Abstract
BackgroundThe present study validates a symphysis-fundal height chart (SFH-chart) for pregnant women with type 2 diabetes mellitus (DM2), gestational diabetes mellitus (GDM) and mild gestational hyperglycemia (MGH) attending at the Diabetes and Pregnancy Reference Service of the Botucatu Medical School, UNESP, Brazil.MethodsA cross-sectional study was carried out to evaluate the performance of the specific FHC in predicting small (SGA) and large (LGA) for gestational age newborns (NB). We evaluated 206 pregnant women with DM2, GDM or MGH and their NB. The last symphysis-fundal height measure, taken at birth, was used to determine the sensitivity index (Sens), specificity index (Spe), positive prediction value (PPV), negative prediction value (NPV) and accuracy in predicting SGA and LGA. The gold standard was the Lubchenco birth weight/gestational age ratio evaluated at birth.ResultsThe mothers showed adequate glycemic control; 91.3 % of all pregnant women achieved HbA1c < 6,5 % in the third trimester. The SFH-chart tested achieved 100 % of Sens and NPV in predicting both SGA and LGA, with accuracy of 90.3 % (85.5; 93.6) and 91.8 % (87.2; 94.8), respectively, for predicting SGA and LGA newborns.ConclusionsThe Basso SFH-chart showed high performance in predicting both SGA and LGA newborns of DM-2, GDM and MGH mothers, with better performance than the national reference SFH-chart. These findings support the internal validation of the Basso SFH-chart, which may be implemented in the prenatal care of the Diabetes and Pregnancy Reference Service-Botucatu Medical School/UNESP.
Highlights
The present study validates a symphysis-fundal height chart (SFH-chart) for pregnant women with type 2 diabetes mellitus (DM2), gestational diabetes mellitus (GDM) and mild gestational hyperglycemia (MGH) attending at the Diabetes and Pregnancy Reference Service of the Botucatu Medical School, UNESP, Brazil
The reference symphysis-fundal height chart (SFH-chart) recommended by the Brazilian Health Ministry [1] was developed by the Latin American Center of Perinatology and Human Development (CLAP) and published in 1984 [2]
Given the unsuitability of the national reference SFHchart [1, 2] and the lack of specific SFH-charts for risk pregnancy, Basso [16] developed an SFH-chart for pregnancies complicated by diabetes and hyperglycemia
Summary
Design and subjects This observational study was carried out to validate the diagnostic performance of Basso SFH-chart [16] specific for pregnant women with DM2, GDM and MGH (Table 1 and Fig. 1). It was performed at the Diabetes and Pregnancy Reference Service of the Botucatu Medical School, UNESP, Sao Paulo, Brazil (SEDG-FMB/ UNESP). Subjects follow-up According to SEDG-FMB/UNESP protocol [18], the diabetic pregnant women (type 2-DM) were immediately submitted to the glycemic control, with individual nutritional prescription and light to moderate-intensity exercises (walking 30 min five times a week), and received insulin from the first evaluation. McNemar’s test evaluated the performance of Basso SFH-chart [16] and of the national reference SFH-chart [1, 2] in predicting SGA- and LGAnewborns
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