The Relationship between Fetal Abdominal Wall Thickness and Intrapartum Complications amongst Mothers with Pregestational Type 2 Diabetes

Abstract

Objectives. To evaluate the utility of fetal abdominal wall thickness (AWT) for predicting intrapartum complications amongst mothers with pregestational type 2 diabetes. Methods. This was a historical cohort study of pregnant mothers with pregestational type 2 diabetes delivering at a Canadian tertiary-care center between January 1, 2014, and December 31, 2018. Delivery records were reviewed to collect information about demographics and peripartum complications. Stored fetal ultrasound images from 36 weeks’ gestation were reviewed to collect fetal biometry and postprocessing measurement of AWT performed in a standardized fashion by 2 blinded and independent observers. The relationship between fetal AWT was then correlated with risk of intrapartum complications including emergency Caesarean section (CS) and shoulder dystocia. Results. 216 pregnant women with type 2 diabetes had planned vaginal deliveries and were eligible for inclusion. Mean maternal age was 31.3 years, and almost all were overweight or obese at the time of delivery (96.8%). Overall, the incidence of shoulder dystocia and emergency intrapartum CS was 7.4% and 17.6%, respectively. There was no difference in mean fetal AWT between those having a spontaneous vaginal delivery (8.2 mm (95% CI 7.9-8.5)) and those needing emergency intrapartum CS (8.1 mm (95% CI 7.4-8.8); p = 0.71 ) or shoulder dystocia (8.7 mm (95% CI 7.9-9.5); p = 0.23 ). There was strong interobserver correlation of AWT measurements ( r = 0.838 ; p < 0.00001 ). The strongest association with intrapartum complications was birthweight ( p = 0.003 ): with birthweight > 4000 grams, the relative risk of shoulder dystocia or CS is 2.75 (95% CI 1.74-4.36; p < 0.001 ). Conclusions. There was no obvious benefit of AWT measurement at 36 weeks for predicting shoulder dystocia or intrapartum CS amongst women with type 2 diabetes in our population. The strongest predictor of intrapartum complications remained birthweight, and so studies for improving estimation of fetal weight and evaluating the role of intrapartum ultrasound for predicting risk of delivery complications are still needed.

Trends of the Prevalence of Pre-gestational Diabetes in 2030 and 2050 in Belgrade Cohort

“…Increase in the prevalence of pre-gestational diabetes is expected to lead to the increase in the prevalence of all associated pregnancy complications affecting the mothers and the newborns, such as miscarriages, Caesarean deliveries, lacerations during vaginal deliveries, venous thromboembolism, congenital malformations, perinatal asphyxia and an overall higher perinatal mortality [ 15 , 16 , 17 ]. All of these complications are associated with the higher likelihood for increase in the length of hospital stay and the increase in the health care required for each women and the newborn [ 18 ].…”

The Significance of Exposure to Pregestational Type 2 Diabetes in Utero on Fetal Renal Size and Subcutaneous Fat Thickness

“…We were limited to data available up to the time of the midpregnancy ultrasound and recorded in our ultrasound charts, and did not have information about late pregnancy complications. However, another study from our group showed no relationship between fetal abdominal wall thickness and the risk of cesarean section or shoulder dystocia [ 26 ]. Further research is needed to evaluate the influence of glycemic control, other maternal exposures (including gestational versus type 1 diabetes), ethnicity/HNF1 α genotype, and preeclampsia on fetal renal development and fat metabolism.…”

“…Despite the known association between childhood obesity and youthonset T2D, little attention has been paid to fetal fat distribution beyond overall fetal growth or macrosomia. With increasing awareness of the developmental origins of health and disease (DOHaD), there is speculation as to whether fetal renal injury and/or metabolic changes may already begin in utero for offspring of mothers with diabetes [22,[24][25][26].…”

Maternal and neonatal outcomes in pregnancies with type 2 diabetes in First Nation and other Manitoban people: a population-based study

“…Additionally, definitions of macrosomia using an absolute birth weight instead of a percentile corrected for gestational age underestimate the identification of largeforgestational age infants. 11,33,34 Largeforgestationalage size is associated with an increased risk of other adverse pregnancy outcomes such as neonatal hypoglycemia and stillbirth. 3,31,35 Both dia betes in pregnancy and fetal macrosomia are also independent predictors of cesarean delivery, which is consistent with our study finding that type 2 diabetes increased risk of cesarean delivery.…”