Prediction of large-for-gestational-age at birth using fetal biometry in type 1 and type 2 diabetes: A retrospective cohort study.

Autor: Rathcke SL; Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.; Steno Diabetes Center North Jutland, Aalborg, Denmark.; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., Sinding MM; Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., Christensen TT; Steno Diabetes Center North Jutland, Aalborg, Denmark.; Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark., Uldbjerg N; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Christiansen OB; Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark., Kornblad J; Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark., Søndergaard KH; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., Krogh S; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., Sørensen ANW; Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Jazyk: angličtina
Zdroj: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics [Int J Gynaecol Obstet] 2024 Nov; Vol. 167 (2), pp. 695-704. Date of Electronic Publication: 2024 Jun 04.
DOI: 10.1002/ijgo.15711
Abstrakt: Objective: To compare ultrasound-assessed fetal head circumference (HC), abdominal circumference (AC), HC/AC ratio, and estimated fetal weight (EFW) in prediction of large-for-gestational-age (LGA) at birth in pregnancies affected by type 1 (T1DM) and type 2 (T2DM) diabetes.
Methods: This retrospective cohort study included all women with T1DM and T2DM giving birth to singletons between 2010 and 2019 at Aalborg University Hospital, Denmark. Ultrasound scans were performed at 16, 20, 28 and 34 weeks of pregnancy. LGA was defined as birth weight deviation of 15% or greater from the expected for gestational age (≥90th centile). Prediction of LGA was assessed by logistic regression adjusted for maternal characteristics and glycated hemoglobin (HbA 1c ) and area under the receiver operating characteristics curve (AUC).
Results: Among 180 T1DM pregnancies, 118 (66%) had an LGA neonate at birth. At 28 weeks of pregnancy, they were predicted with AUC HC/AC  = 0.67, AUC AC  = 0.85, and AUC EFW  = 0.86. The multivariate analysis did not improve the predictive performance of the HC/AC ratio or AC. Among 87 T2DM pregnancies, 36 (41%) had an LGA neonate at birth. At 28 weeks, they were predicted with AUC HC/AC  = 0.73, AUC AC  = 0.83, and AUC EFW  = 0.87. In T2DM, the multivariate analysis significantly improved the predictive performance for both HC/AC ratio and AC from 20 weeks of pregnancy.
Conclusion: In T1DM and T2DM pregnancies, LGA is characterized by a general fetal overgrowth including both AC and HC. Therefore, AC and EFW perform better than the HC/AC ratio in the prediction of LGA. In T2DM, as opposed to T1DM, the predictive performance was improved by the inclusion of maternal characteristics and HbA 1c in the analysis.
(© 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)
Databáze: MEDLINE
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