P08.08: Pitfalls in interpretation of fetal growth curves in pregnancies complicated with maternal obesity and gestational diabetes

Abstract

The difficulties of interpretation of the fetal growing curves mostly in the third trimester and the necessity to correlate with the clinical exams, pre-pregnancy weight and gestational weight gain. The study group included 43 obese pregnant women, 27 with GDM and 16 without and 34 pregnancies was defined with normal or overweight as pre-pregnancy BMI, but got over 90 kg at the end of pregnancy with a BMI over 30, from which 12 had also a diagnostic of GDM at the 24-30 weeks of gestation The definition of obesity was based on the pre-pregnancy BMI. The extreme BMI (over 45) and gestational diabetes cases with insulin treatment were excluded. In the pre-pregnancy obesity and with gestational diabetes the growing curves were evaluated at 16 wks GA and respectively at the time of the gestational diabetes diagnosis every 2-3 weeks. It was observed that the fetal abdominal circumference over 80 percentile and polyhydramnios were independent predicting factors for a delivery before 38 wks, Caesarean delivery, LGA, admission in NICU and late pre-eclampsia. Accelerate maternal weight growth in the firsts trimester and till 24 weeks of GA give the same pattern of fetal growth curves as the pre-pregnancy obesity. Growth curves, Doppler ultrasound and neonatal follow up and the fetal weight estimation has a good correlation with the gestational percentiles of neonate weight but not with the neonatal wellbeing. More than 40% of neonates delivered at term and early term were admitted in NICU, despite neonatal weight the behaviour was as child with restriction. The studies should be focussed on the more accurate interpretation of the fetal growth in maternal obesity and accelerate maternal weight growth. In obese women and in women with gestational diabetes – even in the well-controlled cases, interpretation of the fetal growth curves should be interpreted with caution in estimated fetal well-being. The present study is still ongoing, and hope to find an algorithm to asses more accurate the risks.