The Diagnostic Utility of Growth Ultrasound for the Indication of Maternal Overweight or Obesity

 

 Buy Article Permissions and Reprints

Abstract

Objective The objective of this study was to evaluate the diagnostic utility of serial growth ultrasounds for the indication of maternal overweight or obesity.

Study Design This is a retrospective cohort study of all women with a body mass index ≥25 kg/m² who underwent at least one growth ultrasound at ≥24 weeks gestation and delivered at a single tertiary care institution between January 2010 and December 2013. Women were excluded if they had other medical indications for growth ultrasounds. Ultrasounds were divided into three gestational age epochs: 24 to 31^6/7 weeks, 32 to 35^6/7 weeks, and ≥36 weeks. Outcomes examined included the accuracy of sonographic detection of fetal growth restriction (FGR) and fetal overgrowth compared with diagnoses of small for gestational age (SGA) and large for gestational age (LGA) based on the birth weight. The test characteristics of ultrasound and the number needed to screen (NNS) to detect growth abnormalities at the time of birth were estimated for each condition and gestational age epoch. The NNS for the detection of fluid abnormalities was also assessed.

Results During the study period, 3,945 eligible sonograms were performed in 2,928 women. FGR was identified on ultrasound in 42 (1.4%) women, fetal overgrowth in 94 (3.2%) women, oligohydramnios in 35 (1.2%) women, and hydramnios in 41 (1.4%) women. The NNS for the diagnoses of SGA, LGA, oligohydramnios, and hydramnios at delivery was at least 137 prior to 32 weeks of gestation and decreased (i.e., at least 45 and 16, for 32 to 35^6/7 weeks and ≥36 weeks, respectively) with advancing gestational age epochs.

Conclusion If growth ultrasounds are to be performed for the sole indication of maternal overweight or obesity, consideration should be given to delaying initiation until at least 32 weeks of gestation given the infrequency of growth and fluid abnormalities identified earlier.

Key Points

• There are limited data to support serial growth ultrasounds in overweight and obese women.

• The sensitivity of ultrasound for growth abnormalities at <32 weeks is low in women with BMI ≥25

• Consideration should be given to delaying initiation of growth ultrasounds until at least 32 weeks

Note

Presented at the 38th Annual Meeting of the Society for Maternal-Fetal Medicine in Dallas, TX, (January 2018) as a poster presentation.

Publication History

Received: 01 February 2021

Accepted: 17 January 2022

Accepted Manuscript online:
19 January 2022

Article published online:
24 February 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

• References

• 1 Reece EA. Perspectives on obesity, pregnancy and birth outcomes in the United States: the scope of the problem. Am J Obstet Gynecol 2008; 198 (01) 23-27
  CrossrefPubMedGoogle Scholar
• 2 Office of the Surgeon General (US), Office of Disease Prevention and Health Promotion (US), Centers for Disease Control and Prevention (US), National Institutes of Health (US). The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity. Rockville, MD: Office of the Surgeon General (US); 2001
  Google Scholar
• 3 Radulescu L, Munteanu O, Popa F, Cirstoiu M. The implications and consequences of maternal obesity on fetal intrauterine growth restriction. J Med Life 2013; 6 (03) 292-298
  PubMedGoogle Scholar
• 4 Frederick IO, Williams MA, Sales AE, Martin DP, Killien M. Pre-pregnancy body mass index, gestational weight gain, and other maternal characteristics in relation to infant birth weight. Matern Child Health J 2008; 12 (05) 557-567
  CrossrefPubMedGoogle Scholar
• 5 American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 134: fetal growth restriction. Obstet Gynecol 2013; 121 (05) 1122-1133
  CrossrefPubMedGoogle Scholar
• 6 Farrell T, Holmes R, Stone P. The effect of body mass index on three methods of fetal weight estimation. BJOG 2002; 109 (06) 651-657
  CrossrefPubMedGoogle Scholar
• 7 Harper LM, Jauk VC, Owen J, Biggio JR. The utility of ultrasound surveillance of fluid and growth in obese women. Am J Obstet Gynecol 2014; 211 (05) 524.e1-524.e8
  CrossrefPubMedGoogle Scholar
• 8 Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991; 181 (01) 129-133
  Google Scholar
• 9 Lubchenco LO, Hansman C, Boyd E. Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks. Pediatrics 1966; 37 (03) 403-408
  CrossrefPubMedGoogle Scholar
• 10 American College of Obstetricians and Gynecologists. Practice Bulletin No. 175:ultrasound in pregnancy. Obstet Gynecol 2016; 128 (06) e241-e256
  CrossrefPubMedGoogle Scholar
• 11 Gunatilake RP, Perlow JH. Obesity and pregnancy: clinical management of the obese gravida. Am J Obstet Gynecol 2011; 204 (02) 106-119
  CrossrefPubMedGoogle Scholar
• 12 Hinkle SN, Sharma AJ, Dietz PM. Gestational weight gain in obese mothers and associations with fetal growth. Am J Clin Nutr 2010; 92 (03) 644-651
  CrossrefPubMedGoogle Scholar
• 13 Ehrenberg HM, Mercer BM, Catalano PM. The influence of obesity and diabetes on the prevalence of macrosomia. Am J Obstet Gynecol 2004; 191 (03) 964-968
  CrossrefPubMedGoogle Scholar
• 14 Caughey AB. How best to diagnose and treat the small-for-gestational-age fetus. Am J Obstet Gynecol 2013; 209 (05) 397-399
  CrossrefPubMedGoogle Scholar
• 15 Yao R, Park BY, Caughey AB. The effects of maternal obesity on perinatal outcomes among those born small for gestational age. J Matern Fetal Neonatal Med 2017; 30 (12) 1417-1422
  CrossrefPubMedGoogle Scholar