Download PDF
Am J Perinatol 2025; 42(08): 1059-1065
DOI: 10.1055/a-2460-5846
Original Article

Fetal Growth Ultrasound in Obese Patients for the Detection of Growth Abnormalities

Juliana G. Martins 
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Elizabeth Miller
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Rebecca Horgan 
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Tetsuya Kawakita 
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
› Author Affiliations
Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective

This study aimed to examine the impact of maternal obesity on fetal growth abnormalities including fetal growth restriction (FGR) and large for gestational age (LGA) fetuses.

Study Design

Secondary analysis from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). The study excluded individuals with pregestational or gestational diabetes, chronic hypertension, and other major maternal medical conditions. First-trimester ultrasound was performed to establish accurate dating criteria. Ultrasound assessments were performed at 16 to 21 and 22 to 29 weeks of gestation. Our exposure was the presence of prepregnancy obesity. Our primary outcome was rates of fetal growth abnormalities identified by ultrasound, defined as FGR (estimated fetal weight [EFW] or abdominal circumference <10th percentile) or LGA (EFW >90th percentile) among obese compared with nonobese women. A secondary analysis was performed after limiting ultrasound performed from 28 to 29 weeks. To estimate adjusted relative risks (aRRs) with 95% confidence intervals (95% CIs), we used generalized linear models with Poisson distribution and log link using robust error variance, adjusting for the predefined covariates.

Results

Of 7,354 participants, 1,443 (19.6%) had prepregnancy obesity while 5,911 (80.4%) did not. Prepregnancy obesity compared with normal weight was associated with an increased risk of fetal growth abnormalities both at 16 to 21 weeks (16.0 vs. 13.2%; aRR = 1.23; 95% CI: 1.06–1.42) and 22 to 29 weeks (16.0 vs. 12.1%; aRR = 1.33; 95% CI: 1.14–1.54). Furthermore, prepregnancy obesity compared with normal weight was associated with an increased risk of LGA both at 16 to 21 weeks (12.5 vs. 10.3%; aRR = 1.24; 95% CI: 1.05–1.47) and 22 to 29 weeks (10.6 vs. 6.9%; aRR = 1.66; 95% CI: 1.38–2.01). In a secondary analysis limited to the ultrasound at 28 to 29 weeks, both fetal growth abnormalities and LGA were associated with the presence of obesity. In any of the analyses, prepregnancy obesity was not associated with FGR compared with normal weight.

Conclusion

Maternal obesity is associated with an increased risk of fetal growth abnormalities and LGA fetuses.

Key Points

  • Obesity is associated with increased LGA risk.

  • Association between obesity and FGR remains unclear.

  • Ultrasound is effective in obese women to detect fetal growth abnormalities.

  • Future research is needed to assess the association between obesity and FGR.

Keywords

fetal growth - ultrasound - maternal obesity - large for gestational age - fetal growth restriction

Supplementary Material



Publication History

Received: 18 July 2024

Accepted: 03 November 2024

Accepted Manuscript online:
04 November 2024

Article published online:
25 November 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins–Obstetrics. Obesity in pregnancy: ACOG Practice Bulletin, Number 230. Obstet Gynecol 2021; 137 (06) e128-e144
    CrossrefPubMedSearch in Google Scholar
  • 2 Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 2009; 301 (06) 636-650
    CrossrefPubMedSearch in Google Scholar
  • 3 Racusin D, Stevens B, Campbell G, Aagaard KM. Obesity and the risk and detection of fetal malformations. Semin Perinatol 2012; 36 (03) 213-221
    CrossrefPubMedSearch in Google Scholar
  • 4 Aagaard-Tillery KM, Flint Porter T, Malone FD. et al. Influence of maternal BMI on genetic sonography in the FaSTER trial. Prenat Diagn 2010; 30 (01) 14-22
    CrossrefPubMedSearch in Google Scholar
  • 5 Kelly AC, Powell TL, Jansson T. Placental function in maternal obesity. Clin Sci (Lond) 2020; 134 (08) 961-984
    CrossrefPubMedSearch in Google Scholar
  • 6 Battarbee AN, Sinkey RG, Harper LM, Oparil S, Tita ATN. Chronic hypertension in pregnancy. Am J Obstet Gynecol 2020; 222 (06) 532-541
    CrossrefPubMedSearch in Google Scholar
  • 7 Ye W, Luo C, Huang J, Li C, Liu Z, Liu F. Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 2022; 377: e067946
    CrossrefPubMedSearch in Google Scholar
  • 8 American College of Obstetricians and Gynecologists. Macrosomia: ACOG Practice Bulletin, Number 216. Obstet Gynecol 2020; 135 (01) e18-e35
    CrossrefPubMedSearch in Google Scholar
  • 9 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics and the Society forMaternal-FetalMedicin. ACOG Practice Bulletin No. 204: Fetal growth restriction. Obstet Gynecol 2019; 133 (02) e97-e109
    CrossrefPubMedSearch in Google Scholar
  • 10 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
    CrossrefPubMedSearch in Google Scholar
  • 11 Eunice Kennedy Shriver National Institute of Child Health and Human Development. Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). Accessed November 8, 2024 at: https://www.nichd.nih.gov/ https://www.nichd.nih.gov/research/supported/nuMoM2b
    PubMed
  • 12 Hadlock FP, Deter RL, Harrist RB, Park SK. Estimating fetal age: computer-assisted analysis of multiple fetal growth parameters. Radiology 1984; 152 (02) 497-501
    CrossrefPubMedSearch in Google Scholar
  • 13 Hadlock FP. Sonographic estimation of fetal age and weight. Radiol Clin North Am 1990; 28 (01) 39-50
    CrossrefPubMedSearch in Google Scholar
  • 14 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
    CrossrefPubMedSearch in Google Scholar
  • 15 Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991; 181 (01) 129-133
    CrossrefPubMedSearch in Google Scholar
  • 16 Aris IM, Kleinman KP, Belfort MB, Kaimal A, Oken E. A 2017 US reference for singleton birth weight percentiles using obstetric estimates of gestation. Pediatrics 2019; 144 (01) e20190076
    CrossrefPubMedSearch in Google Scholar
  • 17 DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988; 44 (03) 837-845
    CrossrefPubMedSearch in Google Scholar
  • 18 Zhang C, Hediger ML, Albert PS. et al. Association of maternal obesity with longitudinal ultrasonographic measures of fetal growth. JAMA Pediatr 2018; 172 (01) 24-31
    CrossrefPubMedSearch in Google Scholar
  • 19 Ehrenberg HM, Mercer BM, Catalano PM. The influence of obesity and diabetes on the prevalence of macrosomia. Am J Obstet Gynecol 2004; 191 (03) 964-968
    CrossrefPubMedSearch in Google Scholar
  • 20 Kirchengast S, Hartmann B. Maternal prepregnancy weight status and pregnancy weight gain as major determinants for newborn weight and size. Ann Hum Biol 1998; 25 (01) 17-28
    CrossrefPubMedSearch in Google Scholar
  • 21 Shapiro C, Sutija VG, Bush J. Effect of maternal weight gain on infant birth weight. J Perinat Med 2000; 28 (06) 428-431
    CrossrefPubMedSearch in Google Scholar
  • 22 Kanadys WM. Prepregnancy body mass, gestational weight gain and birth weight [in Polish]. Ginekol Pol 1998; 69 (12) 1223-1227
    PubMedSearch in Google Scholar
  • 23 Sun B, Li J, Song Q. Influence of prepregnancy weight and maternal weight gain on pregnancy outcome [in Chinese]. Zhonghua Fu Chan Ke Za Zhi 1998; 33 (02) 71-73
    PubMedSearch in Google Scholar
  • 24 Tenenbaum-Gavish K, Hod M. Impact of maternal obesity on fetal health. Fetal Diagn Ther 2013; 34 (01) 1-7
    CrossrefPubMedSearch in Google Scholar
  • 25 Tanner LD, Brock And C, Chauhan SP. Severity of fetal growth restriction stratified according to maternal obesity. J Matern Fetal Neonatal Med 2022; 35 (10) 1886-1890
    CrossrefPubMedSearch in Google Scholar
  • 26 Lewandowska M. Maternal obesity and risk of low birth weight, fetal growth restriction, and macrosomia: multiple analyses. Nutrients 2021; 13 (04) 1213
    CrossrefPubMedSearch in Google Scholar
  • 27 Radulescu L, Munteanu O, Popa F, Cirstoiu M. The implications and consequences of maternal obesity on fetal intrauterine growth restriction. J Med Life 2013; 6 (03) 292-298
    PubMedSearch in Google Scholar
  • 28 Yu Z, Han S, Zhu J, Sun X, Ji C, Guo X. Prepregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analysis. PLoS One 2013; 8 (04) e61627
    CrossrefPubMedSearch in Google Scholar
  • 29 Catalano PM, Ehrenberg HM. The short- and long-term implications of maternal obesity on the mother and her offspring. BJOG 2006; 113 (10) 1126-1133
    CrossrefPubMedSearch in Google Scholar
  • 30 Martins JG, Kawakita T, Gurganus M. et al. Influence of maternal body mass index on interobserver variability of fetal ultrasound biometry and amniotic-fluid assessment in late pregnancy. Ultrasound Obstet Gynecol 2021; 58 (06) 892-899
    CrossrefPubMedSearch in Google Scholar
  • 31 Gevaerd Martins J, Kawakita T, Jain P. et al. Impact of maternal body mass index on the accuracy of third trimester sonographic estimation of fetal weight. Arch Gynecol Obstet 2023; 307 (02) 395-400
    CrossrefPubMedSearch in Google Scholar