Abstract
Objectives
To explore the predictive power of measuring the abdominal fetal fat layer (FFL) as a soft tissue marker at 31, 34, and 37 weeks’ gestation to improve the detection of fetal macrosomia in pregnant women with GDM, in addition to the biometric values with close monitoring of maternal blood sugar level and BMI changes.
Methods
We conducted a prospective observational study at the Department of Obstetrics, University Hospitals, Campus Kiel, Germany, in collaboration with diabetic clinic staff. Participants underwent a third-trimester scan and extra FFL measurements were performed at 31, 34, and 37 weeks of gestation. The clinical outcomes of pregnancy and birth weight were collected from the obstetric record. All of the enrolled women had an early pregnancy ultrasound scan to confirm gestational age.
Results
The FFL at 34 and 37 weeks, with respective cutoff values of >0.48 cm and >0.59 cm, showed a very good sensitivity of 60% for both gestational points, and specificity of 89.3 and 90.6%, respectively. The probability of fetal macrosomia could be more than doubled if the FFL at 34 weeks was more than 0.48 cm. However, the probability of macrosomia dropped to 16% if the FFL was ≤0.48 cm. The median FFLs of macrosomic fetuses at 34 and 37 weeks were 0.50 (IQR 0.10) and 0.60 (IQR 0.25) cm, respectively. The mean age of the study population (n = 80) was 32.26 (SD = 5.06) years. In our study population, ten newborns were born with birth weight >4000 g. The body mass index (BMI) for the mothers of later-onset macrosomic newborns showed higher median values of 30 (IQR 8), 32 (IQR 5), and 33 (IQR 9) at 31, 34, and 37 weeks, respectively, in comparison to mothers of non-macrosomic newborn. However, the BMI did not show any statistically significant difference from those with normal-weight newborn and did not show any specific sensitivity for predicting macrosomia.
Conclusion
Measuring the FFL at 34 and 37 weeks of gestation, in addition to the standard measurement, might be useful for predicting macrosomia and is worth further evaluation.
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Acknowledgements
We thank Professor Walter Jonat for his valuable contribution to the manuscript.
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Mohamed Elessawy: protocol/project development, data collection and management, data analysis, and manuscript writing/editing. Christina Harders: protocol/project development. Helmut Kleinwechter: data collection or management. Norbert Demandt: data collection or management. Ghada Abu Sheasha: data analysis. Nicolai Maass: protocol/project development. Ulrich Pecks: manuscript writing/editing. Christel Eckmann-Scholz: protocol/project development, manuscript editing, and data analysis.
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All authors indicate they have no financial relationship with the organization and did not receive any sponsorship for the research. We also state that we have had full control of all primary data and agree to allow the journal to review the data if requested. Mohamed Elessawy declares that he has no conflict of interest. Christina Harders declares that she has no conflict of interest. Helmut Kleinwechter declares that he has no conflict of interest. Norbert Demandt declares that he has no conflict of interest. Ghada Abu Sheasha declares that she has no conflict of interest. Nicolai Maass declares that he has no conflict of interest. Ulrich Pecks declares that he has no conflict of interest. Christel Eckmann-Scholz declares that she has no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Elessawy, M., Harders, C., Kleinwechter, H. et al. Measurement and evaluation of fetal fat layer in the prediction of fetal macrosomia in pregnancies complicated by gestational diabetes. Arch Gynecol Obstet 296, 445–453 (2017). https://doi.org/10.1007/s00404-017-4433-6
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DOI: https://doi.org/10.1007/s00404-017-4433-6