What is the accuracy of an early third trimester sonogram for identifying LGA infants born to GDM patients diagnosed with the one-step approach?
| Autor: | Meredith Pavicic, Gene T Lee, Kelsey J Simpson |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Pediatrics medicine.medical_specialty Pregnancy Trimester Third 030209 endocrinology & metabolism Third trimester Risk Assessment Ultrasonography Prenatal Fetal Macrosomia 03 medical and health sciences 0302 clinical medicine Pregnancy Medicine Humans Retrospective Studies 030219 obstetrics & reproductive medicine business.industry Incidence (epidemiology) Obstetrics and Gynecology medicine.disease Gestational diabetes Fetal Weight Neonatal outcomes Pediatrics Perinatology and Child Health Female Waist Circumference business |
| Zdroj: | The journal of maternal-fetalneonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 31(19) |
| ISSN: | 1476-4954 |
| Popis: | The one-step approach for screening of GDM will increase the incidence 2- to 3-fold. These larger cohorts may need to target high-morbidity subsets to be cost-effective. We asked whether ultrasound could stratify the GDM patients with the highest risk for a large for gestational age (LGA) infant.A retrospective analysis was performed on 413 GDM patients diagnosed using the one-step approach. Ultrasound data from 28 weeks 0 day to 34 weeks 6 days was studied. The abdominal circumference (AC) and EFW at thresholds between 70 and 95% were examined for their prognostic utility. The primary outcome was an LGA infant.Both the AC and EFW at all gestational ages were predictive of a LGA infant. The AC and EFW at 28-32 weeks 6 days using a threshold of ≥70% showed the following test characteristics: sensitivity (73 versus 66%), specificity (61 versus 77%), positive predictive value (PPV) (30 versus 40%), and negative predictive value (NPV) (91 versus 91%). The specificity of the EFW was significantly higher than the AC (p .001).Among GDM patients diagnosed using the one-step approach, an elevated AC and EFW in the early third trimester are predictive of a LGA infant. This is a possible cost-effective way to stratify the one-step GDM pregnancies at highest risk for neonatal morbidity. |
| Databáze: | OpenAIRE |
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