Abdominal Circumference Measurements Research Articles

Gestational diabetes mellitus, pre-pregnancy body mass index and gestational weight gain predicts fetal growth and neonatal outcomes.

Gestational diabetes mellitus (GDM), body mass index (BMI) and gestational weight gain (GWG) are salient predictors of pregnancy-outcomes. However, findings on the association between GDM, BMI, and GWG with fetal growth measures are limited. The aim of this study was to investigate the effect of GDM on fetal growth measures and birth outcomes. All participants came from Tongji Maternal and Child health cohort, in which pregnant women were enrolled before 16 weeks of gestation and had their weights measured regularly during antenatal visits. GDM was diagnosed by oral glucose tolerance test (OGTT) during 24-28 weeks of gestation. Ultrasound measurements of fetal bi-parietal diameters (BPD), head circumferences (HC), abdominal circumferences (AC) and femur length (FL) before birth were collected and neonate outcomes were obtained from the hospital records. Odds ratios were calculated using logistic regression to assess the association of GDM, pre-pregnancy BMI, and GWG with fetal growth measures of ultrasound and birth outcomes, while controlling confounding. Of 3253 singleton pregnant women, 293 (9.0%) were diagnosed with GDM, 357 (11.0%) were overweight before pregnancy, and 1995 (61.3%) had excessive GWG. GDM was associated with decreased intrauterine fetal growth measurements including BPD and AC. Maternal pre-pregnancy overweight was associated with increased fetal HC and neonatal birth weight and length, women gained excessive GWG had increased fetal growth measurements of BPD, HC, AC, FL, neonatal birth weight and length. Offspring of GDM women had increased odds of cesarean section 1.31 (1.03, 1.66) and preterm birth 2.02 (1.05, 3.91) in unadjusted models, but these associations disappeared after adjustment. Compared with neonate born to mothers with normal pre-pregnancy weight, those born to underweight mother had higher risk of SGA, and lower risk of cesarean section, LGA and macrosamia, whereas those born to overweight mother had increased risk of cesarean section, LGA and macrosamia. Compared with neonate born to mothers of adequate GWG, neonate of women with excessive GWG had elevated risk of cesarean section, LGA and macrosamia, but lower risk of preterm birth and SGA. Pre-pregnancy BMI, GWG and GDM all associated with fetal growth and birth outcomes. The effect of GDM decreased after adjusting pre-pregnancy BMI and GWG. Early screening and management of GDM, preventing excessive GWG could help protect fetuses of GDM mothers from adverse birth outcomes.

574 Fetal abdominal circumference as an early marker in prediction of small for gestational age newborns

This study aims to evaluate the relationship of the fetal abdominal circumference (AC) and the subsequent development of fetal growth restriction (FGR) in small for gestational age (SGA) newborns. This is a retrospective cohort study of singleton fetuses diagnosed with antenatal FGR (EFW < 10th percentile) during ultrasound between 2012 and 2020. Time from diagnosis of AC < 10th percentile to time of diagnosis of FGR and time to delivery were calculated. Primary outcome was SGA newborns (birthweight < 5th percentile). Secondary outcomes included fetal umbilical artery Doppler, maternal comorbid disorders such as hypertension and autoimmune disease, and newborn outcomes. Abnormal umbilical artery Doppler was defined as an S/D ratio >95th percentile for GA, absent end diastolic flow or reverse end diastolic flow. Statistical analyses, including Chi square and logistic regression modeling, were performed with significance levels of <0.05. Of 231 women given an antenatal diagnosis of FGR, there were 182 (79%) SGA newborns and 49 (21%) non-SGA newborns. Both groups were similar in age, parity, ethnicity, substance use disorder, gestational age at delivery, oligohydramnios, preeclampsia, and maternal comorbidities. Fetal AC <10th percentile preceded ultrasound diagnosis of FGR in SGA newborns more frequently than non-SGA newborns (46% v 29%; p=0.03). Time from identification of an AC <10th percentile to diagnosis of FGR averaged 6.7±4.9 weeks. Antenatal abnormal umbilical artery Doppler occurred more frequently in SGA newborns compared with non-SGA newborns (92% v 8%; p=0.002). In logistic regression, the antenatal variables most likely to predict an SGA newborn included fetal AC <10th percentile preceding FGR (OR 2.27; 95%CI: 1.09-4.71) and abnormal umbilical artery Doppler (OR 4.41; 95%CI: 1.7 –11.4). (Table 1) Measurement of fetal AC <10th percentile on antenatal ultrasound independently predicts development of subsequent FGR and SGA newborns. When an ultrasound measurement of the AC is <10th percentile, further monitoring should be recommended.

721 Randomized trial of fundal height versus point-of-care ultrasound during routine antenatal visits

Given the readily available point of care ultrasound (POC-US), we sought to determine whether it can replace fundal height (FH) evaluation in routine prenatal care. Pregnant women with uncomplicated singleton gestation between 22-32 weeks were randomly assigned to either a strategy of exclusive POC-US or FH for assessment at each antenatal visit. Before initiation of the study, all clinic providers were trained and certified for POC-US measurement of abdominal circumference (AC) and deepest vertical pocket (DVP). Patients were referred for a formal ultrasound if at any prenatal visit the FH differed by 3 cm or more from the patient’s gestational age in the FH group or the AC was less than the 10th or more than the 90th percentile, or the DVP was less than 2 or more than 8 cm in the POC-US group. Primary outcome was the proportion of patients who required formal USG that resulted in normal finding. We planned a traditional frequentist analysis with log-binomial regression, and estimated that 143 patients per arm would be needed to provide an 80% power to show a 30% reduction in unnecessary USG. The trial was stopped early because of the COVID-19 pandemic. A Bayesian analysis was then performed with a pre-specified probability of benefit ≥60% as evidence to resume the trial. A total of 177 pregnant patients were randomized (Table 1). Primary outcome was not different between the 2 groups (16% in the POC-US group vs 14% in the FH group). Bayesian analysis using a neutral prior centered at RR of 1 with 95% credible interval of 0.25-4 (a priori assumption: 50-50 chance that either group will be better) showed RR: 0.89 (95% CrI, 0.46-1.74) comparing FH to POC-US group, with a probability of reduced primary outcome of 63% with FH compared to POC-US. POC-US is unlikely to be better than FH for prenatal follow up. A larger study may have a higher probability that FH will outperform POC-US rather than the reverse.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

260 Antepartum and delivery outcomes for growth-restricted fetuses based on gastroschisis-specific fetal growth curves

To determine the utility of gastroschisis-specific fetal growth curves by evaluating antepartum and delivery outcomes for fetuses with fetal growth restriction (FGR) based on Hadlock growth curves compared to gastroschisis-specific growth curves. This was a single-institution, retrospective cohort study of pregnancies complicated by isolated gastroschisis delivered between 2011 and 2020. Using ultrasound biometric data, we generated estimated fetal weight growth curves specific to fetuses with gastroschisis, including the 10th, 50th, and 90th percentiles between 15 and 37 weeks. We compared antepartum and delivery outcomes for fetuses diagnosed with FGR by Hadlock growth curves to fetuses diagnosed with FGR by gastroschisis growth curves. 413 ultrasounds from 116 fetuses were included. 67 (58%) of the fetuses met criteria for FGR based on Hadlock growth curves, and 28 (24%) met criteria based on the gastroschisis growth curves. 60% of fetuses diagnosed with FGR by Hadlock were misdiagnosed based on the new growth curves. When comparing fetuses with FGR by Hadlock to those with FGR by the gastroschisis curves, the new curves better predicted 5 out of 16 observed outcomes, including: increased betamethasone administration (52% vs 45%, p=0.001), decreased spontaneous vaginal delivery (43% vs 51%, p<0.001), increased cesarean delivery (54% vs 49%, p=0.001), increased unplanned hospital admission (96% vs 82%, p<0.001), and worsening bowel findings leading to delivery (39% vs 28%, p=0.033). Hadlock growth curves derived from non-anomalous fetuses over-diagnose FGR in fetuses with gastroschisis due to small abdominal circumference measurements caused by abdominal organ herniation. FGR defined by gastroschisis-specific growth curves better predicts many of the common perinatal outcomes seen in pregnancies complicated by this anomaly. Given the known risks of prematurity, using gastroschisis-specific growth curves may assist in improved risk stratification and delivery planning among cases of gastroschisis.

Assessment of Transcerebellar Diameter Accuracy in Detection of Gestational Age in Third Trimester in Cases of Intrauterine Growth Restriction

Background: Intrauterine Growth Restriction (IUGR) is defined as decreased fetal birth weight less than 10th percentile as regard to gestational age also diagnosed when there is a delay more than 2 weeks in a serial ultrasound monitoring of fetal gestational age. Objective: The aim of the work was to evaluate accuracy of transcerebellar diameter (TCD) in detection of gestational age in pregnancies with intrauterine growth restriction IUGR. Patients and Methods: Case-Control study was carried out on 52 women with normally progressing pregnancies during the third trimesters, with gestational ages between 27 and 37 weeks of gestation came to outpatient clinic of department of Obstetrics and Gynecology, Zagazig General Hospital and Zagazig University Hospital from June 2019 to March 2020, of them, 26 subjects were normal pregnancies and 26 subjects diagnosed as IUGR in 3rd trimester at gestational age (27week to 37 week). Trans-abdominal ultrasound was performed on all subjects; Fetal TCD was measured using the widest diameter of the cerebellum, measurement of fetal Bi-Parietal Diameter (BPD), Abdominal Circumference (AC), and Femur Length (FL). Results: There was statistically significant difference between gestational age (GA) by Last Menstrual Period (LMP) and sonar parameters at normal group but highest was TCD with P value 0.000 but in IUGR group only TCD, AC and FL were significantly positive correlated with GA; and TCD were highly significant. Conclusions: It could be concluded that the TCD measurement appears to be an accurate predictor of gestational age, even in the third trimester of pregnancy.

Assessment of Transcerebellar Diameter Accuracy in Detection of Gestational Age in Third Trimester in Cases of Intrauterine Growth Restriction

Background: Intrauterine Growth Restriction (IUGR) is defined as decreased fetal birth weight less than 10th percentile as regard to gestational age also diagnosed when there is a delay more than 2 weeks in a serial ultrasound monitoring of fetal gestational age. Objective: The aim of the work was to evaluate accuracy of transcerebellar diameter (TCD) in detection of gestational age in pregnancies with intrauterine growth restriction IUGR. Patients and Methods: Case-Control study was carried out on 52 women with normally progressing pregnancies during the third trimesters, with gestational ages between 27 and 37 weeks of gestation came to outpatient clinic of department of Obstetrics and Gynecology, Zagazig General Hospital and Zagazig University Hospital from June 2019 to March 2020, of them, 26 subjects were normal pregnancies and 26 subjects diagnosed as IUGR in 3rd trimester at gestational age (27week to 37 week). Trans-abdominal ultrasound was performed on all subjects; Fetal TCD was measured using the widest diameter of the cerebellum, measurement of fetal Bi-Parietal Diameter (BPD), Abdominal Circumference (AC), and Femur Length (FL). Results: There was statistically significant difference between gestational age (GA) by Last Menstrual Period (LMP) and sonar parameters at normal group but highest was TCD with P value 0.000 but in IUGR group only TCD, AC and FL were significantly positive correlated with GA; and TCD were highly significant. Conclusions: It could be concluded that the TCD measurement appears to be an accurate predictor of gestational age, even in the third trimester of pregnancy.

Agreement Analysis between Sonographic Estimates and Birth Weight, by the WHO and Intergrowth-21st Tables, in Newborns of Diabetic Mothers.

To analyze the agreement, in relation to the 90th percentile, of ultrasound measurements of abdominal circumference (AC) and estimated fetal weight (EFW), between the World Health Organization (WHO) and the International Fetal and Newborn Growth Consortium for the 21st Century (intergrowth-21st) tables, as well as regarding birth weight in fetuses/newborns of diabetic mothers. Retrospective study with data from medical records of 171 diabetic pregnant women, single pregnancies, followed between January 2017 and June 2018. Abdominal circumference and EFW data at admission (from 22 weeks) and predelivery (up to 3 weeks) were analyzed. These measures were classified in relation to the 90th percentile. The Kappa coefficient was used to analyze the agreement of these ultrasound variables between the WHO and intergrowth-21st tables, as well as, by reference table, these measurements and birth weight. The WHO study reported 21.6% large-for-gestational-age (LGA) newborns while the intergrowth-21st reported 32.2%. Both tables had strong concordances in the assessment of initial AC, final AC, and initial EFW (Kappa = 0.66, 0.72 and 0.63, respectively) and almost perfect concordance in relation to final EFW (Kappa = 0.91). Regarding birth weight, the best concordances were found for initial AC (WHO: Kappa = 0.35; intergrowth-21st: Kappa = 0.42) and with the final EFW (WHO: Kappa = 0.33; intergrowth- 21st: Kappa = 0.35). The initial AC and final EFW were the parameters of best agreement regarding birth weight classification. The WHO and intergrowth-21st tables showed high agreement in the classification of ultrasound measurements in relation to the 90th percentile. Studies are needed to confirm whether any of these tables are superior in predicting short- and long-term negative outcomes in the LGA group.

Relationship between Serum Leptin Values and Abdominal Circumference Assessed in the First Trimester of Pregnancy in Obese Women.

Higher serum leptin values have been correlated with several complications of pregnancy, while the abdominal circumference (AC) is an anthropometric measurement usually used to diagnose abdominal obesity. For this study we compared serum leptin levels between two groups of pregnant women: those with abdominal obesity (AC>88cm) and those without abdominal obesity (AC<88cm), diagnosed at the beginning of pregnancy. Serum leptin levels were obtained through measurements performed between 11-14 and 28-32 weeks of gestation. Higher serum leptin levels were found in the group of pregnant women with abdominal obesity comparing to the group without abdominal obesity, but a positive correlation between abdominal circumference and the leptin values was found only at 11-14 weeks of pregnancy. Our study showed that a simple measurement of AC performed at the beginning of pregnancy may predict the average serum levels of leptin throughout the gestation period. A better understanding of the role of leptin during development is needed to make us able to know how maternal-placental-fetal leptin exchange influence the fetal development.

Effects of two different positions on stress, pain and feeding tolerance of preterm infants during tube feeding.

This study aims to investigate the effects of semi-elevated right lateral and semi-elevated supine positions on feeding tolerance, stress severity and pain levels among premature infants during tube feeding. This was a randomized cross-over clinical trial. A total of 34 premature infants who were fed via orogastric tube were included in this study. Feeding tolerance was assessed by abdominal circumference measurements and checking gastric residuals; this assessment was single blinded. Physiological values were evaluated before, during and after tube feeding. The stress severity and pain levels of the infants were also evaluated independently by the researchers before, during and after tube feeding. A significance level of .05 was accepted for all statistical analyses. There were no difference between infants' vital signs, stress and pain scores according to feeding positions before tube feeding (p>.05). By feeding positions, a statistically significant difference was found between infants' vital signs, abdominal circumference and gastric residuals of infants during tube feeding. Pain and stress levels of infants were found to be significantly higher in the semi-elevated supine position during tube feeding (p<.05). Use of the semi-elevated right lateral position during tube feeding was found to have a more helpful effect in reducing stress and pain among premature infants when compared with the use of the semi-elevated supine position.

Evaluation of the INTERGROWTH-21st Fetal Growth Standards in the United Arab Emirates: A Pilot Study.

Objectives: To evaluate the use of recently published INTERGROWTH-21st (IG-21) fetal growth standards in United Arab Emirates native population. Method: This prospective cohort study analyzed fetal ultrasound measurements of head circumference, abdominal circumference and femur length. Z-scores and percentiles of fetal and neonatal growth measurements were calculated using IG-21 and compared with a standard reference. Results: Measurements were performed in 120 pregnancies at a median gestational age of 25.8 weeks (range, 16 to 35). Thirteen out of 15 mean IG-21 Z-scores for all measurements remained between −0.5 and +0.5 at all gestational-ages. Actual standard deviations (SD) using IG-21 charts gave an acceptable SD (0.8 to 1.2) for 13 out of 15 measurements. The proportions of most antenatal measurements 90th and >97th percentiles were identical between standard and IG-21st charts. The median gestational age was 39 weeks (range, 29 to 41) and 14 (13%) were delivered by cesarean section. The mean z-scores of all biometric measurements were close to zero while the mean percentiles were close to the 50th percentile, thus, describing appropriately the neonatal growth parameters in our population. Conclusions: Fetal size in our population was comparable to the IG-21 standards. The IG-21 neonatal growth standards were more similar to that of the anticipated population distribution than to the standard charts. These preliminary results, if confirmed in a larger study in the UAE, would support use of IG-21 standards in UAE instead of the currently used standard charts.

Peer review of third trimester abdominal circumference measurements.

Third trimester growth scans represent a significant proportion of the workload in obstetric ultrasound departments. The objective of these serial growth scans is to improve the antenatal detection of babies with fetal growth restriction. The aim of this paper is to describe a method of peer review for third trimester abdominal circumference measurements which is realistic within busy obstetric ultrasound departments in the UK. Twenty-two, third trimester, measured abdominal circumference images were randomly selected. Images were assessed subjectively by 12 sonographers using the image Criteria Achieved Score. For quantitative assessment, termed the Inter-operator Variability Score, three of the abdominal circumference (AC) images were blindly remeasured. Following this, a questionnaire was used to ascertain which image criteria sonographers considered most important and to reach an agreement on correct caliper placement. The least frequently met image criteria with the lowest Criteria Achieved Score related to an oblique abdominal circumference section. These included fetal kidney present (Criteria Achieved Score 24.6%), multiple oblique ribs (Criteria Achieved Score 39.4%) and oblique spine (Criteria Achieved Score 37.5%). Caliper placement was also identified as inconsistent. This study demonstrates that the perfect AC section is not always possible and sonographers use their professional judgement to determine whether an image is acceptable. Seventy-three percent of the images reviewed were of an acceptable standard. There can be inconsistencies in sonographer opinion regarding what is an acceptable third trimester abdominal circumference image. These differences need to be addressed to maximise the effectiveness of the third trimester ultrasound examination. Peer review can be used to monitor scan quality and identify areas of inconsistency.

Fetal overgrowth in pregnancies complicated by diabetes: validation of a predictive index in an external cohort.

To assess validity of a fetal overgrowth index in an external cohort of women with diabetes in pregnancy METHODS: We performed a retrospective analysis of data derived from women with singleton gestations complicated by diabetes who delivered January 2015-June 2018. The following index variables were used to calculate risk of fetal overgrowth as defined by a customized birthweight ≥ 90th centile: age, history of fetal overgrowth in a prior pregnancy, gestational weight gain, fetal abdominal circumference measurement and fasting glucose between 24 and 30weeks. In our validation cohort, 21% of 477 pregnancies were complicated by fetal overgrowth. The predictive index had a bias-corrected bootstrapped area under receiver operating characteristic curve of 0.90 (95% CI 0.86-0.93). 55% of the cohort had a low-risk index (≤ 3) which had a negative predictive value of 97% (95% CI 94-98%), while 18% had a high-risk index (≥ 8) that had a positive predictive value of 74% (95% CI 66-81%). The fetal overgrowth index incorporates five factors that are widely available in daily clinical practice prior to the period of maximum fetal growth velocity in the third trimester. Despite substantial differences between our cohort and the one studied for model development, we found the performance of the index was strong. This finding lends support for the general use of this tool that may aid counseling and allow for targeted allocation of healthcare resources among women with pregnancies complicated by diabetes.

Fetal biometry assessment with Intergrowth 21st\u2019s and Salomon\u2019s equations in rural Burkina Faso

BackgroundUltrasound scanning during the 2nd or the 3rd trimester of pregnancy for fetal size disturbances screening is heavily dependent of the choice of the reference chart. This study aimed to assess the agreement of Salomon and the Intergrowth 21st equations in evaluating fetal biometric measurements in a rural area of Burkina Faso, and to measure the effect of changing a reference chart.MethodsData collected in Nazoanga, Burkina Faso, between October 2010 and October 2012, during a clinical trial evaluating the safety and efficacy of several antimalarial treatments in pregnant women were analyzed. We included singleton pregnancies at 16–36 weeks gestation as determined by ultrasound measurements of fetal bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). Expected mean and standard deviation at a given gestational age was computed using equations from Salomon references and using Intergrowth 21st standard. Then, z-scores were calculated and used subsequently to compare Salomon references with Intergrowth 21st standards.ResultsThe analysis included 276 singleton pregnancies.Agreement was poor except for HC: mean difference − 0.01, limits of agreement − 0.60 and 0.59. When AC was used as a surrogate of fetal size, switching from the reference of Salomon to the standards of Intergrowth 21st increased ten times the proportion of fetuses above the 90th percentile: 2.9 and 31.2%, respectively.Mean differences were larger in the third trimester than in the second trimester. However, agreement remained good for HC in both trimesters.Difference in the proportion of AC measurements above the 90th percentile using Salomon and Intergrowth 21st equations was greater in the second trimester (2.6 and 36.3%, respectively) than in the third trimester (3.5 and 19.8%, respectively). The greatest difference between the two charts was observed in the number of FL measurements classified as large in the second trimester (6.8 and 54.2%, using Salomon and Intergrowth 21st equations, respectively).ConclusionThe agreement between Intergrowth 21st and Salomon equations is poor apart from HC. This would imply different clinical decision regarding the management of the pregnancy.

Abdominal obesity and association with sociodemographic, behavioral and clinical data in climacteric women assisted in primary care.

This study aims to investigate the prevalence and factors associated with abdominal obesity in climacteric women assisted at Family Health Strategy units of the city of Montes Claros, State of Minas Gerais, Brazil. It is a cross-sectional analytical study. The women were selected by probabilistic sampling from August 2014 to August 2015. A questionnaire containing information referring to sociodemographic and economic characteristics, behavioral characteristics and clinical data was used. To estimate abdominal obesity, the measure of circumference ≥ 88 cm was considered. To analyze the association between abdominal obesity and the independent variables, a bivariate analysis was performed by means of Pearson's chi-square test (p≤0.25). Subsequently, a multiple Poisson regression analysis with robust variance was performed, through which prevalence ratios with level of significance of 5% (p<0.05) were obtained. A total of 805 women were evaluated, aged 40 to 65 years, and the prevalence of women with abdominal obesity was 62.4%. The mean and median of abdominal circumference were 93.0 cm. The associated variables were being sedentary (PR = 1.44) or irregularly active (PR = 1.39), presenting altered total cholesterol (PR = 1.21), and being hypertensive (PR = 1.31). The abdominal obesity in climacteric women was associated with physical inactivity, total cholesterol and arterial hypertension. The measurement of abdominal circumference must be valued and adopted in the routine of professionals who work in Primary Care.

Maternal irisin level in last trimester isolated intrauterine growth-restriction

Purpose Intrauterine Growth Restriction (IUGR) is the inability of the fetus to achieve the biologically accessible growth potential. Irisin is a recently discovered adipomyokine with a crucial role in energy metabolism. Our current study aimed to investigate the relationship between the isolated IUGR in the third trimester and maternal serum irisin level. Materials and methods This prospective case-control study included total 137 pregnant women who were between the 24th and 39th gestational weeks and who applied to the University of Health Sciences, Ankara Zekai Tahir Burak Women's Health Training and Research Center, between 2016 October-2017 May. The Study Group consisted of 68 pregnant women who were diagnosed with Isolated IUGR with Estimated Fetal Weight (EFW) <10th percentile. The Control Group consisted of 69 low-risk uncomplicated pregnant women, matched with the Study Group in terms of gestational week, and with EFW between 10th and 90th percentiles. Demographic data, clinical findings, fetal Doppler parameters, and obstetric-neonatal outcomes were evaluated. Maternal serum irisin levels were measured by ELISA (Enzyme-Linked Immunosorbent Assay) Method and compared between the groups. Results Maternal serum irisin level was found to be significantly lower in IUGR Group as compared to the Control (3.83 ng/ml vs. 4.78 ng/ml, p < .001, respectively). There was a positive correlation between maternal serum irisin level and duration of pregnancy, the weight gain during pregnancy, birth weight, fetal abdominal circumference measurement and cerebroplacental ratio (r = 0.18, p = .03; r = 0.17, p = .04; r = 0.37, p < .001; r = 0.35, p < .001; r = 0.27, p = .001, respectively). Binary Logistic Regression Analysis showed that maternal serum irisin level is an independent estimator of IUGR [OR %95 CI: 8.33 (3.22 − 25.01)]. AUC (Area Under the Curve) analysis of maternal irisin for IUGR estimation was 0.75 (p < .001, 95% CI = 0.67 − 0.82). The optimal cutoff value was below 3.86 ng/ml for maternal irisin level with a sensitivity of 54.41% and a specificity of 88.41%, positive predictive value of 82.22% and negative predictive value of 66.30%. Conclusion Low level of maternal serum irisin in pregnancies with isolated IUGR was consistent with the role of irisin in metabolic pathways and with the increased risk of metabolic diseases in the future life of IUGR fetuses and their mothers.

Midtrimester Ultrasound Predictors of Small-for-Gestational-Age Neonates.

To determine whether a specific estimated fetal weight (EFW) or abdominal circumference (AC) measurement percentile at the 18-to 24-week ultrasound (US) examination is associated with a small-for-gestational-age (SGA) neonate. A retrospective case-control study was conducted including women with uncomplicated singleton gestations who delivered a term SGA neonate identified as having a birth weight (BW) below the 10th percentile on the Olsen growth curve and had an 18- to 24-week US examination in our database. The study period was October 2011 to January 2018. A similar number of control charts were requested randomly over the same time with BW in the 10th to 90th percentiles, all which had an 18-to 24-week US examination in our database. After all neonates meeting BW criteria were identified, a chart review was performed to specifically evaluate biometric parameters from the US at 18 to 24 weeks to determine a potential correlation with the EFW percentile and AC percentile. Pregnancy, neonatal outcomes, and maternal demographic characteristics were collected. A total of 549 term neonates with a BW below the 10th percentile, and 593 control term neonates with BW in the of 10th to 90th percentiles were reviewed. Our analyses revealed that the AC and EFW percentiles were poor predictors of BW (<10th percentile; areas under the receiver operating characteristic curves, 0.68 and 0.69, respectively). A similar low ability of AC and EFW to predict BW below the 5th percentile was noted. (1) No tipping point or cutoff for the EFW or AC percentile at the 18- to 24-week US examination was identified to predict a term SGA neonate. (2) These data are helpful when counseling women in midgestation about specific parameters, their importance, and the potential need for follow up imaging.

Combination of “Markers” and the Consequent Importance of Fetal Abdominal Circumference in the First Trimester for Predicting Complications Specific to Monochorionic Twin Pregnancies

Background: Multifetal pregnancies are considered high-risk pregnancies compared to singleton pregnancies. Monochorionic diamniotic (MCDA) twin pregnancies tend to have a more complicated intrauterine course than their dichorionic counterparts. The most common complications are twin-to-twin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR), and unexplained intrauterine fetal demise (IUFD). Early recognition of pregnancies at risk of developing complications will be helpful for counselling the parents and preparing them for necessary interventions in case a complication arises. Objectives: The aim of our study was to assess the role of discordant crown-rump length (dCRL), discordant nuchal translucency (dNT), and discordant abdominal circumference (dAC) measurements in isolation and in combination at the 11–13⁺⁶ weeks’ scan in predicting the development of TTTS, sFGR, and IUFD. Methods: All MCDA twin pregnancies with structurally normal, both live fetuses at the 11–13⁺⁶ weeks’ scan were followed up by FMF (Fetal Medicine Foundation)-certified operators for development of TTTS, sFGR, and single/double IUFD until delivery. Discordance of CRL, NT, and AC of more than or equal to 10% was considered a “marker,” and its presence was correlated with the occurrence of specific antenatal complications, i.e., TTTS, sFGR, and single or double IUFD. Results: Combination of two markers predicted MCDA-related complications in the majority of cases (70.8% positive predictive value). Combination of dNT and dAC was the strongest predictor (80% positive predictive value). Conclusions: In our population of MC twin pregnancies, dCRL, dNT, and dAC at the 11⁺⁰–13⁺⁶ weeks’ scan, in isolation, had a low predictive value for antenatal complications, i.e., TTTS, sFGR, and single/double IUFD. However, the presence of at least two markers in the first trimester could predict complications in the majority of these pregnancies. The combination of dNT and dAC appears to be the best.

Sonographic and other nonglycemic factors can predict large-for-gestational-age infants in diet-managed gestational diabetes mellitus: A retrospective cohort study.

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. Left untreated or poorly controlled, GDM results in adverse infant outcomes such as large for gestational age (LGA). This study aims to identify nonglycemic maternal and fetal factors predictive of LGA outcomes in pregnancies complicated by diet-managed GDM. This was a retrospective cohort study of singleton pregnancies complicated by diet-managed GDM from 2004 to 2015. Multiple logistic regression analysis was performed on maternal and perinatal factors to identify risk factors for LGA. In addition, a subset univariate analysis was conducted for pregnancies in which fetal ultrasound abdominal circumference measurements were available at gestational weeks 18 to 22, 24 to 28, and 29 to 33. A total of 1064 women were included, delivering 123 LGA infants. Women with higher parity (odds ratio [OR] 1.44; CI, 1.23-1.68; P < .001) and higher prepregnancy body mass index (BMI) (OR 1.09; CI, 1.06-1.12; P < .001) were more likely to have LGA infants. Maternal smoking (OR 0.30; CI, 0.14-0.62; P = .001) and higher gestational age at birth (OR 0.91; CI, 0.84-0.99; P = .018) were associated with reduced risk. Subset univariate analysis showed that fetal abdominal circumference measurements at weeks 24 to 28 and 29 to 33 beyond the 75th percentile (OR 5.92 and 13.74, respectively) and 90th percentile (OR 4.57 and 15.89, respectively) were highly predictive of LGA. Parity, smoking status, maternal BMI, gestational age, and ultrasound fetal abdominal circumference measurements were identified as useful predictors of LGA. Presence of these predictors may prompt closer monitoring of pregnancy and early therapeutic intervention to improve management and reduce the risk of adverse fetal and maternal outcomes.

Accuracy of sonographic estimation of weight in fetuses with abdominal wall defects.

Accurate estimation of fetal weight is essential in guiding management of fetuses with abdominal wall defects (AWDs), as growth restriction is an important predictor of perinatal morbidity and mortality. Several sonographic formulae are available involving multiple biometric parameters, but abdominal circumference measurements may underestimate weight in fetuses with AWDs. No formula has yet shown superior accuracy. The objectives of this study were to evaluate, in fetuses with gastroschisis and omphalocoele, the accuracy of a sonographic estimated fetal weight (EFW) formula proposed by Siemer and colleagues, specifically for use in fetuses with AWDs compared to the commonly used Hadlock IV formula in estimating fetal weight, and detecting small for gestational age (SGA) fetuses. A retrospective cohort of 113 fetuses with AWDs was identified from an Australian teaching hospital over 13years. Pregnancy data and sonographic fetal biometry parameters were obtained. The accuracy of each formula in predicting birthweight was compared using Bland-Altman limits of agreement, and the intraclass correlation coefficient between EFW and actual birthweight. Performance of each formula in detecting SGA fetuses was determined. The Siemer and Hadlock formulae have similar accuracies for predicting birthweight in fetuses with AWDs. The Hadlock formula has a higher detection rate for SGA<10th centile and<3rd centile compared to the Seimer formula (84% vs 68% and 83% vs 67% respectively), albeit with a higher false-positive rate. There is no clear clinical advantage in using the Siemer formula, which is specifically designed for fetuses with AWDs, over the Hadlock formula to estimate weight in fetuses with AWDs.

Urinary trace metals in association with fetal ultrasound measures during pregnancy.

Toxic metals have been associated with lower birth weight while essential metals have been associated with higher birth weight. Evidence for other metals is either inconsistent or limited in terms of number of studies. This study analyzed 17 urinary metals, individually and as a mixture, and their association with measures of fetal growth in the LIFECODES birth cohort. Ultrasound was used to measure abdominal circumference, head circumference, and femur length and measures were used to calculate estimated fetal weight at ~26 and ~35 weeks. We calculated the z-score based on gestational age at scan, and estimated fetal weight (EFW) was combined with birth weight for longitudinal analyses. Metals were measured in samples collected at ~26 weeks. We used linear mixed effects models to examine associations between metals and repeated measures of each outcome, controlling for covariates. Principal components analysis reduced the biomarkers to predictors that may share some commonality. We found that an interquartile range increase in selenium was inversely associated with femur length z-score as well as other growth outcomes. Other essential metals, however, were associated with an increase in growth. Finally, the PCA component comprised of arsenic, mercury, and tin was associated with decreased head circumference z-score (-0.14 [95% CI: -0.23, -0.05]).