Maternal Body Mass Index: A Poor Diagnostic Test for Detection of Abnormal Fetal Growths

Suneet P. Chauhan; Everett F. Magann; Yueqin Zhao; Jennifer M. Klimpel; Jacob A. Brown; John C. Morrison

doi:10.1055/s-0031-1280859

American Journal of Perinatology, Table of Contents

Am J Perinatol 2011; 28(10): 773-780
DOI: 10.1055/s-0031-1280859

Maternal Body Mass Index: A Poor Diagnostic Test for Detection of Abnormal Fetal Growths

Suneet P. Chauhan¹ , Everett F. Magann² , Yueqin Zhao¹ , Jennifer M. Klimpel³ , Jacob A. Brown³ , John C. Morrison⁴

¹Eastern Virginia Medical School, Norfolk, Virginia
²University of Arkansas, Little Rock, Arkansas
³Naval Hospital, Portsmouth, Virginia
⁴University of Mississippi, Jackson, Mississippi

Abstract

ABSTRACT

We sought to determine if maternal body mass index (BMI; kg/m²) identifies newborns with abnormal fetal growth (small for gestational age [SGA], large for gestational age [LGA], or macrosomia) at ≥37 weeks. Singletons with reliable gestational age and without diabetes or hypertension were analyzed. Areas under the receiver-operating characteristic (AUC) curves were calculated for BMI (first visit, delivery, and the change during pregnancy) to identify abnormal growth. If the AUC was ≤0.75 then the diagnostic test was not useful. Among 3582 cohorts, SGA occurred in 10%, LGA in 9%, and 11% were macrosomic. AUC indicates that BMI at delivery is significantly better than BMI at first visit for identification of aberrant growth, but their AUCs were less than 0.75, indicating it is not a useful diagnostic test. Maternal BMIs (at first visit, delivery, or the change during pregnancy) are poor predictors of abnormal fetal growth.

KEYWORDS

Body mass index - large for gestational age - macrosomia - small for gestational age

Full Text

References

REFERENCES

1 American College of Obstetricians and Gynecologists .Intrauterine Growth Restriction. Washington DC: American College of Obstetricians and Gynecologists; 2000
2 Seeds J W, Peng T C. Does augmented growth impose an increased risk of fetal death?. Am J Obstet Gynecol. 2000; 183 316-322 discussion 322-323
3 Boulet S L, Alexander G R, Salihu H M, Pass M A. Macrosomic births in the united states: determinants, outcomes, and proposed grades of risk. Am J Obstet Gynecol. 2003; 188 1372-1378
4 Chauhan S P, Grobman W A, Gherman R A et al.. Suspicion and treatment of the macrosomic fetus: a review. Am J Obstet Gynecol. 2005; 193 332-346
5 American College of Obstetricians and Gynecologists .Fetal Macrosomia. ACOG Practice Bulletin No. 22. Washington DC: ACOG; 2000
6 Chauhan S P, Sullivan C A, Lutton T C, Magann E F, Morrison J C. Parous patients' estimate of birth weight in postterm pregnancy. J Perinatol. 1995; 15 192-194
7 Royal College of Obstetricians and Gynecologists .The Investigation and Management of the Small-for-Gestational-Age Fetus. London: Royal College of Obstetricians and Gynecologists; 2002
8 Chauhan S P, Hendrix N W, Magann E F, Morrison J C, Kenney S P, Devoe L D. Limitations of clinical and sonographic estimates of birth weight: experience with 1034 parturients. Obstet Gynecol. 1998; 91 72-77
9 Chauhan S P, Magann E F. Screening for fetal growth restriction. Clin Obstet Gynecol. 2006; 49 284-294
10 Gillean J R, Coonrod D V, Russ R, Bay R C. Big infants in the neonatal intensive care unit. Am J Obstet Gynecol. 2005; 192 1948-1953 discussion 1953-1955
11 National Institutes of Health . National Heart, Lung, and Blood Institute (NHLBI) and National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK). Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults. The evidence report. Obes Res. 1998; 6 (Suppl 2) 51S-209S
12 Cnattingius S, Bergström R, Lipworth L, Kramer M S. Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med. 1998; 338 147-152
13 Cheng C J, Bommarito K, Noguchi A, Holcomb W, Leet T. Body mass index change between pregnancies and small for gestational age births. Obstet Gynecol. 2004; 104 286-292
14 Leung T Y, Leung T N, Sahota D S et al.. Trends in maternal obesity and associated risks of adverse pregnancy outcomes in a population of Chinese women. BJOG. 2008; 115 1529-1537
15 Surkan P J, Hsieh C C, Johansson A L, Dickman P W, Cnattingius S. Reasons for increasing trends in large for gestational age births. Obstet Gynecol. 2004; 104 720-726
16 Ehrenberg H M, Mercer B M, Catalano P M. The influence of obesity and diabetes on the prevalence of macrosomia. Am J Obstet Gynecol. 2004; 191 964-968
17 American College of Obstetricians and Gynecologists .Obesity in Pregnancy. Committee opinion 315. Washington DC: ACOG; 2005
18 Alexander G R, Himes J H, Kaufman R B, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol. 1996; 87 163-168
19 Jaeschke R, Guyatt G H, Sackett D L. Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA. 1994; 271 703-707
20 Fan J, Upadhye S, Worster A. Understanding receiver operating characteristic (ROC) curves. CJEM. 2006; 8 19-20
21 DeLong E R, DeLong D M, Clarke-Pearson D L. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44 837-845
22 Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J. 2005; 47 458-472
23 Farmer R M, Medearis A L, Hirata G I, Platt L D. The use of a neural network for the ultrasonographic estimation of fetal weight in the macrosomic fetus. Am J Obstet Gynecol. 1992; 166 1467-1472
24 Johnson J M, Chauhan S P, Ennen C S, Niederhauser A, Magann E F. A comparison of 3 criteria of oligohydramnios in identifying peripartum complications: a secondary analysis. Am J Obstet Gynecol. 2007; 197 207 e1-e7 discussion 207 e7-e8
25 Ghosh G S, Gudmundsson S. Uterine and umbilical artery Doppler are comparable in predicting perinatal outcome of growth-restricted fetuses. BJOG. 2009; 116 424-430
26 Chauhan S P, Sullivan C A, Lutton T C, Magann E F, Morrison J C. Parous patients' estimate of birth weight in postterm pregnancy. J Perinatol. 1995; 15 192-194
27 Hassibi S, Farhataziz N, Zaretsky M, McIntire D, Twickler D M. Optimization of fetal weight estimates using MRI: comparison of acquisitions. AJR Am J Roentgenol. 2004; 183 487-492
28 Chauhan S P, Magann E F, Carroll C S, Barrilleaux P S, Scardo J A, Martin Jr J N. Mode of delivery for the morbidly obese with prior cesarean delivery: vaginal versus repeat cesarean section. Am J Obstet Gynecol. 2001; 185 349-354
29 Chu S Y, Callaghan W M, Bish C L, D'Angelo D. Gestational weight gain by body mass index among US women delivering live births, 2004–2005: fueling future obesity. Am J Obstet Gynecol. 2009; 200 271 e1-e7

Suneet P ChauhanM.D.

Eastern Virginia Medical School, 825 Fairfax Avenue

Suite 544, Norfolk, VA 23507

Email: chauhasp@evms.edu