Impact of Maternal Obesity and Maternal Overweight on the Detection Rate of Fetal Heart Defects and the Image Quality of Prenatal Echocardiography

 

 Buy Article Permissions and Reprints

Zusammenfassung

Ziel: Gegenstand der Studie war es, die vorgeburtliche Entdeckung von 4 ausgewählten fetalen Herzfehlern und die Bildqualität der zugehörigen Ultraschallebenen zwischen normalgewichtigen, übergewichtigen und adipösen Schwangeren zu vergleichen. Material und Methoden: In einer retrospektiven Kohortenstudie wurden 54 846 vorgeburtliche fetale Echokardiografien der Jahre 2000 – 2007 zwischen der 18. und der 37. Schwangerschaftswoche untersucht. Die Schwangeren wurden nach dem Body-Mass-Index (BMI) vor Eintritt der Schwangerschaft in folgende Gruppen stratifiziert: normalgewichtig (BMI < 25), übergewichtig (BMI 25 – 29) und adipös (BMI ≥ 30). Die Ultraschallbildqualität und die vorgeburtliche Entdeckung des atrioventrikulären Septumdefekts (AVSD), des Double outlet right Ventricle (DORV), der Fallot’schen Tetralogie (TOF) und der Transposition der großen Arterien (TGA) wurden in den 3 BMI-Gruppen untersucht. Ergebnisse: Im Patientinnenkollektiv fanden sich 108 Fälle der berücksichtigten 4 Herzfehler. Die Prävalenz der Herzfehler in der übergewichtigen und der adipösen Gruppe war signifikant höher als bei Normalgewichtigen (Relatives Risiko = 2,04; 51 / 35,442 vs. 57 / 19,404, p < 0,0002). Insgesamt wurden 86,1 % der Herzfehler vorgeburtlich korrekt spezifiziert (93 / 108, CI: 79,6 – 92,6 %), 84,3 % (43 / 51) in der normalgewichtigen Gruppe, 88,6 % (39 / 44) bei den Übergewichtigen und 84,6 % (11 / 13) bei den Adipösen. Der Anteil insuffizienter Ultraschallbilder bei den 108 Herzfehlern stieg von 6,4 % bei normalgewichtigen auf 17,4 % bei adipösen Patientinnen an. Schlussfolgerungen: Die vorgeburtliche Ultraschalldiagnostik von fetalen AVSDs, DORVs, TOFs und TGAs war in allen 3 BMI-Gruppen zufriedenstellend, obwohl die Bildqualität mit steigendem BMI substanziell abfiel.

Abstract

Purpose: The purpose of this study was to compare the prenatal detection of four congenital heart defects (CHDs) and the image quality of five corresponding ultrasound planes among obese, overweight and normal-weight women. Materials and Methods: This was a retrospective cohort study of 54 846 pregnancies undergoing fetal echocardiography between 18 and 37 weeks of gestation in the years from 2000 to 2007. The women were categorized according to pre-pregnancy body mass index (BMI) as normal-weight (BMI < 25), overweight (BMI 25 – 29.9) and obese (BMI ≥ 30). Image quality and prenatal detection of atrioventricular septal defect (AVSD), double outlet right ventricle (DORV), tetralogy of fallot (TOF) and dextro transposition of the great arteries (D-TGA) were evaluated in the BMI strata. Results: 108 cases with one of the considered CHDs were identified. The prevalence was significantly higher (relative risk = 2.04) in overweight or obese women (57 / 19,404 vs. 51 / 35,442, p < 0.0002) than in normal-weight women. In total 86.1 % of CHDs were correctly identified prenatally (93 / 108, CI: 79.6 %–92.6 %), 84.3 % (43 / 51) in the normal weight group, 88.6 % (39 / 44) in the overweight group and 84.6 % (11 / 13) in the obese group. The rate of insufficient ultrasound images increased from 6.4 % in normal-weight patients to 17.4 % in obese women within the 108 CHD cases. Conclusion: The prenatal detection of fetal AVSD, DORV, TOF and D-TGA was also satisfactory in overweight and obese patients, but image quality substantially decreases with an increasing maternal BMI. If there is a BMI-associated difference in the detection rate, it probably will not exceed 20 %.

References

• 1 Heslehurst N, Ells L J, Simpson H et al. Trends in maternal obesity incidence rates, demographic predictors, and health inequalities in 36 821 women over a 15-year period.  BJOG. 2007;  114 187-194
  Google Scholar
• 2 Kopelman P G. Obesity as a medical problem.  Nature. 2000;  404 635-643
  Google Scholar
• 3 International Obesity Task Force .Managing the global epidemic of obesity. Report of the WHO Consultation on Obesity. Geneva: World Health Organization; 1998: 1-276
  Google Scholar
• 4 Mills J L, Troendle J, Conley M R et al. Maternal obesity and congenital heart defects: a population-based study.  Am J Clin Nutr. 2010;  91 1543-1549
  Google Scholar
• 5 Cnattingius S, Bergstrom R, Lipworth L et al. Prepregnancy weight and the risk of adverse pregnancy outcomes.  N Engl J Med. 1998;  338 147-152
  Google Scholar
• 6 Field A E, Coakley E H, Must A et al. Impact of overweight on the risk of developing common chronic diseases during a 10 year period.  Arch Intern Med. 2001;  161 1581-1586
  Google Scholar
• 7 Robinson H E, O’Connell C M, Joseph K S et al. Maternal outcomes in Pregnancies complicated by obesity.  Obstet Gynecol. 2005;  106 1357-1364
  Google Scholar
• 8 UshaKiran T S, Hemmadi S, Bethel J et al. 2Outcome of pregnancy in a woman with increased body mass index.  BJOG. 2005;  112 768-772
  Google Scholar
• 9 Weiss J L, Malone F D, Emig D et al. Obesity, obstetric complications and cesarean delivery rate – A population-based screening study.  Am J Obstet Gynecol. 2004;  190 1091-1097
  Google Scholar
• 10 Queisser-Luft A, Kieninger-Baum D, Menger H et al. Does maternal obesity increase the risk of fetal abnormalities? Analysis of 20 248 newborn infants of the Mainz Birth Register for detecting congenital abnormalities.  Ultraschall in Med. 1998;  19 40-44
  Google Scholar
• 11 Shaw G M, Velie E M, Schaffer D. Risk of neural tube defect-affected pregnancies among obese women.  JAMA. 1996;  275 1093-1096
  Google Scholar
• 12 Stothard K J, Tennant P W, Bell R et al. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis.  JAMA. 2009;  301 636-650
  Google Scholar
• 13 Watkins M L, Botto L E. Maternal prepregnancy weight and congenital heart defects in the offspring.  Epidemiology. 2001;  11 439-446
  Google Scholar
• 14 Watkins M L, Rasmussen S A, Nonein M A et al. Maternal obesity and risk for birth defects.  Pediatrics. 2003;  111 1152-1158
  Google Scholar
• 15 Gilboa S M, Correa A, Botto L D et al. Association between prepregnancy body mass index and congenital heart defects.  Am J Obstet Gynecol. 2010;  202 51.e1-51.e10
  Google Scholar
• 16 Hendler I, Blackwell S C, Bujold E et al. The impact of maternal obesity on midtrimester sonographic visualization of fetal cardiac and craniospinal structures.  Int J Obes. 2004;  28 1607-1611
  Google Scholar
• 17 Schwarzler P, Senat M V, Holden D et al. Feasibility of the second trimester fetal ultrasound examination in an unselected population at 18, 20, or 22 weeks of pregnancy: a randomized trial.  Ultrasound Obstet Gynecol. 1999;  14 92-97
  Google Scholar
• 18 Wolfe H M, Sokol R J, Martier S M et al. Maternal obesity: a potential source of error in sonographic prenatal diagnosis.  Obstet Gynecol. 1990;  76 339-342
  Google Scholar
• 19 DeVore G R, Medearis A L, Bear M B et al. Fetal echocardiography: factors that influence imaging of the fetal heart during the second trimester of pregnancy.  J Ultrasound Med. 1993;  12 659-663
  Google Scholar
• 20 Dashe J S, McIntire D D, Twickler D M. Effect of Maternal Obesity on the Ultrasound Detection of Anomalous Fetuses.  Obstet Gynecol. 2009;  113 1001-1007
  Google Scholar
• 21 Aagaard-Tillery K M, Porter T F, Malone F D et al. Influence of maternal BMI on genetic sonography in the FaSTER trial.  Prenat Diagn. 2010;  30 14-22
  Google Scholar
• 22 Merz E, Eichhorn K H, Hansmann M et al. Quality demands on continuing differential diagnostic sonography in prenatal diagnostics (DEGUM stage II) during the 18th to 22nd weeks of gestation.  Ultraschall in Med. 2002;  23 11-12
  Google Scholar
• 23 Berg C, Gembruch U, Geipel A. Outflow tract sectional planes in two-dimensional fetal echocardiography – part I.  Ultraschall in Med. 2009;  30 128-144
  Google Scholar
• 24 Berg C, Gembruch U, Geipel A. Outflow tract sectional planes in two-dimensional fetal echocardiography – part II.  Ultraschall in Med. 2009;  30 230-251
  Google Scholar
• 25 Shapiro R S, Wagreish J, Parsons R B et al. Tissue harmonic imaging sonography: evaluation of image quality compared with conventional sonography.  Am J Roentgenol. 1998;  171 1203-1206
  Google Scholar
• 26 Paladini D, Vassallo M, Tartaglione A et al. The role of tissue harmonic imaging in fetal echocardiography.  Ultrasound Obstet Gynecol. 2004;  23 159-164
  Google Scholar

Dr. Mirella Uhden

praenatal.de, Praenatal Medizin und Genetik

Graf-Adolf-Str. 35

40210 Düsseldorf

Phone:  ++ 49/2 11/38 45 70

Fax:  ++ 49/2 11/3 84 57 33

Email: uhden@gmx.net