Main Fetal Predictors of Adverse Neonatal Outcomes in Pregnancies with Gestational Diabetes Mellitus.

Maria-Christina Antoniou,Yvan Vial,Jardena Jacqueline Puder,Céline Julie Fischer Fumeaux,Jean-Benoît Rossel,Leah Gilbert,Justine Gross

doi:10.3390/jcm9082409

Maria-Christina Antoniou, Yvan Vial + Show 5 more

Open Access

https://doi.org/10.3390/jcm9082409

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Abstract

The objectives of this study were to (a) assess the utility of fetal anthropometric variables to predict the most relevant adverse neonatal outcomes in a treated population with gestational diabetes mellitus (GDM) beyond the known impact of maternal anthropometric and metabolic parameters and (b) to identify the most important fetal predictors. A total of 189 patients with GDM were included. The fetal predictors included sonographically assessed fetal weight centile (FWC), FWC > 90% and <10%, and fetal abdominal circumference centile (FACC), FACC > 90% and < 10%, at 29 0/7 to 35 6/7 weeks. Neonatal outcomes comprising neonatal weight centile (NWC), large and small for gestational age (LGA, SGA), hypoglycemia, prematurity, hospitalization for neonatal complication, and (emergency) cesarean section were evaluated. Regression analyses were conducted. Fetal variables predicted anthropometric neonatal outcomes, prematurity, cesarean section and emergency cesarean section. These associations were independent of maternal anthropometric and metabolic predictors, with the exception of cesarean section. FWC was the most significant predictor for NWC, LGA and SGA, while FACC was the most significant predictor for prematurity and FACC > 90% for emergency cesarean section. In women with GDM, third-trimester fetal anthropometric parameters have an important role in predicting adverse neonatal outcomes beyond the impact of maternal predictors.

Highlights

Gestational diabetes mellitus (GDM) carries an increased risk for short and long-term adverse outcomes, both for the mothers and their offspring [1,2]
Fetal abdominal circumference centile (FACC) cut-offs in association with maternal capillary glycemic values have been used for medical treatment guidance in women with GDM, leading to a reduction in neonatal complications, but these studies were limited to experienced centres and obstetricians [9,10,11]
We evaluated the respective importance of fetal weight centile (FWC) and FACCs, and their higher and lower cut-offs in predicting neonatal outcomes

Summary

Introduction

Gestational diabetes mellitus (GDM) carries an increased risk for short and long-term adverse outcomes, both for the mothers and their offspring [1,2]. Third-trimester fetal ultrasound (US) is a helpful tool to predict neonatal outcomes. FW and fetal abdominal circumference (FAC) were associated with preterm birth [7,8]. There is a need for studies investigating the association between third-trimester fetal parameters and diverse adverse neonatal outcomes in the context of a population with GDM. Fetal abdominal circumference centile (FACC) cut-offs in association with maternal capillary glycemic values have been used for medical treatment guidance in women with GDM, leading to a reduction in neonatal complications, but these studies were limited to experienced centres and obstetricians [9,10,11]

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