In overweight and obese women, fetal ultrasound biometry accurately predicts newborn measures

O’Brien, Cecelia M.; Louise, Jennie; Deussen, Andrea R; Dodd, Jodie M

doi:10.1111/ajo.13025

Cited by 8 publications

(5 citation statements)

References 49 publications

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“…Although some have suggested that the accuracy of US EFW is negatively impacted by increasing maternal BMI, 14–16 in our experience, scan accuracy was not influenced by maternal BMI. This is consistent with more recent studies, 17–19 which have also demonstrated no statistically significant link. We also found that scan accuracy was not influenced by ethnicity, parity or gestational age at scan.…”

Section: Discussionsupporting

confidence: 93%

Accuracy of ultrasound in the estimation of customised birth weight in a public hospital service

et al. 2022

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Introduction: Studies have shown that ultrasound estimated foetal weight (EFW) in small for gestational age (SGA) babies tends to be less-accurate when compared to appropriate (AGA) and large (LGA) for gestational age babies. We aimed to analyse the accuracy of ultrasound EFW overall, and by customised birth weight centile category (severe SGA, SGA, AGA, LGA). Also, the accuracy of estimating the centile category using calculated customised EFW centiles. Methods: We performed a retrospective study of pregnant women between 20-43 weeks gestation who underwent ultrasound within 7 days of delivery at a large tertiary maternity unit between January 2018 and December 2020. Stillbirths, major foetal anomalies and multiple pregnancies were excluded. The EFW and birth weight were compared, and an accurate estimate defined as ≤15% difference. The customised EFW and birth weight centiles were calculated and used to analyse the accuracy of category prediction. Results: Of 2061 foetuses included, 92% (n = 1902) were born weighing within 15% of their EFW. Accuracy was not affected by maternal BMI, ethnicity, parity or gestation. 87% of SGA babies were within 15% of their EFW. Ultrasound sensitivity for SGA was 51% (95% CI: 46-55%). The specificity and positive predictive values were 97% (95% CI: 96-98%) and 87% (95% CI: 82-90%) respectively. Conclusion:The accuracy of Ultrasound EFW overall is good, however, is reduced in SGA babies whose EFW and birth weight centile categories tended to be overestimated. The high specificity for SGA supports monitoring with a lowered threshold to intervene in pregnancies identified by ultrasound as SGA.

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Section: Discussionsupporting

confidence: 93%

Accuracy of ultrasound in the estimation of customised birth weight in a public hospital service

et al. 2022

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“…A recent Australian report suggested, in contrast to our findings, that a 36‐week ultrasound scan can accurately represent birthweight 19 . The difference may result from a different approach to the statistical analysis: our study used classification measurements including sensitivity, specificity, PPV and negative predictive value.…”

Section: Discussioncontrasting

confidence: 59%

A routine third trimester growth ultrasound in the obese pregnant woman does not reliably identify fetal growth abnormalities: A retrospective cohort study

Neel

Cunningham

Teale

2020

Aust NZ J Obst Gynaeco

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Background In response to the challenges of assessing fetal growth in obese women, guidelines recommend routine third trimester ultrasound scans. Aim The aim of this study was to assess the diagnostic performance of this routine scan in obese women (body mass index (BMI) ≥ 35 kg/m2). Methods A retrospective cohort study of 1008 pregnancies with maternal BMI ≥ 35 kg/m2 born after 37 weeks gestation at a Victorian hospital from 2015 to 2017. Multiple pregnancies and those affected by diabetes were excluded. Growth ultrasounds were performed between 34 + 0 and 36 + 6 weeks gestation. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection of large for gestational age (LGA > 90%) and small for gestational age (SGA < 10%) were calculated using ultrasound estimated fetal weight (EFW) or abdominal circumference (AC) and compared with gestational age and gender‐based birthweight percentiles. Results Using EFW, sensitivity for detecting SGA at birth was 8.1% (six of 74) with a PPV of 100%. Sensitivity for detecting LGA at birth was 61.0% (119 of 195), PPV 54.8%. Sensitivity, specificity, PPV and NPV percentages were all lower using AC. Only 40% of actual birthweight percentiles (405/1008) were within ±10 percentiles of their growth ultrasound EFW percentile. Conclusion The performance of a routine third trimester ultrasound in women with BMI ≥ 35 kg/m2 suggests limited utility in helping identify aberrant fetal growth. This has important implications for the management of obese pregnant women.

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“… 36 51 52 53 AFM measures taken during the third trimester have only variably been associated with birth weight and neonatal adiposity. 54 55 56 This suggests that fetal AFM measurements may not be the most reliable fetal subcutaneous tissue measurement for defining a fetal population at increased risk of being born LGA, and additional work on other fetal subcutaneous tissue measurements, and overall fetal body composition, are required.…”

Section: Discussionmentioning

confidence: 99%

“…With regards to fetal subcutaneous tissue thickness measurements, most interest in the literature has focused on abdominal fat mass measurements, and the utility of this measurement in predicting birth weight and risk of LGA infants (36,(51)(52)(53). Abdominal fat mass measures taken during the third trimester have only variably been associated with birth weight and neonatal adiposity (54)(55)(56). This suggests that fetal AFM measurements may not be the most reliable fetal subcutaneous tissue measurement for defining a fetal population at increased risk of being born LGA, and additional work on other fetal subcutaneous tissue measurements, and overall fetal body composition, are required.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Fetal Growth and Adiposity of Infants Born Large for Gestational Age in Three Harmonized Randomized Trials

Poprzeczny,

Louise,

Deussen

et al. 2023

Am J Perinatol

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Objective: Infants born LGA are at an increased risk of short and longer term adverse outcomes. Understanding fetal growth and adiposity, and their trajectories may help inform interventions to prevent birth of LGA infants. We aimed to compare fetal growth and adiposity measures of infants born LGA with those born not LGA, to determine whether the discrepancy at birth was primarily due to larger size throughout gestation, or instead to different trajectories of fetal growth. Study Design: This was a secondary analysis of secondary outcomes of fetal growth and adiposity from three harmonized randomized trials – the LIMIT, GRoW, and Optimise randomized trials. These trials recruited women in early pregnancy, and a singleton gestation, from three major public metropolitan Adelaide maternity hospitals. Maternal BMI ranged from 18.5-≥40.0 kg/m2. Data were obtained from enrolled women who underwent research ultrasounds at 28 and 36 weeks’ gestation. Outcome measures were ultrasound measures of fetal biometry and adiposity. Results: Infants born LGA had larger fetal biometry measures, and higher growth trajectories, from 20 weeks’ gestation. Fetal adiposity measures were consistently larger among infants born LGA and these differences increased over time. We did not find evidence that the differences in biometry and adiposity measurements varied according to maternal BMI. Conclusions: Infants born LGA had larger fetal biometry measures at all time points from 20 weeks’ gestation, compared to infants born not LGA suggesting any interventions to prevent LGA likely need to commence earlier in pregnancy, or prior to conception.

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In overweight and obese women, fetal ultrasound biometry accurately predicts newborn measures

Cited by 8 publications

References 49 publications

Accuracy of ultrasound in the estimation of customised birth weight in a public hospital service

Accuracy of ultrasound in the estimation of customised birth weight in a public hospital service

A routine third trimester growth ultrasound in the obese pregnant woman does not reliably identify fetal growth abnormalities: A retrospective cohort study

Fetal Growth and Adiposity of Infants Born Large for Gestational Age in Three Harmonized Randomized Trials

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