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

Autor: Tomlinson TM; Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Women's Health, Saint Louis University School of Medicine, 6420 Clayton Road, Suite 2800, Saint Louis, MO, 63117, USA. tracy.tomlinson@health.slu.edu., Mostello DJ; Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Women's Health, Saint Louis University School of Medicine, 6420 Clayton Road, Suite 2800, Saint Louis, MO, 63117, USA., Lim KH; Department of Obstetrics and Gynecology, Boston Maternal-Fetal Medicine, South Shore Hospital, Weymouth, MA, USA., Pritchard JS; New England Quality Care Alliance, Braintree, MA, USA., Gross G; Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Women's Health, Saint Louis University School of Medicine, 6420 Clayton Road, Suite 2800, Saint Louis, MO, 63117, USA.
Jazyk: angličtina
Zdroj: Archives of gynecology and obstetrics [Arch Gynecol Obstet] 2018 Jul; Vol. 298 (1), pp. 67-74. Date of Electronic Publication: 2018 Apr 26.
DOI: 10.1007/s00404-018-4758-9
Abstrakt: 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.
Databáze: MEDLINE
Externí odkaz: