Fetal Abdominal Circumference Research Articles

The association between first-trimester omega-3 fatty acid supplementation and fetal growth trajectories

Prenatal omega-3 fatty acid supplementation, particularly docosahexaenoic acid and eicosapentaenoic acid, has been associated with greater birthweight in clinical trials; however, its effect on fetal growth throughout gestation is unknown. This study aimed to examine the association between first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation and growth trajectories of estimated fetal weight and specific fetal biometrics measured longitudinally from the second trimester of pregnancy to delivery. In a multisite, prospective cohort of racially diverse, low-risk pregnant women, we used secondary data analysis to examine fetal growth trajectories in relation to self-reported (yes or no) first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation. Fetal ultrasonographic measurements, including abdominal circumference, biparietal diameter, femur length, head circumference, and humerus length, were measured at enrollment (8-13 weeks) and up to 5 follow-up visits. Estimated fetal weight and head circumference-to-abdominal circumference ratio (a measure of growth symmetry) were calculated. Fetal growth trajectories were modeled for each measure using a linear mixed model with cubic splines. If significant differences in fetal growth trajectories between groups were observed (global P<.05), weekly comparisons were performed to determine when in gestation these differences emerged. Analyses were adjusted for maternal sociodemographics, parity, infant sex, total energy consumption, and diet quality score. All analyses were repeated using dietary docosahexaenoic acid and eicosapentaenoic acid intake, dichotomized at the recommended cutoff for pregnant and lactating women (≥0.25 vs <0.25 g/d), among women who did not report supplement intake in the first trimester of pregnancy were repeated. Among 1535 women, 143 (9%) reported docosahexaenoic acid and eicosapentaenoic acid supplementation in the first trimester of pregnancy. Overall, first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation was associated with statistically significant differences (P-value <.05) in fetal growth trajectories during pregnancy. Specifically, estimated fetal weight was larger among women with docosahexaenoic acid and eicosapentaenoic acid supplementation than among those without supplementation (global P=.028) with significant weekly differences in median estimated fetal weight most apparent between 38 to 41 weeks of gestation (median estimated fetal weight difference at 40 weeks of gestation, 114 g). Differences in fetal growth trajectories for abdominal circumference (P=.003), head circumference (P=.003), and head circumference-to-abdominal circumference ratio (P=.0004) were also identified by supplementation status. In weekly comparisons, docosahexaenoic acid and eicosapentaenoic acid supplement use was associated with larger median abdominal circumference (changed from 2 to 9 mm) in midpregnancy onward (19 to 41 weeks), larger median head circumference between 30 to 33 weeks of gestation, and smaller median head circumference-to-abdominal circumference ratio in the second and third trimesters of pregnancy. There was no specific weekly difference in fetal femur length or humerus length by docosahexaenoic acid and eicosapentaenoic acid supplementation. First-trimester dietary sources of docosahexaenoic acid and eicosapentaenoic acid among women with no first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation (n=1392) were associated with differences in fetal biparietal diameter (P=.043), but not other metrics of fetal growth. At the recommended dietary docosahexaenoic acid and eicosapentaenoic acid levels compared with below-recommended levels, biparietal diameter was larger between 38 to 41 weeks of gestation. In this racially diverse pregnancy cohort, first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation was associated with significant increases in fetal growth, specifically greater estimated fetal abdominal circumference in the second and third trimesters of pregnancy.

Influence of intrauterine factors on birth weight and on child linear growth in rural Ethiopia: A prospectivecohortstudy.

Little is known about the influence of intrauterine fetal factors on childhood growth in low-income countries. The objective of this study was to examine the influence of intrauterine fetal growth on child linear growth in rural Ethiopia. We conducted a prospective community-based cohort study from July 2016 to October 2018. All pregnant women with gestational age of 24 weeks or below living in 13 kebeles, in central Ethiopia were enrolled. The fetuses were followed from pregnancy up to 11-24 months after birth. We measured biparietal diameter, head circumference, femoral length, and abdominal circumference at 26, 30 and 36 weeks of pregnancy. At birth, we measured infant weight. At 11-24 months of age, z-scores of length- for- age, and weight-for-length were calculated. A multilevel, mixed-effect, linear regression model was used to examine the influence of fetal, newborn, maternal, household factors and residence area on child linear growth. We included 554 children. The prevalence rate of stunting was 54.3% and that of wasting was 10.6%. Fetal biparietal diameter, head circumference, and abdominal circumference, were significantly associated with birth weight. Femoral length z-score in early pregnancy, gestational age at delivery and child age were significantly associated with length-for-age z-score. Family size was significantly associated with length-for-age z-score. Family size and maternal height were associated with weight-for-height z-score. There was a large variation in length-for-age z-score (Intra cluster correlation, or ρ (rho) = 0.30) and weight-for-length z-score (ρ = 0.22) than of birth weight of new-born (ρ = 0.11) in kebeles indicating heterogeneity in clusters for length-for-age z-score and weight-for-length z-score than birth weight. Child linear growth was influenced by fetal growth, duration of pregnancy, maternal height, and family size. Environmental factors that are associated with the area of residence play a bigger role for linear growth than for birth weight.

The Gestational Effects of Maternal Bone Marker Molecules on Fetal Growth, Metabolism and Long-Term Metabolic Health: A Systematic Review.

Fetal exposure in adverse environmental factors during intrauterine life can lead to various biological adjustments, affecting not only in utero development of the conceptus, but also its later metabolic and endocrine wellbeing. During human gestation, maternal bone turnover increases, as reflected by molecules involved in bone metabolism, such as vitamin D, osteocalcin, sclerostin, sRANKL, and osteoprotegerin; however, recent studies support their emerging role in endocrine functions and glucose homeostasis regulation. Herein, we sought to systematically review current knowledge on the effects of aforementioned maternal bone biomarkers during pregnancy on fetal intrauterine growth and metabolism, neonatal anthropometric measures at birth, as well as on future endocrine and metabolic wellbeing of the offspring. A growing body of literature converges on the view that maternal bone turnover is likely implicated in fetal growth, and at least to some extent, in neonatal and childhood body composition and metabolic wellbeing. Maternal sclerostin and sRANKL are positively linked with fetal abdominal circumference and subcutaneous fat deposition, contributing to greater birthweights. Vitamin D deficiency correlates with lower birthweights, while research is still needed on intrauterine fetal metabolism, as well as on vitamin D dosing supplementation during pregnancy, to diminish the risks of low birthweight or SGA neonates in high-risk populations.

Associations of maternal and foetoplacental factors with prehypertension/hypertension in early childhood.

To evaluate whether characterization of maternal and foetoplacental factors beyond birthweight can enable early identification of children at risk of developing prehypertension/hypertension. We recruited 693 mother-offspring dyads from the GUSTO prospective mother-offspring cohort. Prehypertension/hypertension at age 6 years was identified using the simplified paediatric threshold of 110/70 mmHg. We evaluated the associations of pregnancy complications (gestational diabetes, excessive/inadequate gestational weight gain, hypertensive disorders of pregnancy), foetal growth deceleration (decline in foetal abdominal circumference at least 0.67 standard deviations between second and third trimesters), high foetoplacental vascular resistance (third trimester umbilical artery systolic-to-diastolic ratio ≥90th centile), preterm birth, small-for-gestational age and neonatal kidney volumes with risk of prehypertension/hypertension at age 6 years, after adjusting for sex, ethnicity, maternal education and prepregnancy BMI. Pregnancy complications, small-for-gestational age, preterm birth, and low neonatal kidney volume were not associated with an increased risk of prehypertension/hypertension at age 6 years. In contrast, foetal growth deceleration was associated with a 72% higher risk [risk ratio (RR) = 1.72, 95% confidence interval (CI) 1.18-2.52]. High foetoplacental vascular resistance was associated with a 58% higher risk (RR = 1.58, 95% CI 0.96-2.62). Having both these characteristics, relative to having neither, was associated with over two-fold higher risk (RR = 2.55, 95% CI 1.26-5.16). Over 85% of the foetuses with either of these characteristics were born appropriate or large for gestational age. Foetal growth deceleration and high foetoplacental vascular resistance may be helpful in prioritizing high-risk children for regular blood pressure monitoring and preventive interventions, across the birthweight spectrum.

Plasma phospholipid polyunsaturated fatty acids composition in early pregnancy and fetal growth trajectories throughout pregnancy: Findings from the US fetal growth studies-singletons cohort.

SummaryBackgroundWe aimed to investigate plasma phospholipid PUFA levels in early pregnancy and fetal growth trajectories throughout pregnancy.MethodsWithin the NICHD Fetal Growth Studies–Singleton Cohort, we enrolled 2,802 pregnant women at gestational weeks 8–13 and randomly assigned them to four ultrasonogram schedules to capture weekly fetal growth throughout pregnancy. Eleven plasma phospholipid PUFAs were measured at early pregnancy using blood samples collected from a subsample of 321 pregnant women. We modeled fetal growth trajectories across tertiles of PUFAs with cubic splines using linear mixed models after adjusting for major confounders. We then compared pairwise weekly fetal growth biometrics referencing the lowest tertile in each PUFA using the Wald test.FindingsAmong plasma n-3 PUFAs in early pregnancy, docosahexaenoic acid (DHA, 22:6n3) and alpha-linolenic acid (ALA, 18:3n3) showed positive associations with all fetal growth measurements. For instance, compared with the lowest tertile, the highest tertile of DHA had greater estimated fetal growth (EFW) and abdominal circumference (AC), starting at 13 weeks of gestation and throughout pregnancy (at gestational week 38: 3235.3 vs. 3089.0 g for EFW; 344.6 vs. 339.2 mm for AC). As for plasma n-6 PUFAs, some showed positive associations (e.g., linoleic acid [LA], 18:2n6) while others (e.g., docosatetraenoic acid [DTA], 22:4n6) showed inverse associations with fetal growth measures.InterpretationOur data suggested that higher plasma levels of DHA and ALA in the first trimester were associated with increased fetal size and weight throughout subsequent pregnancy.FundingNational Institute of Child Health and Human Development intramural funding.

A retrospective study on the need of deriving ultrasonographical fetal gestational nomograms for fetal biometric parameters in the population of Udaipur Region

Fetal gestational age is routinely calculated in sonography by the radiologists, with the dimensions of fetal biometric parameters, as the expectant mother may not remember the exact date of the last menstrual period. The expected date of delivery is then calculated accordingly and the antenatal period is managed consequently. Accurate fetal age estimation is of crucial importance for proper antenatal care in order to reduce infant mortality, and achieve the goal of delivering a healthy child. Various studies have been done to derive fetal nomograms for indigenous populations claiming that the Western data being used cannot be applied to their population. Therefore, need of deriving ultrasonographic fetal gestational nomograms for fetal biometric parameters (head circumference, abdominal circumference and femur length) for the population of Udaipur in the northwestern region of India was investigated. Fetal sonography records of pregnant women in second and third trimesters were studied. The study derived fetal gestational nomograms for fetal head circumference, fetal abdominal circumference and fetal femur length for estimating the fetal age. These nomograms were compared with the standard nomograms of Hadlock et al. used by radiologists for the same parameters. No significant difference was found between the two, and it was concluded that the routinely used nomograms may be also used for the local population of Udaipur, Rajasthan, India.

Fetal Abdominal Circumference and Risk of Neonatal Morbidity in Pregnancies Complicated by Diabetes [A246

INTRODUCTION: We aimed to characterize the relationship between fetal abdominal circumference and neonatal morbidity in pregnancies complicated by diabetes. METHODS: After institutional review board approval, patients with gestational diabetes (GDM) or preexisting diabetes type 1 or type 2 (T1DM, T2DM) who delivered a live, singleton, non-anomalous infant at a single center 2002–2013 were identified within a large, National Institutes of Health-funded database of detailed pregnancy and delivery information extracted by trained research nurses. Neonatal morbidity (NM) was defined as one or more of the following: 5-minute Apgar &lt;7, arterial cord pH &lt;7.0, sepsis, neonatal death, or need for respiratory support, chest compressions, phototherapy, exchange transfusion, or hypoglycemia treatment. Rates of morbidity were calculated for the following groups stratified by fetal abdominal circumference (AC) percentile for gestational age: below the 20th percentile, 20th–39th percentile, 40th–59th percentile, 60th–79th percentile, and 80th percentile or greater. Unadjusted relative risk (RR) of neonatal morbidity was calculated for each group, with AC 40th–59th percentile as the reference. RESULTS: A total of 721 eligible pregnancies were identified (643 GDM, 35 T1DM, 43 T2DM). Neonatal morbidity occurred in 261 (36%). The lowest rate of neonatal morbidity (22%) occurred in pregnancies with a fetal AC below the 20th percentile (RR, 0.55; 95% CI, 0.31–0.98). The highest rate of neonatal morbidity (42%) occurred in those with an AC at or above the 80th percentile, but this was not a statistically significant increase in risk compared to the reference group (RR, 1.05; 95% CI, 0.82–1.33). CONCLUSION: Among pregnancies complicated by diabetes, fetal abdominal circumference below the 20th percentile was associated with decreased risk of neonatal morbidity.

Developing A Reference Charts for Foetal Biometry in Indian Population to Predict Growth &amp; Development of Foetus

ObjectivesThe objective of the study was to develop reference charts for foetal abdominal circumference and femur length in normal singleton pregnancies. The modality used in the study was by means of ultrasonography which is easily available and safe during the pregnancy.MethodIn this study, we conducted ultrasonography examination in 300 singleton pregnant women coming for routine checkups. Out of various foetal biometric parameters abdominal circumference (AC) and femur length (FL) were measured and reference charts (10th, 50th, 90th and 95th percentiles) for each parameter corresponding to its gestational age were developed.ResultsAge distribution of pregnant women was uniform (p=0.87). Both parameters i.e. AC and FL were found to be in linear correlation with the corresponding gestational age in weeks. Therefore, their use in determining development and age of the foetus is reliable. We compared our reference charts with other studies conducted in European and Chinese population. From which, it is obvious that the data found in Indian population is different from studies conducted in other ethnic population.ConclusionReference charts derived in this study can be used to determine growth and development of foetus depending upon Indian standards. Because ethnicity, race, nutritional and environmental factors are known to impact the foetal development. Most of the health care set ups are using data from the studies conducted in western population. Which may cause misrepresentation of data in diagnosis. Thus can lead to unnecessary medical intervention which may cause burden in limited resources in developing nations like India. Therefore, we conclude that each population should have their own reference charts for foetal biometry.

Effect of Race in the Diagnosis of Fetal Growth Restriction in a Multicultural Urban Population [A202

INTRODUCTION: Despite significant differences in fetal growth curves based on maternal race/ethnicity, fetal growth restriction (FGR) continues to be defined by the Hadlock formula generated from a study involving 392 predominantly White pregnancies. Accuracy in FGR diagnosis is crucial to prevent iatrogenic preterm delivery and unnecessary antenatal surveillance and intervention. We sought to compare the diagnostic accuracy of FGR in fetuses classified by Hadlock criteria versus Eunice Kennedy Shriver National Institute of Child Health and Human Development racial/ethnic-stratified criteria in a multicultural urban population. METHODS: A retrospective recalculation of estimated fetal weight (EFW) and abdominal circumference (AC) in fetuses diagnosed with FGR over a 5-year period using NICHD race-specific fetal growth criteria was performed. FGR was defined as EFW or AC less than 10th percentile. Chi-square analysis was performed to evaluate the differential effects of recalculation across racial groups. RESULTS: A total of 384 pregnancies with FGR were identified in 147 (38.3%) Asian, 114 (29.67%) Hispanic, 111 (28.9%) Black, and 12 (3.3%) White mothers. Recalculation normalized growth in 64 (16.7%) pregnancies and was disproportionate, with the greatest effect in pregnancies of Black mothers (29, 26.1%), followed by Hispanic mothers (17, 14.9%) and Asian mothers (18, 12.2%) (P=.01). CONCLUSION: Application of NICHD race-specific criteria reversed the diagnosis of a substantial number of FGR pregnancies, with the greatest reversal seen in pregnancies of Black mothers. More research is needed to evaluate the neonatal and long-term outcomes of fetuses misdiagnosed as FGR based on the old growth standards, as iatrogenic preterm delivery and steroid administration carry potential morbidity later in life.

Urinary phthalate metabolite mixtures in pregnancy and fetal growth: Findings from the infant development and the environment study

BackgroundPrenatal phthalate exposure has been linked to reductions in fetal growth in animal and laboratory studies, but epidemiologic evidence is equivocal. ObjectiveExamine the association between prenatal phthalate metabolite mixtures and fetal growth and evaluate whether that association is modified by fetal sex or omega-3 intake during pregnancy. MethodsAnalyses included 604 singleton pregnancies from TIDES, a prospective pregnancy cohort with spot urine samples and questionnaires collected in each trimester. Pregnancy-averaged phthalate exposure estimates were calculated as the geometric means of specific-gravity corrected phthalate metabolites. Fetal growth outcomes included birthweight and length, and ultrasound-derived size and velocity of estimated fetal weight, femur length, abdominal and head circumferences in the second and third trimesters. We used a novel application of quantile g-computation to estimate the joint association between pregnancy-averaged phthalate exposure and fetal growth, and to examine effect modification of that association by infant sex or omega-3 intake during pregnancy. ResultsThere were few statistically significant differences in birth size and fetal growth by exposure. A one-quartile increase in the phthalate mixture was modestly associated with reduced birthweight(β [95% confidence interval)]: −54.6 [−128.9, 19.7] grams; p = 0.15) and length (−0.2 [−0.6, 0.2] centimeters; p = 0.40). A one-quartile increase in the phthalate mixture was associated with reduced birth length in males (−0.5 [−1.0, 0.0] centimeters) but not for females (0.1 [−0.2, 0.3] centimeters); interaction p = 0.05. The phthalate metabolite mixture was inversely associated with ultrasound-derived fetal growth among those with adequate omega-3 intake. For example, a one-quartile increase in the phthalate mixture was associated with reduced abdominal circumference in the third trimesters in those with adequate omega-3 intake (−3.3 [−6.8, 0.1] millimeters) but not those with inadequate omega-3 intake (1.8 [−0.8, 4.5] millimeters); interaction p = 0.01. ConclusionPrenatal phthalate exposure was not significantly associated with fetal growth outcomes, with some exceptions for certain subgroups.

Perinatal and 2-year neurodevelopmental outcome in late preterm fetal compromise: the TRUFFLE 2 randomised trial protocol

IntroductionFollowing the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late...

Predictors Associated with Adverse Pregnancy Outcomes in a Cohort of Women with Systematic Lupus Erythematosus from Romania-An Observational Study (Stage 2).

Background: Pregnancy in women with systemic lupus erythematosus (SLE) is accompanied by adverse pregnancy outcomes (APOs). We aimed to investigate the association between clinical, sonographic, and laboratory parameters and APOs (preeclampsia, intrauterine growth restriction, premature birth, and maternal mortality). Methods: This observational retrospective study included all pregnancies in women with SLE who attended two tertiary maternity hospitals from Romania between January 2013 and December 2020. Clinical, sonographic, and laboratory variables were examined. Bivariate associations of APO status and each predictor variable were evaluated, and significant predictors were further included in a classification model based on discriminant analysis. Results: Predictors of APOs included BMI > 25 kg/m2, personal history of lupus nephritis or chronic hypertension, proteinuria, low C3, SLE Disease Activity Index 2000 (SLEDAI-2k score ≥ 4 and physician’s global-assessment (PGA) score ≥ 1 throughout pregnancy, increased mean uterine arteries pulsatility index in the first and second trimesters, cerebroplacental ratio < 1 in the second and third trimesters, and small fetal abdominal circumference in the third trimester. Glucocorticoids, methyldopa, and aspirin use appeared to be protective against APOs. Conclusions: This study provides a comprehensive analysis of the most important predictors for APOs in pregnant patients with SLE, which could constitute a basis for further research.

A prenatal standard for fetal weight improves the prenatal diagnosis of small for gestational age fetuses in pregnancies at increased risk

ObjectiveOur aim was to assess diagnostic accuracy in the prediction of small for gestational age (SGA <10th centile) and fetal growth restricted (FGR) (SGA <3rd centile) fetuses using three different sonographic methods in pregnancies at increased risk of fetal growth restriction: 1) fetal abdominal circumference (AC) z-scores, 2) estimated fetal weight (EFW) z-scores according to postnatal reference standard; 3) EFW z-scores according to a prenatal reference standard.MethodsSingleton pregnancies at increased risk of fetal growth restriction seen in two university hospitals between 2014 and 2015 were studied retrospectively. EFW was calculated using formulas proposed by the INTERGROWTH-21st project and Hadlock; data derived from publications by the INTEGROWTH-twenty-first century project and Hadlock were used to calculate z-scores (AC and EFW). The accuracy of different methods was calculated and compared.ResultsThe study group included 406 patients. Prenatal standard EFW z-scores derived from INTERGROWTH-21st project and Hadlock and co-workers performed similarly and were more accurate in identifying SGA infants than using AC z-scores or a postnatal reference standard. The subgroups analysis demonstrated that EFW prenatal standard was more or similarly accurate compared to other methods across all subgroups, defined by gestational age and birth weight.ConclusionsPrenatal standard EFW z-scores derived from either INTERGROWTH-21 st project or Hadlock and co-workers publications demonstrated a statistically significant advantage over other biometric methods in the diagnosis of SGA fetuses.

Magnetic Resonance Imaging-Based Nomogram to Antenatal Predict Cesarean Delivery for Cephalopelvic Disproportion in Primiparous Women.

Cephalopelvic disproportion (CPD)-related obstructed labor is associated with maternal and neonatal morbidity and mortality. Accurate prediction of whether a primiparous woman is at high risk of an unplanned cesarean delivery would be a major advance in obstetrics. To develop and validate a predictive model assessing the risk of cesarean delivery in primiparous women based on MRI findings. Prospective. A total of 150 primiparous women with clinical findings suggestive of CPD. T1-weighted fast spin-echo sequences, single-shot fast spin-echo (SSFSE) T2-weighted sequences at 1.5T. Pelvimetry and fetal biometry were assessed independently by two radiologists. A nomogram model combined that the clinical and MRI characteristics was constructed. Univariable and multivariable logistic regression analyses were applied to select independent variables. Receiver operating characteristic (ROC) analysis was performed, and the discrimination of the model was assessed by the area under the curve (AUC). Calibration was assessed by calibration plots. Decision curve analysis was applied to evaluate the net clinical benefit. A P value below 0.05 was considered to be statistically significant. In multivariable modeling, the maternal body mass index (BMI) before delivery, bilateral femoral head distance, obstetric conjugate, fetal head circumference, and fetal abdominal circumference was significantly associated with the likelihood of cesarean delivery. The discrimination calculated as the AUC was 0.838 (95% confidence interval [CI]: 0.774-0.902). The sensitivity and specificity of the nomogram model were 0.787 and 0.764, and the positive predictive and negative predictive values were 0.696 and 0.840, respectively. The model demonstrated satisfactory calibration (calibration slope=0.945). Moreover, the decision curve analysis proved the superior net benefit of the model compared with each factor included. Our study might provide a nomogram model that could identify primiparous women at risk of cesarean delivery caused by CPD based on MRI measurements. 2 TECHNICAL EFFICACY: Stage 2.

Reference values of fetal ultrasound biometry: results of a prospective cohort study in Lithuania.

The aim of the study was to construct a reference range for the Lithuanian population for fetal biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HC), abdominal circumference (AC) and femur length (FL) and to compare them with the old local and current international reference values. A prospective cross-sectional study was carried out in secondary referral centres Vilnius University Hospital Santariškių Klinikos Centro Affiliate in 2008-2009 and Vilnius Maternity Hospital in 2009-2014. The fetal biometry of 556 fetuses between 12 and 42weeks gestation was performed. BPD, OFD, HC, AC and FL were measured. The data were collected and the analysis was performed using statistical programs MS Excel, SPSS and Matlab. Different regression models were fitted to calculate the mean and standard deviation at each gestational age for each parameter. The biometric measurements of HC, BPD, OFD as well as AC and FL were performed for 556 fetuses. The centile charts, tables and regression formulae of the biometric parameters were constructed. The comparison of the current charts with those of other two studies revealed no significant differences of HC centiles. AC values were similar to those presented in the international study INTERGROWTH-21 and significantly higher in comparison to the study for the Lithuanian population conducted by Ališauskas (1980). FL values, especially in late pregnancy, were significantly smaller in the INTERGROWTH-21 study compared to our charts; however, there were no significant differences of the 50th centile compared to the results from Ališauskas. We have constructed and presented centile charts, tables and regression formulae for fetal biometry for the Lithuanian population and compared them with the results of two other studies. The significant differences between our centile charts and those from INTERGROWTH-21 imply the necessity to have local standards of fetal biometry, while the differences of our results from the older study in the same population show the importance of updating fetal biometry reference charts for every generation.

A comparison of four fetal biometry growth charts within an Australian obstetric population.

The aim of this study was to investigate the applicability of four existing fetal growth charts to a local tertiary hospital obstetric population. Four existing fetal growth charts (the Raine study reference charts, INTERGROWTH-21st charts, World Health Organization (WHO) fetal growth study charts and Australasian Society for Ultrasound in Medicine (ASUM) endorsed Campbell Westerway charts were compared using data from 11651 singleton pregnancy ultrasound scans at King Edward Memorial Hospital (KEMH). The 3rd, 10th, 50th 90th and 97th percentile curves for abdominal circumference (AC) biometry for the KEMH data were calculated and the four primary correlation parameters from fitted 3rd order polynomials (a, b, c and d) were used to generate like-for-like comparisons for all charts. The overall comparisons showed a significant variation with different growth charts, giving different percentiles for the same fetal AC measurement. INTERGROWTH-21st percentile curves tended to fall below those of other charts for AC measurements. Both the Raine Study charts and ASUM charts were the charts of closest overall fit to the local data. Our data show the Raine Study charts are the most appropriate for our population compared with the other three charts assessed suggesting the 'one size fits all' model may not be appropriate. However, additional analysis of biometry measurements, primarily AC, is needed to address the deficiency of data at 14-18 weeks gestation which exists for the Raine Study data.A reasonable alternative may be to adopt the WHO charts with local calibration (including the 14 - 18 week gestation period).

Influence of Pre-Pregnancy Underweight Body Mass Index on Fetal Abdominal Circumference, Estimated Weight, and Pregnancy Outcomes in Gestational Diabetes Mellitus.

This study aimed to determine the influence of pre-pregnancy body mass index on pregnancy outcomes in gestational diabetes mellitus (GDM), comparing underweight patients with GDM with normal weight patients with GDM. Maternal baseline characteristics, ultrasonographic results, and pregnancy and neonatal outcomes were reviewed in 946 women with GDM with singleton pregnancies. Underweight patients with GDM showed a benign course in most aspects during pregnancy, except for developing a higher risk of giving birth to small for gestational age neonates. Underweight women with GDM required less insulin treatment, had a higher rate of vaginal delivery, and had a lower rate of cesarean delivery. In addition, their neonates were more likely to have fetal abdominal circumference and estimated fetal weight below the 10th percentile both at the time of GDM diagnosis and before delivery. Notably, their risk for preeclampsia and macrosomia were lower. Collectively, our data suggest that underweight women with GDM may require a different approach in terms of diagnosis and management throughout their pregnancy.

Effect of SARS-CoV-2 infection on fetal umbilical vein flow and cardiac function: a prospective study.

To explore whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect umbilical vein blood flow (UVBF) and fetal cardiac function. Prospective case-control study of consecutive pregnancies complicated by SARS-CoV-2 infection during the second half of pregnancy matched with unaffected women. Measurements of UVBF normalized for fetal abdominal circumference (UVBF/AC), atrial area (AA) and ventricular sphericity indices (SI) were compared between the two study groups. Chi-square and Mann-Whitney U tests were sued to analyze the data. Fifty-four consecutive pregnancies complicated and 108 not complicated by SARS-CoV-2 infection were included. The median gestational age at infection was 30.2 (interquartile range [IQR] 26.2 34.1). General baseline and pregnancy characteristics were similar between pregnant women with compared to those without SARS-CoV-2 infection. There was no difference in UVBF/AC (study groups z value-0.11 vs. 0.14 control p 0.751) values between pregnancies complicated compared to those not complicated by SARS-CoV-2 infection. Likewise, there was no difference in the left and right AA (left 1.30 vs. 1.28 p=0.221 and right 1.33 vs. 1.31 p=0.324) and SI (left 1.75 vs. 1.77 p=0.208 and right 1.51 vs. 1.54 p=0.121) between the two groups. SARS-CoV-2 infection does not affect UVBF and fetal cardiac function in uncomplicated pregnancies.

Physical activity and sedentary behaviours during pregnancy are associated with neonatal size at birth

Background. Pregnancy is a crucial time to examine modifiable maternal behaviours associated with neonatal outcomes so that preventative measures can be taken against childhood obesity. Objectives. This study aimed to examine the pathways through which maternal physical activity impacted neonatal size and body composition. Methods. A subsample of participants who had objectively measured physical activity data were included from a pregnancy cohort study. Sociodemographic data were collected at the first visit during pregnancy. Gestational weight gain (GWG) was calculated at each visit, and the presence of gestational diabetes, hypertension and HIV were assessed. Physical activity was measured using a hip-worn triaxial accelerometer, at 14 - 18 weeks’ and 29 - 33 weeks’ gestation. At delivery, gestational age, birthweight and length were measured and neonatal body composition was analysed. A structural equation model (SEM) was run with either weight-to-length ratio (WLR) or fat mass index (FMI) as the outcome. Results. A total of 84 participants were included in this study, and a subsample of neonates (n=45) also had FMI data. Most (66%) mothers presented as overweight or obese at their first visit, and gained on average 0.35 (19) kg per week. The SEM showed that only gestational age at delivery and sedentary time were positively associated with WLR. Step count was directly associated with GWG (ß=-0.02, p=0.01), and with gestational age (ß=0.16, p=0.04), and was therefore indirectly associated with decreased fetal abdominal circumference. Conclusion. This study showed that increasing daily step count and decreasing sedentary behaviour could have beneficial effects on maternal health as well as delivery outcomes and neonatal size.

Risk of adverse outcomes for small fetuses not meeting consensus criteria for fetal growth restriction

To assess whether an independent association exists between an estimated fetal weight (EFW) and/or abdominal circumference (AC) < 10th centile and adverse outcomes when Delphi consensus criteria [Gordijn S et al Ultrasound Obstet Gynecol 2016;48(3):333-9] for fetal growth restriction (FGR) are not met.