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Erschienen in: Archives of Gynecology and Obstetrics 1/2018

26.04.2018 | Maternal-Fetal Medicine

Fetal overgrowth in pregnancies complicated by diabetes: development of a clinical prediction index

verfasst von: Tracy M. Tomlinson, Dorothea J. Mostello, Kee-Hak Lim, Jennifer S. Pritchard, Gil Gross

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 1/2018

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Abstract

Purpose

To develop an index to predict fetal overgrowth in pregnancies complicated by diabetes.

Methods

Data were derived from a cohort of 275 women with singleton gestations in a collaborative diabetes in pregnancy program. Regression analysis incorporated clinical factors available in the first 20–30 weeks of pregnancy that were assigned beta-coefficient-based weights, the sum of which yielded a fetal overgrowth index (composite score).

Results

Fifty-one (18.5%) pregnancies were complicated by fetal overgrowth. The derived index included five clinical factors: age ≤ 30, history of macrosomia, excessive gestational weight gain, enlarged fetal abdominal circumference, and fasting hyperglycemia. Area under the curve (AUC) for the index is 0.88 [95% confidence interval (CI) 0.82–0.92]. Cut-points were selected to identify “high-risk” and “low-risk” ranges (≥ 8 and ≤ 3) that have positive and negative predictive values of 84% (95% CI 70–98%) and 95% (95% CI 92–98%), respectively. The majority of women in our cohort (n = 182, 66%) had a “low-risk” index while 9% (n = 25) had a “high-risk” index. Sub-analyses of nulliparous women and women with gestational and pre-gestational diabetes revealed that the overgrowth index was equally or more predictive when applied separately to each of these groups.

Conclusion

This fetal overgrowth index that incorporates five clinical factors provides a means of predicting fetal overgrowth and thereby serves as a tool for targeting the allocation of healthcare resources and treatment individualization.
Literatur
1.
Zurück zum Zitat Boney CM, Verma A, Tucker R, Vohr BR (2005) Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 115(3):e290–e296CrossRef Boney CM, Verma A, Tucker R, Vohr BR (2005) Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 115(3):e290–e296CrossRef
2.
Zurück zum Zitat Committee on Practice Bulletins-Obsterics (2013) Practice bulletin no. 137: gestational diabetes mellitus. Obstet Gynecol 122:406–416CrossRef Committee on Practice Bulletins-Obsterics (2013) Practice bulletin no. 137: gestational diabetes mellitus. Obstet Gynecol 122:406–416CrossRef
3.
Zurück zum Zitat Barker DJP, Gluckman PD, Godfrey KM, Harding J, Owens JA, Robinson JS (1993) Fetal nutrition and cardiovascular disease in adult life. Lancet 341:938–941CrossRef Barker DJP, Gluckman PD, Godfrey KM, Harding J, Owens JA, Robinson JS (1993) Fetal nutrition and cardiovascular disease in adult life. Lancet 341:938–941CrossRef
4.
Zurück zum Zitat Gardosi J, Chang A, Kalyan B, Sahota D, Symonds EM (1992) Customised antenatal growth charts. Lancet 339:283–287CrossRef Gardosi J, Chang A, Kalyan B, Sahota D, Symonds EM (1992) Customised antenatal growth charts. Lancet 339:283–287CrossRef
5.
Zurück zum Zitat Larkin JC, Speer PD, Simhan HN (2011) A customized standard of large size for gestational age to predict intrapartum morbidity. Am J Obstet Gynecol 204:499.e1–499.e10CrossRef Larkin JC, Speer PD, Simhan HN (2011) A customized standard of large size for gestational age to predict intrapartum morbidity. Am J Obstet Gynecol 204:499.e1–499.e10CrossRef
6.
Zurück zum Zitat Gardosi J, Francis A (2009) A customised standard to assess fetal growth in a US population. Am J Obstet Gynecol 201:25.e1–25.e7CrossRef Gardosi J, Francis A (2009) A customised standard to assess fetal growth in a US population. Am J Obstet Gynecol 201:25.e1–25.e7CrossRef
7.
Zurück zum Zitat Lee W, Riggs T, Koo W, Deter RL, Yeo L, Romero R (2012) The relationship of newborn adiposity to fetal growth outcome based on birth weight or the modified neonatal growth assessment score. J Matern Fetal Neonatal Med 25(10):1933–1940CrossRef Lee W, Riggs T, Koo W, Deter RL, Yeo L, Romero R (2012) The relationship of newborn adiposity to fetal growth outcome based on birth weight or the modified neonatal growth assessment score. J Matern Fetal Neonatal Med 25(10):1933–1940CrossRef
8.
Zurück zum Zitat González-González NL, González-Dávila E, Cabrera F, Vega B, Padron E, Bartha JL et al (2015) Application of customized birth weight curves in the assessment of perinatal outcomes in infants of diabetic mothers. Fetal Diagn Ther 37(2):117–122CrossRef González-González NL, González-Dávila E, Cabrera F, Vega B, Padron E, Bartha JL et al (2015) Application of customized birth weight curves in the assessment of perinatal outcomes in infants of diabetic mothers. Fetal Diagn Ther 37(2):117–122CrossRef
9.
Zurück zum Zitat Rasmussen KM, Catalano PM, Yaktine AL (2009) New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know. Curr Opin Obstet Gynecol 21(6):521–526CrossRef Rasmussen KM, Catalano PM, Yaktine AL (2009) New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know. Curr Opin Obstet Gynecol 21(6):521–526CrossRef
10.
Zurück zum Zitat Hadlock FP, Deter RL, Harrist RB, Park SK (1984) Estimating fetal age: computer-assisted analysis of multiple fetal growth parameters. Radiology 152(2):497–501CrossRef Hadlock FP, Deter RL, Harrist RB, Park SK (1984) Estimating fetal age: computer-assisted analysis of multiple fetal growth parameters. Radiology 152(2):497–501CrossRef
11.
Zurück zum Zitat Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M (1996) A United States national reference for fetal growth. Obstet Gynecol 87(2):163–168CrossRef Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M (1996) A United States national reference for fetal growth. Obstet Gynecol 87(2):163–168CrossRef
12.
Zurück zum Zitat Dalfrà MG, Sartore G, Di Cianni G, Mello G, Lencioni C, Ottanelli S et al (2011) Glucose variability in diabetic pregnancy. Diabetes Technol Ther 13(8):853–859CrossRef Dalfrà MG, Sartore G, Di Cianni G, Mello G, Lencioni C, Ottanelli S et al (2011) Glucose variability in diabetic pregnancy. Diabetes Technol Ther 13(8):853–859CrossRef
13.
Zurück zum Zitat Cheng YW, Chung JH, Kurbisch-Block I, Inturrisi M, Shafer S, Caughey AB (2008) Gestational weight gain and gestational diabetes mellitus: perinatal outcomes. Obstet Gynecol 112(5):1015–1022CrossRef Cheng YW, Chung JH, Kurbisch-Block I, Inturrisi M, Shafer S, Caughey AB (2008) Gestational weight gain and gestational diabetes mellitus: perinatal outcomes. Obstet Gynecol 112(5):1015–1022CrossRef
14.
Zurück zum Zitat Yang J, Cummings EA, O’connell C, Jangaard K (2006) Fetal and neonatal outcomes of diabetic pregnancies. Obstet Gynecol 108(3):644–650CrossRef Yang J, Cummings EA, O’connell C, Jangaard K (2006) Fetal and neonatal outcomes of diabetic pregnancies. Obstet Gynecol 108(3):644–650CrossRef
15.
Zurück zum Zitat Kase BA, Cormier CM, Costantine MM, Hutchinson M, Ramin SM, Saade GR et al (2012) Population standards of birth weight underestimate fetal growth abnormalities in diabetic pregnancies. Am J Perinat 29(2):147–152CrossRef Kase BA, Cormier CM, Costantine MM, Hutchinson M, Ramin SM, Saade GR et al (2012) Population standards of birth weight underestimate fetal growth abnormalities in diabetic pregnancies. Am J Perinat 29(2):147–152CrossRef
16.
Zurück zum Zitat Habayeb O, Daemen A, Timmerman D, De Moor B, Hackett GA, Bourne T et al (2010) The relationship between first trimester fetal growth, pregnancy-associated plasma protein A levels and birthweight. Prenat Diagn 30(9):873–878CrossRef Habayeb O, Daemen A, Timmerman D, De Moor B, Hackett GA, Bourne T et al (2010) The relationship between first trimester fetal growth, pregnancy-associated plasma protein A levels and birthweight. Prenat Diagn 30(9):873–878CrossRef
17.
Zurück zum Zitat Spencer K, Cowans NJ (2013) The association between gestational diabetes mellitus and first trimester aneuploidy screening markers. Ann Clin Biochem 50:603–610CrossRef Spencer K, Cowans NJ (2013) The association between gestational diabetes mellitus and first trimester aneuploidy screening markers. Ann Clin Biochem 50:603–610CrossRef
18.
Zurück zum Zitat Wald NJ, Watt HC, George L (1996) Maternal serum inhibin-A in pregnancies with insulin-dependent diabetes mellitus: implications for screening for Down’s syndrome. Prenat Diagn 16(10):923–926CrossRef Wald NJ, Watt HC, George L (1996) Maternal serum inhibin-A in pregnancies with insulin-dependent diabetes mellitus: implications for screening for Down’s syndrome. Prenat Diagn 16(10):923–926CrossRef
19.
Zurück zum Zitat Wallace EM, Crossley JA, Ritoe SC, Groome NP, Aitken DA (1997) Maternal serum inhibin-A in pregnancies complicated by insulin dependent diabetes mellitus. Br J Obstet Gynaecol 104(8):946–948CrossRef Wallace EM, Crossley JA, Ritoe SC, Groome NP, Aitken DA (1997) Maternal serum inhibin-A in pregnancies complicated by insulin dependent diabetes mellitus. Br J Obstet Gynaecol 104(8):946–948CrossRef
20.
Zurück zum Zitat Flegal KM, Carroll MD, Kit BK, Ogden C (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 307:491–497CrossRef Flegal KM, Carroll MD, Kit BK, Ogden C (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 307:491–497CrossRef
Metadaten
Titel
Fetal overgrowth in pregnancies complicated by diabetes: development of a clinical prediction index
verfasst von
Tracy M. Tomlinson
Dorothea J. Mostello
Kee-Hak Lim
Jennifer S. Pritchard
Gil Gross
Publikationsdatum
26.04.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Archives of Gynecology and Obstetrics / Ausgabe 1/2018
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-018-4758-9

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