Abstract
BackgroundExcess abdominal adiposity cause metabolic disturbances, particularly in pregnancy. Methods of accurate measurement are limited in pregnancy due to risks associated with these procedures. This study outlines a non-invasive methodology for the measurement of adipose tissue in pregnancy and determines the intra- and inter-observer reliability of ultrasound (US) measurements of the two components of adipose tissue (subcutaneous (SAT) and visceral adipose tissue (VAT)) within a pregnant population.MethodsThirty pregnant women were recruited at the end of their first trimester, from routine antenatal clinic at the University Maternity Hospital Limerick, Ireland. Measurements of adipose tissue thickness were obtained using a GE Voluson E8 employing a 1–5 MHz curvilinear array transducer. Two observers, employing methodological rigour in US technique, measured thickness of adipose tissue three times, and segmented the US image systematically in order to define measurements of SAT and VAT using specifically pre-defined anatomical landmarks.ResultsIntra-observer and inter-observer precision was assessed using Coefficient of Variation (CV). Measurements of SAT and total adipose for both observers were < 5% CV and < 10% CV for VAT in measures by both observers. Inter-observer reliability was assessed by Limits of Agreement (LoA). LoA were determined to be − 0.45 to 0.46 cm for SAT and − 0.34 to 0.53 cm for VAT values. Systematic bias of SAT measurement was 0.01 cm and 0.10 cm for VAT. Inter-observer precision was also assessed by coefficient of variation (CV: SAT, 3.1%; VAT, 7.2%; Total adipose, 3.0%).ConclusionIntra-observer precision was found to be acceptable for measures of SAT, VAT and total adipose according to anthropometric criterion, with higher precision reported in SAT values than in VAT. Inter-observer reliability assessed by Limits-Of-Agreement (LoA) confirm anthropometrically reliable to 0.5 cm. Systematic bias was minimal for both measures, falling within 95% confidence intervals. These results suggest that US can produce reliable, repeatable and accurate measures of SAT and VAT during pregnancy.
Highlights
Excess abdominal adiposity cause metabolic disturbances, in pregnancy
Validity and reproducibility of ultrasound techniques against computed tomography (CT) scanning has been previously assessed [5,6,7,8] in non-pregnant populations, and reportedly the inter-observer correlation coefficient of the mean ultrasound distance was 0.94 (P < 0.001), and coefficient of variation 5.4% within a non-pregnant population [7]
Intra-observer precision was assessed by co-efficient of variation
Summary
Excess abdominal adiposity cause metabolic disturbances, in pregnancy. Methods of accurate measurement are limited in pregnancy due to risks associated with these procedures. Validity and reproducibility of ultrasound techniques against CT scanning has been previously assessed [5,6,7,8] in non-pregnant populations, and reportedly the inter-observer correlation coefficient of the mean ultrasound distance was 0.94 (P < 0.001), and coefficient of variation 5.4% within a non-pregnant population [7]. Other methods for quantifying risk using abdominal measures and ratios of these, are; DXA scanning, waist: hip circumference ratio, and anthropometric skinfold measurements. During pregnancy these three techniques have distinct disadvantages, which render them inadequate within a clinical setting and in a pregnant population [9, 10]. Limitations include exposure to ionising radiation, expense, lack of validation of technique, time-consuming techniques and requirement of a trained skilful measurer [9, 10]
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