Sonographic Estimated Fetal Weight among Diabetics at ≥ 34 Weeks and Composite Neonatal MorbidityFunding There was no funding received for conducting this project.
24 October 2017
22 March 2018
11 June 2018 (online)
Objectives The objective was to assess the composite neonatal morbidity (CNM) among diabetic women with sonographic estimated fetal weight (SEFW) at 10 to 90th versus >90th percentile for gestational age (GA).
Study Design The inclusion criteria for this retrospective study were singleton pregnancies at 34 to 41 weeks, complicated by diabetes, and that had SEFW within 4 weeks of delivery. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated.
Results Among the 140 cohorts that met the inclusion criteria, 72% had SEFW at 10th to 90th percentile for GA, and 28% at >90th percentile. Compared with women with diabetes with last SEFW at 10th to 90th percentile, those with estimate > 90th percentile for GA had a significantly higher rate of CNM (13 vs. 28%; OR, 2.65; 95% CI, 1.07–6.59). Among 109 diabetic women who labored, the rate of shoulder dystocia was significantly higher with SEFW at >90th percentile for GA than those at 10th to 90th percentile (25 vs. 2%; p = 0.002); the corresponding rate of CNM was 29 versus 10% (p = 0.02).
Conclusion Among diabetic women with SEFW > 90th percentile for GA, CNM was significantly higher than in women with estimate at 10 to 90th percentile. Despite the increased risk of CNM, these newborns did not have long-term morbid sequela.
The article was presented at the 2017 Central Association of Obstetricians and Gynecologists Annual Meeting in Scottsdale, Arizona.
Among diabetics, the composite neonatal morbidity was higher if sonographic estimated fetal weight was > 90th percentile for gestational age (28%) than at 10 to 90th percentile (13%; OR, 2.65; 95% CI, 1.07–6.59).
- 1 Martin JA, Hamilton BE, Osterman MJK. , et al. Births: Final Data for 2015. National Vital Statistics Report; Vo.l 66, No. 1. Hyattsville, MD: National Center for Health Statistics; 2017
- 2 McLaren RA, Puckett JL, Chauhan SP. Estimators of birth weight in pregnant women requiring insulin: a comparison of seven sonographic models. Obstet Gynecol 1995; 85 (04) 565-569
- 3 Yee LM, Cheng YW, Inturrisi M, Caughey AB. Effect of gestational weight gain on perinatal outcomes in women with type 2 diabetes mellitus using the 2009 Institute of Medicine guidelines. Am J Obstet Gynecol 2011; 205 (03) 257.e1-257.e6
- 4 Nguyen BT, Cheng YW, Snowden JM, Esakoff TF, Frias AE, Caughey AB. The effect of race/ethnicity on adverse perinatal outcomes among patients with gestational diabetes mellitus. Am J Obstet Gynecol 2012; 207 (04) 322.e1-322.e6
- 5 Bennett SN, Tita A, Owen J, Biggio JR, Harper LM. Assessing White's classification of pregestational diabetes in a contemporary diabetic population. Obstet Gynecol 2015; 125 (05) 1217-1223
- 6 Scifres CM, Feghali M, Dumont T. , et al. Large-for-gestational-age ultrasound diagnosis and risk for cesarean delivery in women with gestational diabetes mellitus. Obstet Gynecol 2015; 126 (05) 978-986
- 7 Lavery JA, Friedman AM, Keyes KM, Wright JD, Ananth CV. Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010. BJOG 2017; 124 (05) 804-813
- 8 Bukowski R, Hansen NI, Willinger M. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Stillbirth Collaborative Research Network. Fetal growth and risk of stillbirth: a population-based case-control study. PLoS Med 2014; 11 (04) e1001633
- 9 Hansen A, Chauhan SP. Shoulder dystocia: definitions and incidence. Semin Perinatol 2014; 38 (04) 184-188
- 10 Chauhan SP, Cole J, Laye MR. , et al. Shoulder dystocia with and without brachial plexus injury: experience from three centers. Am J Perinatol 2007; 24 (06) 365-371
- 11 Freeman MD, Goodyear SM, Leith WM. A multistate population-based analysis of linked maternal and neonatal discharge records to identify risk factors for neonatal brachial plexus injury. Int J Gynaecol Obstet 2017; 136 (03) 331-336
- 12 Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 180: gestational diabetes mellitus. Obstet Gynecol 2017; 130 (01) e17-e37
- 13 ACOG Committee on Practice Bulletins. ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 60, March 2005. Pregestational diabetes mellitus. Obstet Gynecol 2005; 105 (03) 675-685
- 14 Chauhan SP, Parker D, Shields D, Sanderson M, Cole JH, Scardo JA. Sonographic estimate of birth weight among high-risk patients: feasibility and factors influencing accuracy. Am J Obstet Gynecol 2006; 195 (02) 601-606
- 15 Spellacy WN, Miller S, Winegar A, Peterson PQ. Macrosomia--maternal characteristics and infant complications. Obstet Gynecol 1985; 66 (02) 158-161
- 16 Ecker JL, Greenberg JA, Norwitz ER, Nadel AS, Repke JT. Birth weight as a predictor of brachial plexus injury. Obstet Gynecol 1997; 89 (5, Pt 1): 643-647
- 17 Boulet SL, Alexander GR, Salihu HM, Pass M. Macrosomic births in the united states: determinants, outcomes, and proposed grades of risk. Am J Obstet Gynecol 2003; 188 (05) 1372-1378
- 18 Zhang X, Decker A, Platt RW, Kramer MS. How big is too big? The perinatal consequences of fetal macrosomia. Am J Obstet Gynecol 2008; 198 (05) 517.e1-517.e6
- 19 Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982; 144 (07) 768-773
- 20 Reddy UM, Abuhamad AZ, Levine D, Saade GR. ; Fetal Imaging Workshop Invited Participants. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol 2014; 123 (05) 1070-1082
- 21 Abuhamad AZ. ; ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin, clinical management guidelines for obstetrician-gynecologists number 98, October 2008 (replaces Practice Bulletin number 58, December 2004). Ultrasonography in pregnancy. Obstet Gynecol 2008; 112 (04) 951-961
- 22 Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements--a prospective study. Am J Obstet Gynecol 1985; 151 (03) 333-337
- 23 Practice bulletin no. 145: antepartum fetal surveillance. Obstet Gynecol 2014; 124 (01) 182-192
- 24 Committee on Practice Bulletins—Obstetrics. Practice bulletin no 178: shoulder dystocia. Obstet Gynecol 2017; 129 (05) e123-e133
- 25 Adamkin DH. Neonatal hypoglycemia. Semin Fetal Neonatal Med 2017; 22 (01) 36-41
- 26 Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996; 87 (02) 163-168
- 27 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 173: fetal macrosomia. Obstet Gynecol 2016; 128 (05) e195-e209
- 28 Chiossi G, Pedroza C, Costantine MM, Truong VTT, Gargano G, Saade GR. Customized vs population-based growth charts to identify neonates at risk of adverse outcome: systematic review and Bayesian meta-analysis of observational studies. Ultrasound Obstet Gynecol 2017; 50 (02) 156-166
- 29 Jenner ZB, O'Neil Dudley AE, Mendez-Figueroa H, Ellis VS, Chen HY, Chauhan SP. Morbidity associated with fetal macrosomia among women with diabetes mellitus. Am J Perinatol 2018; 35 (05) 515-520
- 30 Heywood RE, Magann EF, Rich DL, Chauhan SP. The detection of macrosomia at a teaching hospital. Am J Perinatol 2009; 26 (02) 165-168
- 31 Sparks TN, Cheng YW, McLaughlin B, Esakoff TF, Caughey AB. Fundal height: a useful screening tool for fetal growth?. J Matern Fetal Neonatal Med 2011; 24 (05) 708-712
- 32 Endres L, DeFranco E, Conyac T. , et al; CAOG FAR Research Network. Association of fetal abdominal-head circumference size difference with shoulder dystocia: a multicenter study. AJP Rep 2015; 5 (02) e099-e104
- 33 Doty MS, Al-Hafez L, Chauhan SP. Sonographic examination of the fetus vis-à-vis shoulder dystocia: a vexing promise. Clin Obstet Gynecol 2016; 59 (04) 795-802
- 34 Chauhan SP, Lynn NN, Sanderson M, Humphries J, Cole JH, Scardo JA. A scoring system for detection of macrosomia and prediction of shoulder dystocia: a disappointment. J Matern Fetal Neonatal Med 2006; 19 (11) 699-705
- 35 Modanlou HD, Komatsu G, Dorchester W, Freeman RK, Bosu SK. Large-for-gestational-age neonates: anthropometric reasons for shoulder dystocia. Obstet Gynecol 1982; 60 (04) 417-423
- 36 Burkhardt T, Schmidt M, Kurmanavicius J, Zimmermann R, Schäffer L. Evaluation of fetal anthropometric measures to predict the risk for shoulder dystocia. Ultrasound Obstet Gynecol 2014; 43 (01) 77-82
- 37 Bahar AM. Risk factors and fetal outcome in cases of shoulder dystocia compared with normal deliveries of a similar birthweight. Br J Obstet Gynaecol 1996; 103 (09) 868-872
- 38 Pedersen J. The Pregnant Diabetic and Her Newborn. Problems and Management. Baltimore, MD: Williams & Wilkins Company; 1977
- 39 Metzger BE, Persson B, Lowe LP. , et al; HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcome study: neonatal glycemia. Pediatrics 2010; 126 (06) e1545-e1552
- 40 Metzger BE, Lowe LP, Dyer AR. , et al; HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358 (19) 1991-2002
- 41 Froehlich RJ, Sandoval G, Bailit JL. , et al; MSCE, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Association of recorded estimated fetal weight and cesarean delivery in attempted vaginal delivery at term. Obstet Gynecol 2016; 128 (03) 487-494
- 42 Chauhan SP. Shoulder dystocia and neonatal brachial plexus palsy: eliminating the nightmare. Semin Perinatol 2014; 38 (04) 183
- 43 Boulvain M, Senat MV, Perrotin F. , et al; Groupe de Recherche en Obstétrique et Gynécologie (GROG). Induction of labour versus expectant management for large-for-date fetuses: a randomised controlled trial. Lancet 2015; 385 (9987): 2600-2605
- 44 Chauhan SP, Hendrix NW, Magann EF, Morrison JC, Scardo JA, Berghella V. A review of sonographic estimate of fetal weight: vagaries of accuracy. J Matern Fetal Neonatal Med 2005; 18 (04) 211-220