McLean A; Katz M; Oats J; Wang Z; Barr E; Maple-Brown, Louise

Author(s)

McLean A

Katz M

Oats J

Wang Z

Barr E

Maple-Brown, Louise

Publication Date

2021-01-03

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.

Affiliation

Department of Endocrinology, Cairns Diabetes Centre, Cairns, Queensland, Australia.

Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.

Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.

Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.

Citation

Aust N Z J Obstet Gynaecol . 2021 Jun;61(3):366-372. doi: 10.1111/ajo.13281. Epub 2021 Jan 3.

OrcId

0000-0001-5578-0188

Pubmed ID

https://pubmed.ncbi.nlm.nih.gov/33389751/?otool=iaurydwlib

Link

https://hdl.handle.net/10137/11616

Title

Rethinking third trimester ultrasound measurements and risk of adverse neonatal outcomes in pregnancies complicated by hyperglycaemia: A retrospective study.

Type of document

Journal Article

Entity Type

Publication

Author(s)	McLean A Katz M Oats J Wang Z Barr E Maple-Brown, Louise
Publication Date	2021-01-03
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.
Affiliation	Department of Endocrinology, Cairns Diabetes Centre, Cairns, Queensland, Australia. Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Citation	Aust N Z J Obstet Gynaecol . 2021 Jun;61(3):366-372. doi: 10.1111/ajo.13281. Epub 2021 Jan 3.
OrcId	0000-0001-5578-0188
Pubmed ID	https://pubmed.ncbi.nlm.nih.gov/33389751/?otool=iaurydwlib
Link	https://hdl.handle.net/10137/11616
Title	Rethinking third trimester ultrasound measurements and risk of adverse neonatal outcomes in pregnancies complicated by hyperglycaemia: A retrospective study.
Type of document	Journal Article
Entity Type	Publication

Rethinking third trimester ultrasound measurements and risk of adverse neonatal outcomes in pregnancies complicated by hyperglycaemia: A retrospective study.

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