Talk:Birth - Macrosomia
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Cite this page: Hill, M.A. (2024, May 6) Embryology Birth - Macrosomia. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Talk:Birth_-_Macrosomia |
2011
Maternal serum adiponectin at 11 to 13 weeks of gestation in the prediction of macrosomia
Prenat Diagn. 2011 May;31(5):479-83. doi: 10.1002/pd.2723. Epub 2011 Mar 10.
Nanda S, Akolekar R, Sarquis R, Mosconi AP, Nicolaides KH. Source Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK. Abstract OBJECTIVE: To examine the potential role of maternal serum level of adiponectin in the first trimester of pregnancy in the prediction of neonatal macrosomia. METHODS: Maternal serum adiponectin concentration was measured in a case-control study of singleton pregnancies at 11 to 13 weeks' gestation, which included 50 cases that subsequently delivered macrosomic neonates with birth weight above the 95th percentile for gestation at delivery and 300 controls who delivered appropriate for gestational age neonates. The median multiple of the median (MoM) serum adiponectin in the two outcome groups was compared and the bivariate Gaussian distributions were simulated in a screened population of 33 344 pregnancies to estimate the performance of screening for macrosomia by a combination of maternal characteristics and obstetric history with serum adiponectin. RESULTS: In the macrosomic group the median serum adiponectin [0.82, interquartile range (IQR): 0.56-1.02 MoM] was significantly lower than in the non-macrosomic controls (1.02, IQR: 0.70-1.29 MoM; p = 0.001). The estimated detection rate of macrosomia, at fixed false positive rate of 10%, from maternal characteristics and obstetric history was 34.6% and this increased to 38.2% with the addition of serum adiponectin. CONCLUSION: Maternal serum adiponectin at 11 to 13 weeks is a useful biomarker for early prediction of macrosomia. Copyright © 2011 John Wiley & Sons, Ltd.
PMID 21394735
Effect of screening and management of diabetes during pregnancy on stillbirths
BMC Public Health. 2011 Apr 13;11 Suppl 3:S2.
Syed M, Javed H, Yakoob MY, Bhutta ZA.
Source
Division of Women & Child Health, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, Pakistan.
Abstract
BACKGROUND:
Diabetes during pregnancy is associated with significant risk of complications to the mother, fetus and newborn. We reviewed the potential impact of early detection and control of diabetes mellitus during pregnancy on stillbirths for possible inclusion in the Lives Saved Tool (LiST).
METHODS:
A systematic literature search up to July 2010 was done to identify all published randomized controlled trials and observational studies. A standardized data abstraction sheet was employed and data were abstracted by two independent authors. Meta-analyses were performed with different sub-group analyses. The analyses were graded according to the CHERG rules using the adapted GRADE criteria and recommendations made after assessing the overall quality of the studies included in the meta-analyses.
RESULTS:
A total of 70 studies were selected for data extraction including fourteen intervention studies and fifty six observational studies. No randomized controlled trials were identified evaluating early detection of diabetes mellitus in pregnancy versus standard screening (glucose challenge test between 24th to 28th week of gestation) in pregnancy. Intensive management of gestational diabetes (including specialized dietary advice, increased monitoring and tailored dietary therapy) during pregnancy (3 studies: 3791 participants) versus conventional management (dietary advice and insulin as required) was associated with a non-significant reduction in the risk of stillbirths (RR 0.20; 95% CI: 0.03-1.10) ('moderate' quality evidence). Optimal control of serum blood glucose versus sub-optimal control was associated with a significant reduction in the risk of perinatal mortality (2 studies, 5286 participants: RR = 0.40, 95% CI 0.25- 0.63), but not stillbirths (3 studies, 2469 participants: RR = 0.51, 95% CI 0.14-1.88). Preconception care of diabetes (information about need for optimization of glycemic control before pregnancy, assessment of diabetes complications, review of dietary habits, intensification of capillary blood glucose self-monitoring and optimization of insulin therapy) versus none (3 studies: 910 participants) was associated with a reduction in perinatal mortality (RR = 0.29, 95% CI 0.14 -0.60). Using the Delphi process for estimating effect size of optimal diabetes recognition and management yielded a median effect size of 10% reduction in stillbirths.
CONCLUSIONS:
Diabetes, especially pre-gestational diabetes with its attendant vascular complications, is a significant risk factor for stillbirth and perinatal death. Our review highlights the fact that very few studies of adequate quality are available that can provide estimates of the effect of screening for aid management of diabetes in pregnancy on stillbirth risk. Using the Delphi process we recommend a conservative 10% reduction in the risk of stillbirths, as a point estimate for inclusion in the LiST.
PMID 21501437
2010
Birth-weight prediction by two- and three-dimensional ultrasound imaging
Ultrasound Obstet Gynecol. 2010 Apr;35(4):426-33.
Bennini JR, Marussi EF, Barini R, Faro C, Peralta CF. Source Department of Obstetrics and Gynecology, Center for Integral Assistance to Women's Health, State University of Campinas Medical School, Campinas, Brazil.
Abstract
OBJECTIVES: To compare the accuracies of birth-weight predicting models derived from two-dimensional (2D) ultrasound parameters and from total fetal thigh volumes measured by three-dimensional (3D) ultrasound imaging; and to compare the performances of these formulae with those of previously published equations. METHODS: A total of 210 patients were evaluated to create a formula-generating group (n = 150) and a prospective-validation group (n = 60). Polynomial regression analysis was performed on the first group to generate one equation based on 2D ultrasound measurements, one based on fetal thigh volume measured by the multiplanar technique (ThiM) and one based on fetal thigh volume obtained by the Virtual Organ Computer-aided AnaLysis (VOCAL()) method (ThiV). Paired-samples t-tests with Bonferroni adjustments were used to compare the performances of these equations in the formula-finding and the prospective-validation groups. The same approach was used to compare the accuracies of the new 2D and 3D formulae with those of both original and modified 2D equations from previous publications, as well as the 3D model reported by Chang et al. RESULTS: The formulae with the best fit for the prediction of birth weight were: estimated fetal weight (EFW) = - 562.824 + 11.962x AC x FDL + 0.009 x BPD(2)x AC(2) (where AC is abdominal circumference, FDL is femur diaphysis length and BPD is biparietal diameter), EFW = 1033.286 + 12.733 x ThiM, and EFW = 1025.383 + 12.775 x ThiV. For both the formula-generating and the prospective-validation groups, there were no significant differences between the accuracies of the new 2D and 3D models in the prediction of birth weight. When applied to our population, the performances of the modified and original versions of the previously published 2D equations and the performance of the original 3D formula reported by Chang et al. were all significantly worse than our models. CONCLUSIONS: We believe that the greatest sources of discrepancy in estimation of birth weight are the phenotypic differences among patients used to create each of the formulae mentioned in this study. Our data reinforce the need for customized birth-weight prediction formulae, regardless of whether 2D or 3D measurements are employed. Copyright 2009 ISUOG. Published by John Wiley & Sons, Ltd.
PMID 20069666
2010
Macrosomia: a new formula for optimized fetal weight estimation
Ultrasound Obstet Gynecol. 2010 Jan;35(1):42-7.
Hart NC, Hilbert A, Meurer B, Schrauder M, Schmid M, Siemer J, Voigt M, Schild RL. Source Department of Obstetrics and Gynecology, Diakonische Dienste Henriettenstiftung, Hannover, Germany. Erratum in Ultrasound Obstet Gynecol. 2011 Feb;37(2):254.
Abstract
OBJECTIVES: To develop and test a specific formula for estimating weight in the macrosomic fetus. METHODS: Ultrasound estimations of fetal weight were carried out within 1 week of delivery in 424 singleton fetuses with a birth weight of > or = 4000 g. Exclusion criteria were multiple pregnancy, intrauterine death and major structural or chromosomal anomalies. Stepwise regression modeling was used to derive a prediction formula with birth weight as the dependent variable and maternal booking weight and fetal biometric measurements as independent parameters. After a new formula for estimated fetal weight (EFW) had been developed in a formula-finding group (n = 284), it was compared with commonly used weight equations (evaluation group, n = 140). RESULTS: The new formula (log(e)EFW = 7.6377445039 + 0.0002951035 x maternal weight + 0.0003949464 x head circumference + 0.0005241529 x abdominal circumference + 0.0048698624 x femur length) proved to be superior to established equations, with the smallest mean error (mean +/- SD, -10 +/- 202 g), the smallest mean percentage error (mean +/- SD, -0.03 +/- 4.6%) and the lowest mean absolute percentage error (3.69 (range, 0.05-13.57)%) when studied in the evaluation group. With the new formula, 77.9% of estimates fell within +/- 5% of the actual weight at birth, 97.1% within +/- 10%, and 100% within +/- 15% and +/- 20%. CONCLUSIONS: The new formula allows better weight estimation in the macrosomic fetus. Comment in Ultrasound Obstet Gynecol. 2010 Apr;35(4):503-4; author reply 504-5.
PMID 20034003
see also PMID 20373483
