seoul, Korea
| | - Won I. Park
- Department of Obstetrics and Gynecology, School of Medicine, Eulji University, Seoul, Korea
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Vasudeva A, Abraham AA, Kamath A. A prospective observational study of early fetal growth velocity and its association with birth weight, gestational age at delivery, preeclampsia, and perinatal mortality. Eur J Radiol 2013; 82:1313-7. [PMID: 23499339 DOI: 10.1016/j.ejrad.2013.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/13/2013] [Accepted: 02/14/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We aimed to measure early fetal growth velocity and to correlate this with the birth weight, gestational age at delivery, and with the incidence of adverse pregnancy outcomes specifically preeclampsia and perinatal mortality. METHODS A data based prospective observational study, wherein sonographic biometry data and specific pregnancy outcome related data were collected from pregnant women's records, starting soon after their first antenatal visit. Early fetal growth velocity was measured using BPD growth between 11 and 14 weeks scan and anomaly scan and standardizing this by Z scoring. RESULTS Out of 607 fetuses, 41 (6.7%) were slow growing, 531 (87.4%) normally growing, and 35 (5.7%) fast growing (Z scoring <10th(,) 10-90th, and >90th percentiles respectively). As fetal growth velocity increased, the mean birth weight decreased from 2958.7±388.9 (<10th centile), 2742.1±576.6 (10-90th centile), to 2339.3±729.4 (>90th centile); and gestational age at delivery decreased from 38.5±1.3 (<10th centile), 37.5±2.1 (10-90th centile), to 36.4±2.2 (>90th centile), and both these trends were statistically significant (p<0.001).Faster growing fetuses had a higher risk of preterm delivery(spontaneous+indicated) compared to other 2 groups [OR 4.42 (2.18,8.98)], and slower growing fetuses had a higher risk of postdated deliveries compared to other 2 groups [OR 3.042 (1.44, 6.45)].We found no significant association between early fetal growth velocity and incidence of small for gestational age at birth/low birth weight at term, preeclampsia, and perinatal mortality. CONCLUSIONS Early fetal growth velocity between first and second trimesters, may be one of the important factors influencing ultimate birthweight and gestational age at delivery.
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Affiliation(s)
- Akhila Vasudeva
- Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka State, India.
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Mayer C, Joseph KS. Fetal growth: a review of terms, concepts and issues relevant to obstetrics. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:136-45. [PMID: 22648955 DOI: 10.1002/uog.11204] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/07/2012] [Indexed: 05/26/2023]
Abstract
The perinatal literature includes several potentially confusing and controversial terms and concepts related to fetal size and growth. This article discusses fetal growth from an obstetric perspective and addresses various issues including the physiologic mechanisms that determine fetal growth trajectories, known risk factors for abnormal fetal growth, diagnostic and prognostic issues related to restricted and excessive growth and temporal trends in fetal growth. Also addressed are distinctions between fetal growth 'standards' and fetal growth 'references', and between fetal growth charts based on estimated fetal weight vs those based on birth weight. Other concepts discussed include the incidence of fetal growth restriction in pregnancy (does the frequency of fetal growth restriction increase or decrease with increasing gestation?), the obstetric implications of studies showing associations between fetal growth and adult chronic illnesses (such as coronary heart disease) and the need for customizing fetal growth standards.
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Affiliation(s)
- C Mayer
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital of British Columbia, Vancouver, Canada
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Salomon LJ, Hourrier S, Fanchin R, Ville Y, Rozenberg P. Is first-trimester crown-rump length associated with birthweight? BJOG 2011; 118:1223-8. [DOI: 10.1111/j.1471-0528.2011.03009.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Antsaklis A, Anastasakis E, Komita O, Theodora M, Hiridis P, Daskalakis G. First trimester 3D volumetry. Association of the gestational volumes with the birth weight. J Matern Fetal Neonatal Med 2011; 24:1055-9. [PMID: 21247238 DOI: 10.3109/14767058.2010.545915] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the three dimensional ultrasound (3D) in the volume assessment of the gestational contents during the 1st trimester of pregnancy. Our aim was to correlate the embryo, gestational sac, and placenta volume with the birth weight. To monitor the increase of these volumes according to the gestational age. METHOD Prospective study of 199 singleton low risk pregnant women undergoing the 1st trimester ultrasound for fetal anomalies. In these women, gestational volumetry was performed and it was compared with the crown-rump length (CRL). Regression models were computed in order to analyze the dependence of birth weight with the volumes. RESULTS The embryo volume reveals the strongest association with the birth weight at delivery (β = 0.24), followed by the CRL (β = 0.20) and the gestational sac volume (β = 0.20). The placenta volume appears the weakest association with fetal weight at delivery (β = 0.16). All volumes increased significantly from 11(+0)-11(+6) to 13(+0)-13(+6) weeks of gestation (p < 0.001). Ten cubic millimeter increase in embryo volume corresponds to a mean birth weight increase of 75 g, while 1 mm increase in the CRL corresponds to a birth weight increase of 113 g. CONCLUSION Our results provide evidence that the embryo volume during the first trimester of pregnancy correlates better with birth weight than the CRL. This might assist in the identification of the high risk pregnancies caring macrosomic and low birth weight fetuses.
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Affiliation(s)
- Aris Antsaklis
- Fetal-Medicine Unit, 1st Department of Obstetrics and Gynaecology, "Alexandra" Maternity Hospital, University of Athens, Athens, Greece
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Pardo J, Peled Y, Yogev Y, Melamed N, Ben-Haroush A. Association of crown-rump length at 11 to 14 weeks' gestation and risk of a large-for-gestational-age neonate. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1315-1319. [PMID: 20733187 DOI: 10.7863/jum.2010.29.9.1315] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the association between crown-rump length (CRL) and the risk of a large-for-gestational-age (LGA) neonate. METHODS Data were retrospectively collected on consecutive women with a healthy singleton pregnancy followed to delivery at our center from 2003 to 2006 who underwent nuchal translucency, pregnancy-associated plasma protein-A, and free beta-human chorionic gonadotropin screening at 11 to 14 weeks' gestation. Pregnancies were dated by the last menstrual period (LMP) confirmed by CRL at 6 to 10 weeks or the known time of fertilization. The fetal CRL at 11 to 14 weeks was obtained from frozen sonographic images. The measured CRL was converted to gestational weeks using the method of Hadlock et al (Radiology 1992; 182:501-505). The expected gestational age (GA) by the LMP was subtracted from the measured GA to yield the DeltaCRL. The association between the DeltaCRL and birth weight was statistically analyzed. RESULTS The sample included 521 women. Fifty neonates (9.6%) were LGA (>or=90th percentile), 38 (7.3%) small for gestational age, and 433 (83.1%) appropriate for gestational age. The LGA group was characterized by significantly larger-than-expected CRL measurements (P = .033). The birth weight percentile and rate of LGA neonates were significantly higher in pregnancies in which the DeltaCRL was 1/2 week or greater (P = .007 and .033, respectively). There was a significant linear correlation between the DeltaCRL and birth weight percentile (P = .001). On multivariate logistic regression analysis, the DeltaCRL was the only significant predictor of an LGA neonate (odds ratio, 1.6; 95% confidence interval, 1.07-2.4; P = .023). CONCLUSIONS Pregnancies with LGA neonates are characterized by larger-than-expected CRL measurements at 11 to 14 weeks' gestation.
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Affiliation(s)
- Joseph Pardo
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tiqwa, Israel
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Salomon LJ. Early fetal growth: concepts and pitfalls. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:385-389. [PMID: 20373482 DOI: 10.1002/uog.7623] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- L J Salomon
- Université Paris Descartes, Service de Gynécologie Obstétrique, Centre Hospitalo-Universitaire Necker-Enfants Malades, AP-HP, 75015 Paris, France.
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