Elessawy Mohamed, Harders Christina, Kleinwechter Helmut, Demandt Norbert, Sheasha Ghada Abu, Maass Nicolai, Pecks Ulrich, Eckmann-Scholz Christel
Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, Haus 24, 24105, Kiel, Germany.
Diabetologikum, Kiel, Germany.
Arch Gynecol Obstet. 2017 Sep;296(3):445-453. doi: 10.1007/s00404-017-4433-6. Epub 2017 Jun 19.
To explore the predictive power of measuring the abdominal fetal fat layer (FFL) as a soft tissue marker at 31, 34, and 37 weeks' gestation to improve the detection of fetal macrosomia in pregnant women with GDM, in addition to the biometric values with close monitoring of maternal blood sugar level and BMI changes.
We conducted a prospective observational study at the Department of Obstetrics, University Hospitals, Campus Kiel, Germany, in collaboration with diabetic clinic staff. Participants underwent a third-trimester scan and extra FFL measurements were performed at 31, 34, and 37 weeks of gestation. The clinical outcomes of pregnancy and birth weight were collected from the obstetric record. All of the enrolled women had an early pregnancy ultrasound scan to confirm gestational age.
The FFL at 34 and 37 weeks, with respective cutoff values of >0.48 cm and >0.59 cm, showed a very good sensitivity of 60% for both gestational points, and specificity of 89.3 and 90.6%, respectively. The probability of fetal macrosomia could be more than doubled if the FFL at 34 weeks was more than 0.48 cm. However, the probability of macrosomia dropped to 16% if the FFL was ≤0.48 cm. The median FFLs of macrosomic fetuses at 34 and 37 weeks were 0.50 (IQR 0.10) and 0.60 (IQR 0.25) cm, respectively. The mean age of the study population (n = 80) was 32.26 (SD = 5.06) years. In our study population, ten newborns were born with birth weight >4000 g. The body mass index (BMI) for the mothers of later-onset macrosomic newborns showed higher median values of 30 (IQR 8), 32 (IQR 5), and 33 (IQR 9) at 31, 34, and 37 weeks, respectively, in comparison to mothers of non-macrosomic newborn. However, the BMI did not show any statistically significant difference from those with normal-weight newborn and did not show any specific sensitivity for predicting macrosomia.
Measuring the FFL at 34 and 37 weeks of gestation, in addition to the standard measurement, might be useful for predicting macrosomia and is worth further evaluation.
除了密切监测孕妇血糖水平和体重指数（BMI）变化以及生物测量值外，探讨在妊娠31、34和37周时测量腹部胎儿脂肪层（FFL）作为软组织标志物对改善妊娠期糖尿病（GDM）孕妇巨大儿检测的预测能力。
我们与糖尿病门诊工作人员合作，在德国基尔大学校医院产科进行了一项前瞻性观察研究。参与者接受了孕晚期超声检查，并在妊娠31、34和37周时进行了额外的FFL测量。从产科记录中收集妊娠临床结局和出生体重。所有纳入的妇女都进行了早孕超声检查以确认孕周。
妊娠34周和37周时的FFL，各自的临界值分别为>0.48 cm和>0.59 cm，在这两个孕周点的敏感性均为60%，特异性分别为89.3%和90.6%。如果妊娠34周时的FFL大于0.48 cm，胎儿巨大儿的概率可能会增加一倍多。然而，如果FFL≤0.48 cm，巨大儿的概率降至16%。妊娠34周和37周时巨大儿胎儿的FFL中位数分别为0.50（四分位间距0.10）和0.60（四分位间距0.25）cm。研究人群（n = 80）的平均年龄为32.26（标准差 = 5.06）岁。在我们的研究人群中，有10名新生儿出生体重>4000 g。与非巨大儿新生儿的母亲相比，晚期巨大儿新生儿母亲的体重指数（BMI）在妊娠31、34和37周时的中位数分别较高，为30（四分位间距8）、32（四分位间距5）和33（四分位间距9）。然而，BMI与正常体重新生儿母亲的BMI没有任何统计学上的显著差异，并且对预测巨大儿没有任何特异性敏感性。
除标准测量外，在妊娠34周和37周时测量FFL可能有助于预测巨大儿，值得进一步评估。
