Does a Large Fetal Abdominal Circumference in Women Without Diabetes Predict Adverse Outcomes? [5P

Abstract

INTRODUCTION: We sought to determine if fetuses that have a large abdominal circumference (AC) have an increase in adverse outcomes. METHODS: This is a retrospective cohort study conducted via chart review of women seen for ultrasound at 28-32 weeks gestation with fetal AC measuring >90th percentile during the study period of 1/1/2014 through 12/31/2015. Women with a known diagnosis of diabetes were excluded. Multivariate logistic regressions were conducted to determine relationships between fetal AC and neonatal and maternal outcomes: neonatal hypoglycemia, birth weight, NICU admission, 5-minute Apgar scores, mode of delivery, development of gestational diabetes, and polyhydramnios. These outcomes were adjusted for presence or absence of gestational diabetes, race, maternal age, and gravidity. RESULTS: 1715 women were included. Mean gestational age was 31 weeks. Increasing fetal AC is predictive of primary cesarean delivery (OR 1.486, p=0.0023). Fetuses with larger abdominal circumferences on antenatal ultrasounds are more likely to be macrosomic with birth weight >4000 grams (OR 2.496, p < 0.0001). Increasing fetal AC is associated with the later development of gestational diabetes (OR 2.343, p=0.0023) and polyhydramnios (OR 2.938, p=0.0003). Fetal AC does not predict lower Apgar score (OR 0.615, p=0.416), NICU admission (OR 0.824, p=0.167), or neonatal hypoglycemia (OR 1.047, p=0.852). Though none of the patients in this study were initially diagnosed with diabetes, 220 (12.8%) were found to have gestational diabetes by the time of delivery. CONCLUSION: Women should be counseled about the increased risks of primary cesarean delivery, polyhydramnios, macrosomia, and gestational diabetes when a large fetal AC is found.