Serial fetal abdominal circumference measurements in predicting normal birth weight in gestational diabetes mellitus

A Predictive Model for Large-for-Gestational-Age Infants among Korean Women with Gestational Diabetes Mellitus Using Maternal Characteristics and Fetal Biometric Parameters

Background: With increasing incidence of gestational diabetes mellitus (GDM), newborn infants with perinatal morbidity, including large-for-gestational-age (LGA) or macrosomia, are also increasing. The purpose of this study was to develop a prediction model for LGA infants with GDM mothers. Methods: This was a retrospective case-control study of 660 women with GDM and singleton pregnancies in four tertiary care hospitals from 2006 to 2013 in Korea. Biometric parameters were obtained at diagnoses of GDM and within two weeks before delivery. These biometric data were all transformed retrospectively into Z-scores calculated using a reference. Interval changes of values between the two periods were obtained. Multivariable logistic and stepwise backwards regression analyses were performed to develop the most parsimonious predictive model. The prediction model included pre-pregnancy body mass index (BMI), head circumference (HC), Z-score at 24 + 0 to 30 + 6 weeks’ gestation, and abdominal circumference (AC) Z-score at 34 + 0 to 41 + 6 weeks within 2 weeks before delivery. The developed model was then internally validated. Results: Our model’s predictive performance (area under the curve (AUC): 0.925) was higher than estimated fetal weight (EFW) within two weeks before delivery (AUC: 0.744) and the interval change of EFW Z-score between the two periods (AUC: 0.874). It was internally validated (AUC: 0.916). Conclusions: A clinical model was developed and internally validated to predict fetal overgrowth in Korean women with GDM, which showed a relatively good performance.

The trends and risk factors to predict adverse outcomes in gestational diabetes mellitus: a 10-year experience from 2006 to 2015 in a single tertiary center

Objective

To investigate the change of maternal characteristics, delivery and neonatal outcomes in gestational diabetes mellitus (GDM) over recent 10 years and to identify the risk factors associated with adverse outcome.

Methods

Consecutive GDM patients (n=947) delivered in our institution were included. Research period was arbitrarily divided into 2 periods (period 1: from 2006 to 2010, period 2: from 2011 to 2015). Multiple pregnancies or preexisting diabetes were excluded. Maternal baseline characteristics, delivery and neonatal outcomes were reviewed. Fetal biometric findings by prenatal ultrasonography were collected. Adverse pregnancy outcome (APO) was defined by the presence of one of the followings; shoulder dystocia, neonatal macrosomia (>4 kg), neonatal hypoglycemia (<35 mg/dL), respiratory distress syndrome (RDS), and admission to the neonatal intensive care unit (NICU) in term pregnancy.

Results

Period 2 was associated with older maternal age (34 vs. 33, P<0.001) and higher proportion of GDM A2 compared to period 1 (30.9% vs. 23.0%, P=0.009). By univariate analysis, APO was associated with increased body mass index (BMI) at pre-pregnancy (23.4 kg/m² vs. 21.8 kg/m², P=0.001) or delivery (27.9 kg/m² vs. 25.8 kg/m², P<0.001), higher HbA1c at diagnosis (5.6% vs. 5.3%, P<0.001) or delivery (5.8% vs. 5.5%, P=0.044), and larger fetal biometric findings (abdominal circumference [AC] and estimated fetal weight, P=0.029 and P=0.007, respectively). Multivariate analysis showed pre-pregnancy BMI (odds ratio [OR], 1.101; 90% confidence interval [CI], 1.028–1.180) and fetal AC (OR, 1.218; 90% CI, 1.012–1.466) were independently associated with adverse outcomes.

Conclusion

Our study demonstrated the trends and relevant factors associated with the adverse outcomes.

Accelerated Fetal Growth Prior to Diagnosis of Gestational Diabetes Mellitus: A Prospective Cohort Study of Nulliparous Women

OBJECTIVE

To determine whether fetal overgrowth precedes the diagnosis of gestational diabetes mellitus (GDM) and to quantify the interrelationships among fetal overgrowth, GDM, and maternal obesity.

RESEARCH DESIGN AND METHODS

We conducted a prospective cohort study of unselected nulliparous women and performed ultrasonic measurement of the fetal abdominal circumference (AC) and head circumference (HC) at 20 and 28 weeks of gestational age (wkGA). Exposures were diagnosis of GDM ≥28 wkGA and maternal obesity. The risk of AC >90th and HC-to-AC ratio <10th percentile was modeled using log-binomial regression, adjusted for maternal characteristics.

RESULTS

Of 4,069 women, 171 (4.2%) were diagnosed with GDM at ≥28 wkGA. There was no association between fetal biometry at 20 wkGA and subsequent maternal diagnosis of GDM. However, at 28 wkGA, there was an increased risk of AC >90th percentile (adjusted relative risk 2.05 [95% CI 1.37-3.07]) and HC-to-AC ratio <10th percentile (1.97 [1.30-2.99]). Maternal obesity showed similar associations at 28 wkGA (2.04 [1.62-2.56] and 1.46 [1.12-1.90], respectively). The combination of GDM and obesity was associated with an approximately fivefold risk of AC >90th (4.52 [2.98-6.85]) and approximately threefold risk of HC-to-AC ratio <10th percentile (2.80 [1.64-4.78]) at 28 wkGA. Fetal AC >90th percentile at 28 weeks was associated with an approximately fourfold risk of being large for gestational age at birth.

CONCLUSIONS

Diagnosis of GDM is preceded by excessive growth of the fetal AC between 20 and 28 wkGA, and its effects on fetal growth are additive with the effects of maternal obesity.

The influence of placental perfusion on birthweight in women with gestational diabetes

OBJECTIVE

To evaluate the influence of both uterine and umbilical arteries Doppler pulsatility indexes (PI) and metabolic control on birthweight in pregnant women with gestational diabetes mellitus.

METHODS

One hundred sixty-nine women with gestational diabetes were evaluated. Doppler measurements of umbilical artery and mean uterine arteries PI were recorded and the corresponding Z-score values by gestational age calculated. Maternal pregestational body mass index (BMI) and the levels of glycosylated hemoglobin were also recorded. The relationships between these studied variables and customised birthweight centiles according to sex and gestational age were analyzed using Spearman's correlation coefficient and linear regression.

RESULTS

There was a significant correlation between birthweight centiles and Z-score values of the umbilical artery PI (r = -0.25, p = 0.001), but not with the Z-score values of the uterine artery PI (r = -0.12, p = 0.43). Third trimester maternal glycosylated hemoglobin was also positively correlated to birthweight (r = 0.29, p = 0.01). When using stepwise linear regression both maternal glycosylated hemoglobin and the Z-score of umbilical artery PI were included as independent variables in the predictive model of birthweight centile (p = 0.0002, p = 0.001 respectively, R(2)( )= 0.27).

CONCLUSIONS

Umbilical artery PI predicts birthweight in women with gestational diabetes. However, metabolic control is the only important determinant of fetal macrosomia in these mothers.

Association between fetal abdominal circumference and birthweight in maternal hyperglycemia

OBJECTIVES

To compare fetal abdominal circumference and its relationship with birthweight at increasing gestational ages in the context of maternal hyperglycemia of varying severity.

DESIGN

Retrospective cohort study.

SETTING

Two centers participated in building one database.

POPULATION

A total of 1538 Korean pregnant women were subjected to a two-step approach to diagnose gestational diabetes mellitus.

METHODS

Pregnant women were classified into gestational diabetes mellitus, borderline gestational diabetes mellitus, and normal groups. Fetal abdominal circumferences, which were measured with ultrasound at 4-week intervals starting at 16 weeks of gestation and ending prior to delivery, were evaluated in the groups.

MAIN OUTCOME MEASURE

The significance of fetal abdominal circumferences as predictors or risk factors of macrosomia/large-for-gestational age.

RESULTS

Fetal abdominal circumferences measured from 16 weeks of gestation until prior to delivery predicted birthweight in all groups with some exceptions. Fetal abdominal circumferences measured from 32 weeks of gestation until prior to delivery were predictive of macrosomia in all groups. Fetal abdominal circumferences measured from 28 weeks of gestation until prior to delivery were predictive of neonates being large-for-gestational age in all groups. Fetal abdominal circumferences measured at 16 and 24 weeks of gestation were also predictive of large-for-gestational age in the borderline gestational diabetes mellitus group. Fetal abdominal circumference measured at 24 weeks of gestation was also a predictor of macrosomia/large-for-gestational age in normal women.

CONCLUSIONS

Fetal abdominal circumferences measured during the second and especially third trimesters were significantly associated with excessive birthweight, irrespective of the severity of maternal glucose intolerance.