Universal third-trimester ultrasonic screening using fetal macrosomia in the prediction of adverse perinatal outcome: A systematic review and meta-analysis of diagnostic test accuracy

Abstract

Background The effectiveness of screening for macrosomia is not well established. One of the critical elements of an effective screening program is the diagnostic accuracy of a test at predicting the condition. The objective of this study is to investigate the diagnostic effectiveness of universal ultrasonic fetal biometry in predicting the delivery of a macrosomic infant, shoulder dystocia, and associated neonatal morbidity in low-and mixed-risk populations. Methods and findings We conducted a predefined literature search in Medline, Excerpta Medica database (EMBASE), the Cochrane library and ClinicalTrials.gov from inception to May 2020. No language restrictions were applied. We included studies where the ultrasound was performed as part of universal screening and those that included low-and mixed-risk pregnancies and excluded studies confined to high risk pregnancies. We used the estimated fetal weight (EFW) (multiple formulas and thresholds) and the abdominal circumference (AC) to define suspected large for gestational age (LGA). Adverse perinatal outcomes included macrosomia (multiple thresholds), shoulder dystocia, and other markers of neonatal morbidity. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Meta-analysis was carried out using the hierarchical summary receiver

Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review

“…In a meta-analysis of 41 studies, including 112,034 patients that had third-trimester ultrasounds for the prediction of macrosomia, the EFW did not have a clinically significant effect at predicting shoulder dystocia. Most studies reported sensitivities below 30%, and only one small study reported a sensitivity of >50% [ 180 ]. Untreated diabetes in pregnancy was associated with an increased rate of shoulder dystocia (risk ratio, 1.25 compared to controls).…”

“…Antoniou et al found 8.2% premature births among 576 diabetic pregnancies associated with HbA1c ≥ 5.5% at the end of pregnancy [ 187 ]. Prematurity was more common among women with type 1 and 2 PGDM without pre-pregnancy care (17.7% of 265) compared to women with pre-pregnancy care (11.4% of 149), p = 0.09 [ 180 ]. Kawakita evaluated 222,978 singleton pregnancies, of them, 11,327 (5%) had GDM and 3296 (1.5%) PGDM and found prematurity rate of 16.3% and 32.3% among GDM and PGDM, respectively, compared to controls (10.9%) [ 188 ].…”

Newer Insights Into Fetal Growth and Body Composition

“…Fetal ultrasonography is commonly used to evaluate fetal growth in clinical practice, and most studies use conventional biometry (estimated fetal weight). Estimated fetal weight has been reported to be a useful predictor of fetal macrosomia (18), or fetal growth restriction with decreased percent body fat (19). However, the estimated fetal weight can fluctuate by approximately 15% compared to the actual weight and has poor accuracy, especially for fetuses with growth restriction or macrosomic infants (20).…”

Authors’ reply re: How often do we identify fetal abnormalities during routine third‐trimester ultrasound? A systematic review and meta‐analysis

“…In most settings, the rationale for third‐trimester ultrasound – whether universal or selective – is aimed at identifying fetuses at risk of adverse perinatal outcome due to growth restriction, 3 abnormal Doppler studies, 4 macrosomia 5 or non‐cephalic presentation 6…”