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Fetal overgrowth in pregnancies complicated by diabetes: validation of a predictive index in an external cohort

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To assess validity of a fetal overgrowth index in an external cohort of women with diabetes in pregnancy

Methods

We performed a retrospective analysis of data derived from women with singleton gestations complicated by diabetes who delivered January 2015–June 2018. The following index variables were used to calculate risk of fetal overgrowth as defined by a customized birthweight ≥ 90th centile: age, history of fetal overgrowth in a prior pregnancy, gestational weight gain, fetal abdominal circumference measurement and fasting glucose between 24 and 30 weeks.

Results

In our validation cohort, 21% of 477 pregnancies were complicated by fetal overgrowth. The predictive index had a bias-corrected bootstrapped area under receiver operating characteristic curve of 0.90 (95% CI 0.86–0.93). 55% of the cohort had a low-risk index (≤ 3) which had a negative predictive value of 97% (95% CI 94–98%), while 18% had a high-risk index (≥ 8) that had a positive predictive value of 74% (95% CI 66–81%).

Conclusion

The fetal overgrowth index incorporates five factors that are widely available in daily clinical practice prior to the period of maximum fetal growth velocity in the third trimester. Despite substantial differences between our cohort and the one studied for model development, we found the performance of the index was strong. This finding lends support for the general use of this tool that may aid counseling and allow for targeted allocation of healthcare resources among women with pregnancies complicated by diabetes.

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Availability of data/material

The minimal data set underlying the findings in our study data is within the paper.

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Funding

No financial support from any sponsors of any kind was used in the collection, analysis, interpretation of the data, or manuscript preparation.

Author information

Authors and Affiliations

  1. Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Women’s Health, Saint Louis University School of Medicine, 6420 Clayton Road, Suite 2800, Saint Louis, MO, 63117, USA

    Tracy M. Tomlinson, Alexandra M. Johnson, Alexandra M. Edwards, Gilad A. Gross & Dorothea J. Mostello

Authors
  1. Tracy M. Tomlinson
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  2. Alexandra M. Johnson
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  3. Alexandra M. Edwards
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  4. Gilad A. Gross
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  5. Dorothea J. Mostello
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Contributions

TMT: Protocol/project development, data collection/management, data analysis, manuscript writing/editing; AMJ: data collection/management, manuscript writing/editing; AME: data collection/management, manuscript writing/editing; GAG: manuscript writing/editing; DJM: manuscript writing/editing.

Corresponding author

Correspondence to Tracy M. Tomlinson.

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Conflict of interest

The authors declare that they have no conflicts of interest or competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research. This study was approved by the Saint Louis University Institutional Review Board (no. 29480).

Consent to participate/Consent for publication

For this type of study formal consent is not required. A waiver of consent was approved, because the study involved validation of a prediction index using anonymized medical chart data that had been routinely collected. The only risk to patients was potential breach of confidentiality which was minimized by use of a password-protected database and a code to protect patient confidentiality. The key to the code was kept separate from the data and destroyed at the completion of the data analysis.

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Tomlinson, T.M., Johnson, A.M., Edwards, A.M. et al. Fetal overgrowth in pregnancies complicated by diabetes: validation of a predictive index in an external cohort. Arch Gynecol Obstet 303, 877–884 (2021). https://doi.org/10.1007/s00404-020-05768-z

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  • DOI: https://doi.org/10.1007/s00404-020-05768-z

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