Release date: 2015-10-19

It is very common for pregnant women with diabetes to have too much amniotic fluid and too large a fetus. For the evaluation of the fetus, because it is in the belly of the pregnant woman, only the fetal condition is seen by B-ultrasound, and the fetal growth and development is evaluated according to the detection index under the two-dimensional condition. Ultrasound assessment of fetal weight affects the choice of delivery methods for pregnant women.
Scifres CM et al. conducted a study to evaluate the accuracy of fetal ultrasound diagnosis of “larger than gestational age (lga)” for pregnant women with gestational diabetes and the risk of subsequent cesarean delivery due to this diagnosis.

The investigators conducted a retrospective cohort study of 903 pregnant women with GDM. All subjects gave birth after 36 weeks of gestation and underwent ultrasound examination within 31 days of delivery.

The investigators divided the subjects into two groups based on whether the ultrasound was diagnosed as LGA, and the results were compared between the two groups.

Based on an ultrasound-based assessment, the researchers found 248 suspected LGA pregnant women and 655 non-LGA pregnant women. In the LGA group, 56/248 (22.6%) of the newborns were LGA at delivery; in the non-LGA group, 18/655 (2.8%) of the newborns were LGA after delivery.

After adjusting for relevant confounding factors, the investigators found that ultrasound diagnosis of “LGA” increased the risk of cesarean section (aOR 3.13, 95% CI 2.10-4.67, P<.001).

A stratified analysis based on neonatal birth weight found that regardless of birth weight in the range of 2500-3499g or between 3500-4500g, the diagnosis of "LGA" under ultrasound examination would increase the risk of cesarean section: 2500-3499g (OR 2.82, 95% CI 1.62-4.84, P<.001); 3500-4500g (OR 3.47, 95% CI 2.06-5.88, P<.001).

The results of the study showed that for pregnant women with gestational diabetes mellitus (GDM), ultrasound over-diagnosis is greater than the incidence of gestational age (LGA) and overestimation of LGA. Ultrasound diagnosis of "LGA" increases the risk of cesarean delivery in pregnant women, and the risk of this increase remains regardless of the birth weight of the newborn.

Source: MedSci

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