Sonographic evaluation of fetal abdominal growth: Predictor of the large-for-gestational-age infant in pregnancies complicated by diabetes mellitus

Landon, Mark B.; Mintz, Marshall C.; Gabbe, Steven G.

doi:10.1016/0002-9378(89)90101-4

Cited by 92 publications

(36 citation statements)

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“…Glucose levels measured outside of this period appeared to have less effect on the fetal macrosomia status and the birth weight. The period of 32 through 35 weeks coincides with the onset of accelerated growth at 30 -33 weeks in diabetic pregnancies, as described in other studies (5,6). Similar to our findings in a study of insulin-dependent diabetic women, the third-trimester glucose was a stronger predictor for macrosomia at birth than glucose levels in early pregnancy (23).…”

Section: Discussionsupporting

confidence: 90%

“…The aim of our study was to determine the maternal parameters with the strongest influence on fetal growth at different periods of pregnancies complicated by both GDM and impaired glucose tolerance (IGT). We used the fetal abdominal circumference (AC) to describe fetal growth because accelerated growth of the fetal AC in the early third trimester has been shown to be a good predictor for macrosomia at birth and reflects the asymmetric growth in diabetic pregnancies (5,6).…”

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confidence: 99%

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Determinants of Fetal Growth at Different Periods of Pregnancies Complicated by Gestational Diabetes Mellitus or Impaired Glucose Tolerance

Schaefer-Graf

Kjos²,

Kilavuz³

et al. 2003

Diabetes Care

103

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OBJECTIVE -To determine maternal parameters with the strongest influence on fetal growth in different periods of pregnancies complicated by an abnormal glucose tolerance test (GTT).RESEARCH DESIGN AND METHODS -Retrospective study of 368 women with gestational diabetes mellitus (GDM; Ն2 abnormal GTT values, n ϭ 280) and impaired glucose tolerance (IGT; one abnormal value, n ϭ 88) with 869 ultrasound examinations at entry to and during diabetic care. Both groups were managed comparably. Abdominal circumference (AC) Ն90th percentile defined fetal macrosomia. Maternal historical and clinical parameters, and diagnostic and glycemic values of glucose profiles divided into five categories of 4 weeks of gestational age (GA; Ͻ24 weeks, 24 weeks/0 days to 27 weeks/6 days, 28/0 -31/6, 32/0 -35/6, and 36/0 -40/0 [referred to as Ͻ24 GA, 24 GA, 28 GA, 32 GA, and 36 GA categories, respectively]) were tested by univariate and multiple logistic regression analysis for their ability to predict an AC Ն90th percentile at each GA group and large-for-gestational-age (LGA) newborn. Data obtained at entry were also analyzed separately irrespective of the GA.RESULTS -Maternal weight, glycemia after therapy, rates of fetal macrosomia, and LGA were not significantly different between GDM and IGT; thus, both groups were analyzed together.LGA in a previous pregnancy, (odds ratio [OR] 3.6; 95% CI 1.8 -7.3) and prepregnancy obesity (BMI Ն30 kg/m 2 ; 2.1; 1.2-3.7) independently predicted AC Ն90th percentile at entry. When data for each GA category were analyzed, no predictors were found for Ͻ24 GA. Independent predictors for each subsequent GA category were as follows: at 24 GA, LGA history (OR 9.8); at 28 GA, LGA history (OR 4.2), and obesity (OR 3.3); at 32 GA, fasting glucose of 32 GA (OR 1.6 per 5-mg/dl increase); at 36 GA, fasting glucose of 32 GA (OR 1.6); and for LGA at birth, LGA history (OR 2.7), and obesity (OR 2.4).CONCLUSIONS -In the late second and early third trimester, maternal BMI and LGA in a previous pregnancy appear to have the strongest influence on fetal growth, while later in the third trimester coincident with the period of maximum growth described in diabetic pregnancies, maternal glycemia predominates.

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

Determinants of Fetal Growth at Different Periods of Pregnancies Complicated by Gestational Diabetes Mellitus or Impaired Glucose Tolerance

Schaefer-Graf

Kjos²,

Kilavuz³

et al. 2003

Diabetes Care

103

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“…Growth patterns of the AC throughout pregnancy have been shown to be altered for women with diabetes compared with normal controls 32 with AC measurements showing increased growth rate in large for gestational age (LGA) infants 4 33 , 34 Symmetry of the AC and HC measurements is also important with fetuses of diabetic mothers having an increased AC/HC ratio 32 .…”

Section: Discussionmentioning

confidence: 99%

Ultrasound (in)accuracy: it's in the formulae not in the technique – assessment of accuracy of abdominal circumference measurement in term pregnancies

Nesbitt‐Hawes

Tetstall

Gee

et al. 2014

Australas J Ultrason Med

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Introduction: Fetal abdominal circumference (AC) is utilised in calculations for the estimation of fetal weight (EFW) and has been proposed as a method of monitoring diabetic pregnancies. We evaluated true ultrasound accuracy by comparing fetal AC biometry with neonatal anthropometry and compared this with standard ultrasound estimations of fetal weight. Methods: A prospective observational study was performed at a tertiary referral centre. Women who were having their confinement of a term, singleton gestation either by induction of labour or elective caesarean section from 2009–2011 were approached to participate. An ultrasound was performed within 24 hours of delivery measuring the biometric parameters of AC, head circumference (HC), biparietal diameter and femur length. Following delivery the AC, HC and birthweight were measured on the neonate. Results: Fifty‐two patients were enrolled in the study with data collected from 50. Mean AC measurement was 35.1 ± 2.1 cm and birth weight was 3596 ± 517 g. A Bland‐Altman plot was used to compare the two AC measurements with the 95% limits of agreement ranging from −2.33–4.69 cm around a mean difference of 1.2 cm. Mean percentage error was 5.0% and 6.2% for the AC and HC measurements respectively, in comparison with percentage errors of 7.0–13.8% for estimation of fetal weight (EFW) from 27 formulae. Conclusions: Sonographic AC measurement is accurate in term pregnancies, with a percentage error less than HC or EFW. Perceptions of ultrasound inaccuracy may relate to the application of formulae rather than the ultrasound technique itself. Fetal surveillance using serial AC measurement has been proposed, in particular monitoring of diabetic pregnancies and in such a group AC may be easier and faster to obtain and more meaningful than EFW.

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“…Estimation of fetal weight is based on measurement of the fetal head circumference, femur length and abdominal circumference, with the abdominal circumference being the most individually sensitive predictor of fetal macrosomia. 104,105 The abdominal circumference is predominantly affected by the size of the fetal liver and is positively correlated with hepatic glycogen stores, which increase towards term. 106,107 Glucose is the major substrate that determines fat accumulation in the fetus, with the greater the glucose supply the greater the deposition of fat.…”

Section: Substudiesmentioning

confidence: 99%

Does metformin reduce excess birthweight in offspring of obese pregnant women? A randomised controlled trial of efficacy, exploration of mechanisms and evaluation of other pregnancy complications

et al. 2016

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This report should be referenced as follows:Chiswick CA, Reynolds RM, Denison FC, Drake AJ, Forbes S, Newby DE, et al. Does metformin reduce excess birthweight in offspring of obese pregnant women? A randomised controlled trial of efficacy, exploration of mechanisms and evaluation of other pregnancy complications. Efficacy Mech Eval 2016;3(7). Efficacy and Mechanism EvaluationISSN 2050-4365 (Print) ISSN 2050-4373 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full EME archive is freely available to view online at www.journalslibrary.nihr.ac.uk/eme. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Efficacy and Mechanism Evaluation journalReports are published in Efficacy and Mechanism Evaluation (EME) if (1) they have resulted from work for the EME programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. EME programmeThe Efficacy and Mechanism Evaluation (EME) programme was set up in 2008 as part of the National Institute for Health Research (NIHR) and the Medical Research Council (MRC) coordinated strategy for clinical trials. The EME programme is broadly aimed at supporting 'science driven' studies with an expectation of substantial health gain and aims to support excellent clinical science with an ultimate view to improving health or patient care.Its remit includes evaluations of new treatments, including therapeutics (small molecule and biologic), psychological interventions, public health, diagnostics and medical devices. Treatments or interventions intended to prevent disease are also included.The EME programme supports laboratory based or similar studies that are embedded within the main study if relevant to the remit of the EME programme. Studies that use validated surrogate markers as indicators of health outcome are also considered.For more information about the EME programme please visit the website: http://www.nets.nihr.ac.uk/programmes/eme This reportThe research reported in this issue of the journal was funded by the EME programme as project number 08/246/09. The contractual start date was in November 2014. The final report began editorial review in July 2015 and was accepted for publication in April 2016. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The EME editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect tho...

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Sonographic evaluation of fetal abdominal growth: Predictor of the large-for-gestational-age infant in pregnancies complicated by diabetes mellitus

Cited by 92 publications

References 9 publications

Determinants of Fetal Growth at Different Periods of Pregnancies Complicated by Gestational Diabetes Mellitus or Impaired Glucose Tolerance

Determinants of Fetal Growth at Different Periods of Pregnancies Complicated by Gestational Diabetes Mellitus or Impaired Glucose Tolerance

Ultrasound (in)accuracy: it's in the formulae not in the technique – assessment of accuracy of abdominal circumference measurement in term pregnancies

Does metformin reduce excess birthweight in offspring of obese pregnant women? A randomised controlled trial of efficacy, exploration of mechanisms and evaluation of other pregnancy complications

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