Abstract
Background Reference symphysis-fundal height (SFH) curves for pregnancies complicated by maternal hyperglycemia are not available. Objective To build an SFH curve according to gestational age for pregnant women with hyperglycemia-type 2 diabetes (T2DM), gestational diabetes mellitus (GDM), or mild gestational hyperglycemia (MGH) and compare it with three other curves in use in Brazil. Methods Prospective cohort study of 422 pregnant women with hyperglycemia attending the Perinatal Diabetes Research Center (PDRC) of Botucatu Medical School, São Paulo State University/UNESP. Between 13 and 41 weeks of pregnancy, 2470 SFH measurements were obtained (mean 5.85 per woman). For the assessment of glycemic control, 2074 glucose level measurements were taken and the glycemic mean (GM) at each gestational week was estimated. Results GM was adequate (<120 mg/dL) in 94.9% and inadequate (≥120 mg/dL) in 5.1% of the cases. The equation applied for SFH prediction was expressed as SFH = 1.082 + 0.966∗week (r2 = 84.6%). At visual analysis, P10 and P90 SFH measurements were higher in the study curve than in the three other curves. Statistical analysis confirmed that SFH median values in this study were higher than those in the reference curve of habitual risk pregnancies, especially after 19 weeks of pregnancy. Conclusion Taking into account that the maternal hyperglycemia was at strict control, our unedited results suggest that the current SFH curve can be a useful tool in prenatal care of T2DM, GDM, and MGH pregnant women.
Highlights
Symphysis-fundal height (SFH) measurement is a simple method to assess fetal growth in relation to gestational age (GA) that can detect twin pregnancies, polyhydramnios, oligohydramnios, and other complications
In the Brazilian Public Health System (SUS), the reference symphysis-fundal height (SFH) chart was developed by Fescina et al, based on measurements taken from 47 Paraguayan pregnant women [3, 4]
Inclusion criteria were as follows: type 2 diabetes mellitus (T2DM) without micro- or macrovascular diseases, gestational diabetes mellitus (GDM), or mild gestational hyperglycemia (MGH); receive prenatal and labor care at our center; gestational age confirmed by ultrasound before 20 weeks of pregnancy; live singleton pregnancy; and written informed consent
Summary
Symphysis-fundal height (SFH) measurement is a simple method to assess fetal growth in relation to gestational age (GA) that can detect twin pregnancies, polyhydramnios, oligohydramnios, and other complications. Oppermann et al [5] constructed a curve based on measurements from 3539 low-risk pregnant Brazilian women and compared it with the curve built by Fescina et al [4]. They concluded that the chart of Fescina et al [4] does not reflect the current pattern of uterine growth in pregnant Brazilian women and is, not appropriate to detect abnormal fetal growth, especially intrauterine growth restriction [5]. Taking into account that the maternal hyperglycemia was at strict control, our unedited results suggest that the current SFH curve can be a useful tool in prenatal care of T2DM, GDM, and MGH pregnant women
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