Rethinking third trimester ultrasound measurements and risk of adverse neonatal outcomes in pregnancies complicated by hyperglycaemia: A retrospective study. (3rd January 2021)

• Record Type: Journal Article
• Authors: McLean, Anna; Katz, Melissa; Oats, Jeremy; Wang, Zhiqiang; Barr, Elizabeth; Maple‐Brown, Louise
• Is Part Of: Australian and New Zealand journal of obstetrics and gynaecology. Volume 61:Number 3(2021)
• Page Start: 366
• Page End: 372
• Publication Date: 2021-01-03
• Subjects: fetal macrosomia -- gestational diabetes -- infant low birth weight -- pregnancy in diabetics -- ultrasound; Obstetrics -- Periodicals; Gynecology -- Periodicals; 618.05
• DOI: 10.1111/ajo.13281
• Languages: English
• ISSNs: 0004-8666

Abstract

Abstract : Background: Antenatal ultrasound is used frequently in pregnancies complicated by hyperglycaemia; however, it is unclear which measurements have the greatest association with adverse neonatal outcomes. Aim: To assess the association between third trimester ultrasound parameters with adverse neonatal outcomes in pregnancies complicated by hyperglycaemia. Method: All pregnant women with gestational or type 2 diabetes who birthed in a regional hospital over 12 months were included. A composite adverse neonatal outcome was defined by one or more: admission to special care nursery, acidosis, hypoglycaemia, jaundice, shoulder dystocia, respiratory distress syndrome or 5‐minute Apgar score < 5. Logistic regression was used to determine odds ratios (OR) for an adverse neonatal outcome, according to pre‐specified cut points in both lower and upper percentiles of abdominal circumference (AC) and estimated fetal weight (EFW). Results: Of 275 births an adverse outcome occurred in 122 (44%). Unadjusted OR (95% CI) for AC ≤30 th was 3.2 (1.1–8.8) and >95 th percentile was 3.1 (1.5–6.0) compared with the reference group of 31–70 th percentile. Unadjusted OR for EFW ≤30 th was 1.5 (0.7–3.1) and >95 th percentile was 3.0 (1.4–6.3). After adjusting for maternal age, body mass index, diabetes type, ethnicity, gravidity, mode of delivery and gestation at birth the OR (95% CI) were as follows: AC ≤30 th percentile, 3.7 (1.1–12.4); AC >95 th, 2.2 (1.1–4.8); EFW ≤30 th, 2.6 (1.1–6.1); EFW >95 th, 2.5 (1.1–6.1). Conclusion: An AC and EFW up to the 30 th percentile may pose just as great a risk to the fetus as an AC or EFW >95 th percentile in pregnancies complicated by hyperglycaemia.