Abstract
Objectives To evaluate the utility of fetal abdominal wall thickness (AWT) for predicting intrapartum complications amongst mothers with pregestational type 2 diabetes. Methods This was a historical cohort study of pregnant mothers with pregestational type 2 diabetes delivering at a Canadian tertiary-care center between January 1, 2014, and December 31, 2018. Delivery records were reviewed to collect information about demographics and peripartum complications. Stored fetal ultrasound images from 36 weeks' gestation were reviewed to collect fetal biometry and postprocessing measurement of AWT performed in a standardized fashion by 2 blinded and independent observers. The relationship between fetal AWT was then correlated with risk of intrapartum complications including emergency Caesarean section (CS) and shoulder dystocia. Results 216 pregnant women with type 2 diabetes had planned vaginal deliveries and were eligible for inclusion. Mean maternal age was 31.3 years, and almost all were overweight or obese at the time of delivery (96.8%). Overall, the incidence of shoulder dystocia and emergency intrapartum CS was 7.4% and 17.6%, respectively. There was no difference in mean fetal AWT between those having a spontaneous vaginal delivery (8.2 mm (95% CI 7.9-8.5)) and those needing emergency intrapartum CS (8.1 mm (95% CI 7.4-8.8); p = 0.71) or shoulder dystocia (8.7 mm (95% CI 7.9-9.5); p = 0.23). There was strong interobserver correlation of AWT measurements (r = 0.838; p < 0.00001). The strongest association with intrapartum complications was birthweight (p = 0.003): with birthweight > 4000 grams, the relative risk of shoulder dystocia or CS is 2.75 (95% CI 1.74-4.36; p < 0.001). Conclusions There was no obvious benefit of AWT measurement at 36 weeks for predicting shoulder dystocia or intrapartum CS amongst women with type 2 diabetes in our population. The strongest predictor of intrapartum complications remained birthweight, and so studies for improving estimation of fetal weight and evaluating the role of intrapartum ultrasound for predicting risk of delivery complications are still needed.
Highlights
Diabetes complicates ~5-7% of pregnancies worldwide, and numbers continue to increase in parallel with worsening rates of obesity [1, 2]
The mean body mass index (BMI) at delivery was high at 36.6 kg/m2: only 3.2% of the entire cohort had a normal BMI and 96.8% were considered overweight or obese, including onethird that were categorized as class 3 obesity with a BMI ≥ 40 kg/m2. 34.4% of these pregnancies were complicated by additional medical conditions, including 18.8% with hypertensive disorders of pregnancy, there was only 1 documented case of preeclampsia
The mean abdominal wall thickness of fetuses exposed to pregestational type 2 diabetes was 8.2 mm
Summary
Diabetes complicates ~5-7% of pregnancies worldwide, and numbers continue to increase in parallel with worsening rates of obesity [1, 2]. The prevalence of pregestational type 2 diabetes is amongst the highest in Canada, and with increasing rates, the number of affected pregnancies has increased [1]. Pregestational diabetes increases the risk of perinatal complications for the mother, fetus, and newborn, including a higher risk of developing other medical complications of pregnancy such as preeclampsia. Another specific concern is the 4-5 times higher rate of stillbirth for mothers with pregestational type 2 diabetes, which has prompted increased efforts to improve antenatal surveillance and maternal glycemic control [3, 4]. Our ability to predict which patients with type 2 diabetes are most at risk of these intrapartum complications remains limited [3,4,5,6,7,8]
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