Macrosomia Group Research Articles

Antenatal macrosomia prediction using sonographic fetal abdominal circumference in South Tunisia

IntroductionIdentifying newborns who weight 4000 g or more is important because birth of macrosomic fetuses is associated with adverse peripartum outcomes. Ultrasound is widely used for this purpose Our objective was to evaluate the diagnostic value of sonographic measurement of fetal abdominal circumference (AC) over 350 mm for the prediction of fetal macrosomia and shoulder dystocia, to specify factors that could generate errors in its measure.MethodsA retrospective clinical trial was conducted at the Department of Obstetrics and Gynecology, Hédi Chaker Hospital, Sfax, Tunisia. The study consisted of comparing two groups of singleton newborns: the first group (n=465) includes macrosomic babies and the second group (n=465) includes the non macrosomic ones. All women underwent sonographic measurements of the fetal abdominal circumference (AC) within 72 hours before delivery. The AC values were correlated to actual fetal birth weight. The cut-off value of AC for predicting of fetal macrosomia was analyzed.ResultsA cut-off value of abdominal circumference ≥350 mm, in predicting of fetal macrosomia., had a sensitivity, specificity, accuracy, positive predictive value, and negative predictive value: 78.7%, 76.8%, 77%, 92.6%, and 49.2%, respectively. In macrosomic group obesity was significantly more frequent when AC≥350mm.ConclusionThe fetal AC measurement was useful in predicting of fetal macrosomia. An AC measurement AC≥350mm could help to suspect shoulder dystocia.

Estimating fetal weight for best clinical outcome.

Clinical decisions are often based on the results of third trimester sonograms, particularly with small or large babies and so accuracy of estimating fetal weight (EFW) is essential. There are numerous EFW formula available and yet in Australia no one formula has been recommended for use due to the lack of clinical evidence as to their accuracy. Objectives: 1 To assess inter/intra observer error for fetal parameter measurements with multiple observers. 2 To compare six of the most commonly used EFW formulae and analyse inter/intra formulae variations for different weight range. Method: EFW of 121 pregnancies assessed within 7 days of birth by measuring the BPD, OFD, HC, AC, FL and comparing to actual birth weight. Results: Inter‐observer error: 1.3 to 3.1%. Intra‐observer error: 1.1 to 1.9% depending on fetal parameter. Accuracy of each EFW formula changed with different weight ranges. For all formulae the highest random error occurred in the macrosomic group. The lowest random error in all weight groups was the Hadlock B formula incorporating the HC/AC/FL (7.7%). Conclusion: Considering the possible problems of head moulding this study suggests the use of: Hadlock FP et al (1982) – Formula B – incorporating HC/AC/FL.

Risk factors and long-term health consequences of macrosomia: a prospective study in Jiangsu Province, China

We sought to determine risk factors associated with fetal macrosomia and to explore the long-term consequence of infant macrosomia at the age of 7 years. A prospective population based cohort study was designed to examine the associations between maternal and perinatal characteristics and the risk of macrosomia. A nested case-control study was conducted to explore the long-term health consequence of infant macrosomia. The mean maternal age of the macrosomia group was 24.74±3.32 years, which is slightly older than that in the control group (24.35±3.14 years, P = 0.000). The mean maternal body mass index (BMI) at early pregnancy was 22.75±2.81 kg/m2, which was also higher than that in the control group (21.76±2.59 kg/m2, P = 0.000). About 64.6% of macrosomic ne-onates were males, compared with 51.0% in the control group (P = 0.000). Compared with women with normal weight (BMI: 18.5-23.9 kg/m2), women who were overweight (BMI: 24-27.9 kg/m2) or obese (BMI≥28 kg/m2), respectively, had a 1.69-fold (P = 0.000) and a 1.49-fold (P = 0.000) increased risks of having a neonate with macrosomia, while light weight (BMI<18.5 kg/m2) women had an approximately 50% reduction of the risk. Fur-thermore, macrosomia infant had a 1.52-fold and 1.50-fold risk, respectively, of developing overweight or obesity at the age of 7 years (P = 0.001 and P = 0.000). Older maternal age, higher maternal BMI at early pregnancy and male gender were independent risk factors of macrosomia. Macrosomic infant was associated with an increased predisposition to develop overweight or obesity at the beginning of their childhood.

The risk factors and the characteristic patterns of development changes of macrosomia

Objective To investigate the risk factors and the characteristic patterns of development changes of macrosomia.Methods 208 cases of macrosoroia were collected.Then the risk factors related to macrosomia by use of Logistic regression analysis were researched.208 infants of normal birth weight were selected as control group.The weight and length in 8 growth development monitoring time according to their health care manual were recorded.Mental development index(MDI)and physical development index(PDI)were tested and calculated by CDCC method when macrosomia and normal birth weight infants were 30 months.The characteristic patterns of development changes of macrosomia wre analyzed statistically.Results The risk factors of macrosomia contain age and height of the pregnant women,weight before pregnancy,weight increasing during pregnancy,nutriture,physical activity,family history of obesity and father's weight.Macrosomia was weighter than normal birth weight infants in the 8 growth development monitoring time and was longer than normal birth weight infants from 3 to 30 months(P ＜0.05).However,the length of macrosomia was not significantly different with that of control group when they were 36 months(P ＞ 0.05).MDI and PDI in macrosomia group were(107.33 ± 7.29)and(104.71 ± 6.93)respectively.MDI and PDI of normal birth weight infants group were(112.58 ± 7.61)and(109.09 ± 7.14)respectively.The differences were statistically significant(t =4.28,5.33;both P ＜ 0.01).Conclusion There were several risk factors for macrosomia such as environment and heredity.At the period of infants and young children,macrosomia were weighter than normal birth weight infants.The mental development and psycho-moter development of macrosomia were behind normal birth weight infants. Key words: Fetal macrosomia; Risk factors; Growth

Association of SLC38A4 and system A with abnormal fetal birth weight

In this study, we aimed to explore the correlation between solute carrier family 38 member 4 (SLC38A4) and system A activity in human placentas from pregnancies with abnormal fetal birth weight. We collected placentas from consenting women immediately after their full-term babies were born, with normal, low birth weight or macrosomia, and used real-time PCR and Western blot analysis to detect the levels of SLC38A4 mRNA and protein [also known as sodium-coupled neutral amino acid transport protein 4 (SNAT4)]. Isotope incorporation assay was applied to measure system A activity in the placentas. Compared to the normal birth weight (NBW) group, placentas from the fetal macrosomia (FM) group had significantly increased levels of SLC38A4 mRNA and SNAT4 (both were increased by almost 2-fold; P<0.05), while no significant changes were detected in the placentas from the low birth weight (LBW) group. In addition, system A activity in the placentas from the FM and LBW groups was significantly different from that in the NBW group (1.2±0.20, 0.6±0.14 vs. 1.0±0.18, P<0.05). The data suggest that SNAT4 and system A have a strong association with abnormal fetal birth weight and that they may play a crucial role in fetal growth and development.

Neonatal outcome of macrosomic infants: an analysis of a two-year period

ObjectiveTo assess the neonatal outcome of macrosomic neonates in uncomplicated, singleton, term deliveries. Study designA retrospective analysis was performed on 5738 live-born term neonates born in the period 2008–2009. The neonatal outcomes were compared between two birth weight (BW) groups: the macrosomic neonates born with BW≥4000g and a control group: 2500–3999g. There were 410 (7.1%) neonates in the macrosomic group, 4757 (82.9%) in the control group, while 571 (10.0%) were less than 2500g at birth. A correlation analysis of two subgroups of the macrosomic neonates (4000–4499g vs. ≥4500g) was also carried out. ResultsThe rate of caesarean section (CS) was significantly higher in the macrosomic group as compared with the control group (49.3% vs. 39.9%), as were the prevalences of hypoglycaemia (6.1% vs. 2.9%), adrenal haemorrhage (0.98% vs. 0.15%) and the male to female ratio (2.15 vs. 0.95). The rate of icterus was significantly higher in the control group (30.4% vs. 18.5%). The macrosomic subgroups were similar in many aspects, but we found significantly more neonates in the higher weight subgroup as regards a low Apgar score, clavicle fracture and the need for intensive care. ConclusionsThe macrosomic infants were born in good general condition, although those with BW ≥4500g more frequently had an adverse outcome. The macrosomic and control groups’ data revealed significant differences in the rate of CS, the male to female ratio, hypoglycaemia and adrenal haemorrhage.

P06.11: Normative values of fetal nasal bone lengths of Turkish singleton pregnancies in first trimester

Objectives: 11–14 week scan and maternal serum markers are used mainly for fetal aneuploidy screening but their clinical implication in assessing the risk of other pregnancy complications has been being evaluated. Traditionally, fetal macrosomia is expected to manifest in later pregnancy but we assumed that it can be predicted earlier. The purpose of this study was to demonstrate the characteristics of the first trimester ultrasound and maternal serum biochemical markers for fetal aneuploidy in pregnancy with fetal macrosomia at term. Methods: We reviewed pregnancies in which 11–14 week scan had been performed and had delivered at term from July 2008 to February 2011. Total 772 pregnancies were included. Multiple pregnancies, pregestational diabetes, pregnancies with fetal growth restriction or major fetal anomalies were excluded. We divided them into 2 groups: macrosomia and appropriate for gestational age (AGA). Fetal macrosomia was defined as a birth weight above the 90th percentile for gestational age at birth. We compared MoMvalues of nuchal translucency (NT), maternal serum PAPP-A and free β-hCG, and crown-to-rump length (CRL) ratio measured at the time of 11–14 week scan in two groups. CRL ratio was the ratio between measured CRL and expected CRL of gestational age at ultrasonography. Results: Total 79 pregnancies (10.2%) were included in macrosomia group. Their MoM-value of PAPP-A was significantly higher than that of AGA group (median 1.26 MoM vs. 1.06 MoM, P = 0.03). CRL ratio was greater in macrosomia group (median 1.10 vs. 1.07, P = 0.03). MoM-value of free β-hCG was higher in macrosomia group which didn’t reach statistical significance (median 1.25 MoM vs. 1.05 MoM, P = 0.06). No difference was shown in MoM-value of NT between two groups. Conclusions: Some characteristics of fetal macrosomia can be demonstrated in the first trimester of pregnancy. 11–14 week scan and maternal serum markers for fetal aneuploidy have clinical implication in prediction of fetal macrosomia at term.

Estimating Fetal Weight for Best Clinical Outcome

Clinical decisions are often based on the results of third trimester sonograms, particularly with small or large babies and so accuracy of estimating fetal weight (EFW) is essential. There are numerous EFW formula available and yet in Australia no one formula has been recommended for use due to the lack of clinical evidence as to their accuracy. Objectives: 1 To assess inter/intra observer error for fetal parameter measurements with multiple observers. 2 To compare six of the most commonly used EFW formulae and analyse inter/intra formulae variations for different weight range. Method: EFW of 121 pregnancies assessed within 7 days of birth by measuring the BPD, OFD, HC, AC, FL and comparing to actual birth weight. Results: Inter-observer error: 1.3 to 3.1%. Intra-observer error: 1.1 to 1.9% depending on fetal parameter. Accuracy of each EFW formula changed with different weight ranges. For all formulae the highest random error occurred in the macrosomic group. The lowest random error in all weight groups was the Hadlock B formula incorporating the HC/AC/FL (7.7%). Conclusion: Considering the possible problems of head moulding this study suggests the use of: Hadlock FP et al (1982) - Formula B - incorporating HC/AC/FL.

Maternal serum adiponectin at 11 to 13 weeks of gestation in the prediction of macrosomia

To examine the potential role of maternal serum level of adiponectin in the first trimester of pregnancy in the prediction of neonatal macrosomia. Maternal serum adiponectin concentration was measured in a case-control study of singleton pregnancies at 11 to 13 weeks' gestation, which included 50 cases that subsequently delivered macrosomic neonates with birth weight above the 95th percentile for gestation at delivery and 300 controls who delivered appropriate for gestational age neonates. The median multiple of the median (MoM) serum adiponectin in the two outcome groups was compared and the bivariate Gaussian distributions were simulated in a screened population of 33 344 pregnancies to estimate the performance of screening for macrosomia by a combination of maternal characteristics and obstetric history with serum adiponectin. In the macrosomic group the median serum adiponectin [0.82, interquartile range (IQR): 0.56-1.02 MoM] was significantly lower than in the non-macrosomic controls (1.02, IQR: 0.70-1.29 MoM; p = 0.001). The estimated detection rate of macrosomia, at fixed false positive rate of 10%, from maternal characteristics and obstetric history was 34.6% and this increased to 38.2% with the addition of serum adiponectin. Maternal serum adiponectin at 11 to 13 weeks is a useful biomarker for early prediction of macrosomia.

Isolated abnormal value during the 3-hour glucose tolerance test: which value is associated with macrosomia?

Objective. The aim of this retrospective review was to evaluate obstetric outcomes in patients with an isolated abnormal value on the oral glucose tolerance test (OGTT) at 0, 1, 2, and 3 h.Methods. From January 2003 through June 2009, all consecutive pregnant women who presented to Baskent University were screened for gestational diabetes mellitus (GDM). Patients with one abnormal value based on findings of the OGTT were grouped according to increased levels of glucose at 0, 1, 2, and 3 h (Group 1 > 95 mg/dl for fasting glucose concentration, Group 2 > 180 mg/dl for the serum glucose concentration in the first hour, Group 3 > 155 mg/dl for the serum glucose concentration in the second hour, Group 4 > 140 mg/dl for serum glucose concentration in the third hour). The four groups were compared for classic GDM risk factors. The primary outcome measures were large for gestational age (LGA) (birthweight >95th percentile for gestational age using population birth weight centile charts) and macrosomia.Results. The incidence of LGA baby (Group 1, 10%; Group 2, 3.8%; Group 3 20.3%; Group 4, 13.2%; p = 0.008) was significantly highest in Group 3 and macrosomia (Group 1, 30%; Group 2, 5.1%; Group 3, 18.6%; Group 4, 15.8%; p = 0.039) was significantly higher in Groups 1 and 3.Conclusions. Our results suggest that even with relatively mild degrees of glucose intolerance at 2 h, no treatment is associated with LGA babies.

Fetal macrosomia: Obstetric outcome of 311 cases in UNTH, Enugu, Nigeria

In modern obstetrics, fetal macrosomia is a major contributor to obstetric morbidity. It is an important cause of perinatal morbidity and mortality. This study aims to determine the maternal characteristics, fetal and neonatal complications associated with fetal macrosomia, and its contribution to obstetric morbidity in Enugu, Nigeria. This was a 3-year retrospective study carried out from 1 st January 2005 to 31 st December 2007. There were a total of 434 cases of fetal macrosomia out of 5,365 deliveries. The incidence of fetal macrosomia was 8.1%. Only 311 case notes (71.6%) were available for analysis. Statistical analysis showed that mothers of macrosomic newborns were older (30.6 ± 5.6 vs. 27.4 ± 4.74; P = 0.001), higher parity (4.1 ± 2.7 vs. 2.5 ± 1.07; P = 0.001), and weighed more at term (89.13 ± 6.17 kg vs. 71.43 ± 5.27 kg; P = 0.002). The study group had more mothers with previous history of macrosomic babies (39.5% vs. 12.5%), diabetes (3.2% vs. 1%), significant higher cesarian section rate (27.3% vs. 11.9%, P = 0.001), and operative vaginal delivery (3.6% vs. 1%; P = 0.001) compared with the control. There was male dominance in the study group compared with the control (63% vs. 56.3%; P = 0.001), higher risk of fetal asphyxia (P = 0.001), and greater mean birth weight (3.6 ± 1.2 kg vs. 3.2 ± 0.6 kg; P = 0.002). There were 7 (2.3%) cases of shoulder dystocia in the macrosomic group and none in the non-macrosomic group. The stillbirth rate (3.2/1000) was the same in both study group and control. This was not statistically significant (P = 0.124). The precise determination of fetal weight is only done at delivery. Clinical and ultrasound determination of fetal weight are highly imprecise especially at the third trimester. The route of delivery should therefore be individualized.

Macrosomia prediction using different maternal and fetal parameters in women with 50 g glucose challenge test between 130 and 140 mg/dl

Our aim in this study was to investigate the association between 1-h glucose challenge test (GCT) of 130-140 mg/dl and the development of macrosomia. In this retrospective cohort study, patients with GCT between 130 and 140 mg/dl were divided into two groups. Macrosomic and appropriate-for-gestational-age (AGA) term neonates were compared for the presence of maternal risk factors and fetal abdominal circumference between 29 and 34 weeks. There were no significant differences between the groups with respect to maternal age, parity, BMI at the first trimester and at the time of GCT, gestational weeks at delivery. However; history of a macrosomic baby delivery was significantly higher in macrosomic group (33.3% for group 1, 11.3% for group 2, p = 0.001). Abdominal circumference at 29-34 weeks of gestations was significantly higher in macrosomic group (32.46 ± 1.97 for group 1 vs. 31.06 ± 2.46 for group 2, p = 0.002). History of a macrosomic baby delivery and abdominal measurement at 29-34 weeks was important predictors of macrosomia in patients with GCT between 130 and 140 mg/dl.

Early metabolic imprinting as a determinant of childhood obesity

AimsChildhood obesity has seen an alarming increase in recent decades. This study was designed to assess the role of family history and perinatal programming in the aetiology of childhood obesity in a population known to have a high risk of developing metabolic syndrome. MethodologyThe study was carried out among two study populations of children. The first was a population of 206 mixed-gender 5-year-old children; the second of 230 mixed-gender 9-year-old children. The children underwent standard anthropomorphic measurements that were correlated to family history of metabolic syndrome-related illness, the child’s birth weight and a history of breastfeeding in early infant life. ResultsNo statistically significant correlation was noted with a family history of metabolic syndrome; but a definite (P=0.04) negative correlation was noted with breastfeeding in the 5-year-old children. Children of low birth weight appeared to retain a lower body weight at five years of age than their higher birth weight counterparts (P=0.002). The pattern changed to suggest a U-shaped distribution of obesity among the various birth weight groups of children, though statistical significance was noted only for the macrosomic group (P=0.002). ConclusionsThe study confirms the importance of intrauterine and early infant nutrition towards the development of childhood and later obesity. Children of low or high birth weight should be considered at risk and parents are advised actively regarding health lifestyle and nutrition options.

Factors relevant to newborn birth weight in pregnancy complicated with abnormal glucose metabolism

Factors relevant to newborn birth weight in pregnancy complicated with abnormal glucose metabolism

First-Trimester Prediction of Macrosomia

Objective: To determine if combinations of maternal characteristics and measurements of parameters used in screening for aneuploidies at 11–13 weeks provide significant prediction of macrosomia. Method: Maternal characteristics, fetal nuchal translucency (NT), free β-human chorionic gonadotrophin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) were recorded at 11⁺⁰–13⁺⁶ weeks in 36,743 singleton pregnancies. Regression analysis was used to determine if in predicting macrosomia significant contributions are provided by maternal factors, fetal NT, free β-hCG and PAPP-A. Results: The risk for macrosomia increased with maternal weight and height and was higher in parous women with previous delivery of a macrosomic baby and in those with diabetes mellitus; the risk was lower in women of African and South Asian racial origins, in cigarette smokers and in those with chronic hypertension. In the macrosomic group compared to the unaffected group there were higher Δ-NT (0.167 vs. 0.116 mm), free β-hCG (1.010 vs. 0.964 MoM) and PAPP-A (1.103 vs. 1.003 MoM). Prediction of macrosomia provided by maternal factors was significantly improved by fetal NT, free β-hCG and PAPP-A (34.4 vs. 33.1% at a false-positive rate of 10%). Conclusion: Prediction of macrosomia is provided in the first trimester of pregnancy by a combination of maternal characteristics and measurements of parameters used in screening for aneuploidies.

Relationship of adiponectin and resistin levels in umbilical serum, maternal serum and placenta with neonatal birth weight

Adiponectin and resistin have been postulated to play a role in the regulation of energy metabolism during pregnancy. However, relationship of adiponectin and resistin levels in umbilical serum, maternal serum and placenta with neonatal birth weight remains to be poorly understood. The purpose of the study was to clarify the correlations between adiponectin and resistin levels and neonatal birth weight. Enzyme immunoassay was used to measure the adiponectin and resistin levels in maternal and umbilical serum from 40 normal pregnant women (control group), 30 women with macrosomia (macrosomia group) and 30 women with fetal growth restriction (FGR group). Immunohistochemistry was used to measure adiponectin and resistin levels in placenta. Serum adiponectin and resistin levels were significantly increased in control women compared with that in macrosomia mothers, but significantly decreased compared with that in FGR mothers. The levels of adiponectin and resistin in control babies were significantly higher than that in macrosomic babies, whereas significantly lower than that in FGR babies. The placental expressions of adiponectin and resistin in macrosomia, control and FGR group were gradually elevated, and there was a significant difference between them. Umbilical serum adiponectin levels and placental adiponectin expression were inversely correlated with birth weight. Umbilical serum levels and placental expression of resistin had positive correlation with maternal serum resistin and negative correlation with birth weight. In addition, maternal serum resistin levels were inversely correlated with birth weight. It is suggested that adiponectin and resistin play an important role in controlling body weight and may be related to the occurrence of fetal macrosomia and FGR.

Possible cause of failure after McCall culdoplasty

To evaluate prospectively the rate of postoperative failure of McCall culdoplasty and the presence of a history of vaginal delivery of macrosomic infants as risk factors in patients with stage III or symptomatic stage II apical prolapse without any other pelvic floor defects. Patients with pelvic organ prolapse who underwent vaginal hysterectomy and McCall culdoplasty procedures were staged according to the POP-Q system before and after the operation (n = 70). POP-Q stages, age, gravidity, parity, body mass index (BMI), and the presence of diabetes mellitus in patients with or without history of vaginal delivery of macrosomic infants were analyzed. A birth weight of ≥4,000 g was accepted as macrosomia. Operative failure was defined as a postoperative POP-Q stage ≥ stage III of the apical segment. Follow-up period was 26.5 ± 6.37 months. Twenty-seven women had a history of macrosomic delivery and the remaining 43 did not. Postoperative failure was observed in 15 patients (44.4%) in the macrosomia group and in 3 patients (6.9%) in the control group. Postoperative failure was seen more frequently in the macrosomia group (Pearson's chi-square test, P = 0.000). No significant difference was found between the groups regarding age, gravidity, parity, BMI and the presence of diabetes mellitus. Failure of McCall culdoplasty occurs more frequently in patients with history of vaginal delivery of macrosomic infants, possibly due to direct pelvic floor damage. This technique should not be used in patients with a possible history of direct pelvic floor damage.

Levels of insulin-like growth factors and their receptors in placenta in relation to macrosomia.

To investigate the associations between mRNA levels that encodes for insulin-like growth factors (IGFS) and their receptors in term placenta, and the risk of macrosomia. Term placentas were collected from 37 neonates with macrosomia and 37 neonates with normal birth weight in Changzhou Women and Children Health Hospital from March 1 to June 30, 2008. The IGF mRNA levels and their receptors in those placentas were measured by Real-time PCR. The placental weight was positively correlated with the birth weight both in the macrosomia group (r=0.550, p=0.004) and the control group (r=0.678, p=0.000). After adjusting for potential confounders, multivariable adjusted ORs of neonates with macrosomia for those in the increasing two tertiles were 17.3 (95%CI: 2.50-19.2) and 5.94 (95%CI: 0.96, 36.8), respectively, compared with those in the lowest tertile in terms of IGF-IImRNA level. Similarly, multivariable adjusted ORs of neonates with macrosomia for those in the increasing two tertiles of IGF-IR mRNA were 25.3 (95%CI: 3.43-187) and 43.0 (95%CI: 4.89, 378), respectively. These results indicate that the levels of placental IGF-IIand IGF-IR mRNA may be involved in the development of macrosomia.

Relationship of adiponectin and visfatin with fetus intrauterine growth

To explore the correlation between adipocyte factors (adiponectin and visfatin) and fetus intrauterine growth. Enzyme immunoassay was used to measure the adiponectin and visfatin levels in maternal and umbilical serum from 14 women with fetal growth restriction (FGR group), 14 women with macrosomia (macrosomia group) and 14 normal pregnant women (control group). The correlations of cord serum adiponectin and visfatin with maternal serum adiponectin and visfatin were analyzed. (1) Serum visfatin levels in FGR mothers [(41.4 +/- 5.5)] microg/L were significantly higher than that in control women [(34.7 +/- 4.9) microg/L] and macrosomia mothers [(37.3 +/- 4.4) microg/L; P < 0.01, P < 0.05]. Serum adiponectin levels in macrosomia mothers [(4.1 +/- 1.3) mg/L] were significantly lower than that in control women [(6.6 +/- 1.5) mg/L] and FGR mothers [(6.4 +/- 1.3) mg/L; P < 0.01]. (2) Serum visfatin levels in FGR babies [(58.1 +/- 7.6) microg/L] were significantly increased than that in control newborns [(42.6 +/- 7.8) microg/L] and macrosomia babies [(48.5 +/- 9.1) microg/L; P < 0.01, P < 0.05]. Serum adiponectin levels in macrosomia babies [(6.5 +/- 1.3) mg/L] were significantly decreased than that in control newborns [(7.7 +/- 1.5) mg/L] and FGR babies [(7.7 +/- 1.0) mg/L; P < 0.05, P < 0.05]. (3) Maternal serum visfatin levels were positively correlated with umbilical serum visfatin levels (r = 0.720, P < 0.01). Umbilical serum adiponectin levels were higher than that in maternal serum, but there were no relationship between them (r = 0.301, P > 0.05). The changes of visfatin and adiponectin levels may be related to the occurrence of FGR and fetal macrosomia.

Use of the Amniotic Fluid Index Combined With Estimated Fetal Weight Within 10 Days of Delivery for Prediction of Macrosomia at Birth

The purpose of this study was to assess the value of combining the sonographically estimated fetal weight (EFW) and amniotic fluid index (AFI) measured within 10 days of term delivery for prediction of macrosomia at birth. Prospective sonographic fetal biometric measurements and delivery ward data of a single center, uploaded separately over a 4-year period, were retrospectively linked to yield an unselected sample of nondiabetic pregnancies with live-born term neonates. Of the 1925 pregnancies evaluated, 140 (7.2%) were macrosomic (birth weight > or =4000 g). The AFI was significantly higher in the macrosomic group (P < .001). On receiver operating characteristic curve analysis, the area under the curve was larger for predictions based on the EFW alone than on the AFI. An EFW of 4000 g or higher had a positive predictive value of 46.6% for macrosomia at birth. Use of the previously suggested combined EFW and AFI cutoffs of 3689 g and 119 mm, respectively, yielded a positive predictive value of 30.3%. Combined use of the EFW and AFI rather than the EFW alone does not improve prediction of macrosomia at birth.