First trimester 3D volumetry. Association of the gestational volumes with the birth weight

Objective.?To evaluate the three dimensional ultrasound (3D) in the volume assessment of the gestational contents during the 1st trimester of pregnancy. Our aim was to correlate the embryo, gestational sac, and placenta volume with the birth weight. To monitor the increase of these volumes according to the gestational age.

Method.?Prospective study of 199 singleton low risk pregnant women undergoing the 1st trimester ultrasound for fetal anomalies. In these women, gestational volumetry was performed and it was compared with the crown-rump length (CRL). Regression models were computed in order to analyze the dependence of birth weight with the volumes.

Results.?The embryo volume reveals the strongest association with the birth weight at delivery (β?=?0.24), followed by the CRL (β?=?0.20) and the gestational sac volume (β?=?0.20). The placenta volume appears the weakest association with fetal weight at delivery (β?=?0.16). All volumes increased significantly from 11⁺⁰–11⁺⁶ to 13⁺⁰–13⁺⁶ weeks of gestation (p?<?0.001). Ten cubic millimeter increase in embryo volume corresponds to a mean birth weight increase of 75?g, while 1?mm increase in the CRL corresponds to a birth weight increase of 113?g.

Conclusion.?Our results provide evidence that the embryo volume during the first trimester of pregnancy correlates better with birth weight than the CRL. This might assist in the identification of the high risk pregnancies caring macrosomic and low birth weight fetuses.     

The correlation between birth weight and insulin-like growth factor-binding protein-1 (IGFBP-1), kisspeptin-1 (KISS-1), and three-dimensional fetal volume

Purpose: This study aimed to determine the relationship between birth weight, and maternal serum insulin-like growth factor-binding protein-1 (IGFBP-1) and kisspeptin-1 (KISS-1) levels, and first-trimester fetal volume (FV) based on three-dimensional ultrasonography.

Materials and methods: The study included 142 pregnant women at gestational week 11°–13⁶. All fetuses were imaged ultrasonographically by the same physician. Maternal blood samples were collected at the time of ultrasonographic evaluation and analyzed for IGFBP-1 and KISS-1 levels via enzyme-linked immunosorbent assay (ELISA). Maternal and neonatal weights were recorded at birth. Birth weight ≤10th and the >90th percentiles was defined as small and large for gestational age (SGA and LGA), respectively.

Results: Median crown-rump length (CRL), FV, and maternal serum IGFBP-1 and KISS-1 levels were 58.2?mm (35.3–79.2?mm), 16.3?cm³ (3.8–34.4?cm³), 68.1?ng?mL^?1 (3.8–377.9?mL^?1), and 99.7?ng?L^?1 (42.1–965.3?ng?L^?1), respectively. First-trimester IGFBP-1 levels were significantly lower in the mothers with LGA neonates (p?p?>?.05). The maternal IGFBP-1 level during the first trimester was a significant independent factor for SGA and LGA neonates (Odds ratio (OR): 0.011, 95%CI: 1.005–1.018, p?p?=?.007, respectively). There was no significant relationship between SGA or LGA, and CRL, FV, or the KISS-1 level.

Conclusions: As compared to the maternal KISS-1 level, the maternal IGFBP-1 level during the first trimester might be a better biomarker of fetal growth. Additional larger scale studies are needed to further delineate the utility of IGFBP-1 as a marker of abnormal birth weight.     

Can we improve the gestation-adjusted projection (GAP) method for prediction of birth weight in morbidly obese women?*

Objective: The gestation-adjusted projection (GAP) is a method to predict birthweight using population birth data and third trimester ultrasound fetal weight. This method usually utilizes population birth weight data from almost 40 years ago. In 2011, a large cohort of racially diverse infants across the US was included to validate updated birth curves. Our objective was to determine if the updated data would improve the accuracy of the GAP method during the third trimester among obese women.

Methods: This secondary analysis of a cohort study included singleton pregnancies of obese women who had fetal growth assessment(s) in the third trimester. The first subgroup (N?=?235) included women with a BMI >40?kg/m² who had ultrasounds during 30?+?0–35?+?0 weeks (EARLY) and greater than 35?+?0 weeks (LATE). The second subgroup (N?=?431) included women with a BMI 30–35, 40–50, or >50?kg/m² who had an ultrasound during 34?+?0–36?+?6 weeks. Mean absolute percent error was calculated for all GAP methods and compared using paired t-tests. Sensitivity, specificity, and area under the curve for diagnosis of birth weight >4000 grams were also estimated for each GAP method.

Results: The mean absolute percent error for the first subgroup (N?=?235) using historical population birth weights was 7.4–7.9%. After using updated population birth weight curves using all neonates, the mean absolute percent error for the first subgroup ranged between 7.6 and 9.4%. GAP predictions using all neonates, as well as male and female-specific birth data compared to the historical population data during both the EARLY and LATE periods were significantly worse (p?N?=?431) using historical population birth weights ranged from 7.2 to 7.9%. The absolute percent error using gender-specific compared to historical data was significant in the BMI 30–35 group (male 8.1% versus historical 7.6%, p?p?50-kg/m² groups (p?=?.05 and p?=?.15, respectively) though still overall performed worse with the updated data.

Conclusions: Prediction of birth weight using the GAP method does not seem to be improved among obese women after using updated population data. Alternatively, modeling techniques may need to be applied to improve the accuracy of the GAP method.     

Added value of cerebro-placental ratio and uterine artery Doppler at routine third trimester screening as a predictor of SGA and FGR in non-selected pregnancies

Objectives: The objective of this study is to determine the added value of cerebroplacental ratio (CPR) and uterine Doppler velocimetry at third trimester scan in an unselected obstetric population to predict smallness and growth restriction.

Methods: We constructed a prospective cohort study of women with singleton pregnancies attended for routine third trimester screening (32⁺⁰–34⁺⁶ weeks). Fetal biometry and fetal–maternal Doppler ultrasound examinations were performed by certified sonographers. The CPR was calculated as a ratio of the middle cerebral artery to the umbilical artery pulsatility indices. Both attending professionals and patients were blinded to the results, except in cases of estimated fetal weight Results: A total of 1030 pregnancies were included. The mean gestational age at scan was 33 weeks (SD 0.6). The addition of CPR and uterine Doppler to maternal characteristics plus EFW improved the explained uncertainty of the predicting models for SGA (15 versus 10%, p?p?=?.03). However, the addition of CPR and uterine Doppler to maternal characteristics plus EFW only marginally improved the detection rates for SGA (38 versus 34% for a 10% of false positives) and did not change the predictive performance for FGR.

Conclusions: The added value of CPR and uterine Doppler at 33 weeks of gestation for detecting defective growth is poor.     

Third trimester ultrasound accuracy and delivery outcome in obese and morbid obese pregnant women

Objective: Several studies have highlighted the negative impact of maternal obesity on ultrasound accuracy for fetal weight estimation (EFW). However, the evidence is conflicting. We aimed in our study to find if the ultrasound accuracy for EFW would differ or decrease in obese and morbid obesity classes. We also studied the mode of delivery within the same cohort.

Methods: It is a retrospective study of obese patients with recorded BMI ≥30?kg/m², class I and II (BMI: 30–39.9?kg/m²) compared with extreme obese class III (BMI ≥40?kg/m²), who gave birth after 28-week gestation of viable singleton, who had an ultrasound within 7 d of delivery with reported normal amniotic fluid and no major fetal anomaly; the EFW was consistently measured through Hadlock regression formula in the period of 2014–2015 inclusive. Differences between the EFW and actual birth weight (ABW) were assessed by percentage error, accuracy in predictions within ±10% of error and the Pearson correlation coefficient were used to correlate EFW with the ABW. The study’s secondary outcome was to study the mode of delivery and the rate of cesarean section in obese and morbid obese patients.

Results: Total 106 cases fulfilled our criteria. Class I and II as the first group (n?=?53). Class III as the second group (n?=?53). Maternal and birth characteristics were similar. The Pearson correlation coefficient equal 1 in both groups. The overall mean absolute difference (MAD) in grams of the whole obese cohort was 242?±?213. The MAD was 242?±?202 and 242?±?226?g for the first and second group, respectively (p?=?1.0). The overall mean absolute percentage error (MAPE) in this obese cohort was 8%. The MAPE for the first and second group, respectively were 8 and 7% (p?=?0.4). The overall rate of cesarean delivery was 60% (64/106) with no differences between the obese and morbid obese BMI classes. Sixty-six percentage (42/64) of these cesarean cases was for repeat cesarean section.

Conclusion: Despite what has been previously reported about the negative impact of maternal obesity on EFW accuracy, we could not demonstrate this relationship in our obese cohort (MAPE <10%). In addition, we could not illustrate a significant difference in ultrasound accuracy across various obesity classes. However, we found a significantly increased rate of delivery by repeated cesarean section in this obese cohort.     

Fetal cardiac axis in non-anomalous pregnancies: does fetal gender or maternal body mass index (BMI) matter?

Objectives: To determine if cardiac axis obtained at an early ultrasound study (11–15 weeks) differs from that obtained at a late ultrasound study (18–22 weeks) in the same fetus and to evaluate the impact of fetal gender and/or maternal body mass index (BMI).

Methods: Cardiac axes of 324 non-anomalous fetuses at 11–15 weeks gestation were measured, with follow-up measurements obtained at 18–22 weeks. Comparisons were performed based on gestational age period, fetal gender and obese/non-obese maternal status.

Results: (1) Mean fetal cardiac axis did not change between 11 and 15 weeks; p?=?0.8, (2) mean fetal cardiac axis was more levorotated at 11–15 weeks than measurements obtained at 18–22 weeks; 48.1?±?7.1° versus 43.7?±?8.9°; p?<?0.0001, (3) male fetuses had less levorotated cardiac axis than female fetuses in late ultrasound studies but there was no difference between them at early ultrasound studies; 18–22 weeks male fetus, 42.7?±?9.3° versus female fetus, 45.2?±?8.3°; p?=?0.02 and 11–15 weeks male fetus, 48.1?±?7.0° versus female fetus, 48.4?±?7.4°, p?=?0.7, respectively, and (4) similar trends with the overall study population were observed in the comparison between fetuses of obese and non-obese women.

Conclusion: Fetal cardiac axis remains stable at 11–15 weeks, becoming less levorotated at 18–22 weeks. This may be attributed to increments in fetal lung volume. The differences in cardiac axis measurements between male and female fetuses examined at 18–22 weeks may also be attributable to differences in increment of fetal lung volume during this gestational age period.     

Ultrasound measurement of fetal adrenal gland in fetuses with intrauterine growth restriction,an early predictive method for adverse outcomes

Objectives: Comparing the sonographic measurements of fetal adrenal gland in pregnancies with intrauterine growth restriction (IUGR) versus healthy controls and to assess whether the changes in adrenal gland measurements could predict adverse pregnancy outcomes in IUGR fetuses.

Methods: This prospective cohort study evaluated 97 pregnant women (48 with IUGR pregnancies and 49 healthy controls) during their third gestational trimester. All mothers underwent two dimensional ultrasonography of the fetal adrenal gland, and the fetal zone in transverse, sagittal, and coronal planes. Adrenal gland volume (AGV) and fetal zone volume (FZV) were calculated and corrected (c) for fetal weight. The mothers were then followed until delivery.

Results: Fetuses in the IUGR group had larger corrected adrenal gland volume (c_AGV) and smaller corrected fetal zone volume (c_FZV) compared to the fetuses in the control groups (p?p?Conclusions: Third trimester fetal adrenal gland sonography could potentially be used as an easy noninvasive method for identifying those IUGR fetuses who might have poorer outcomes.     

The association of first trimester uterine arteries Doppler velocimetry with different clinical phenotypes of hypertensive disorders of pregnancy: a longitudinal study

Introduction: Current classification of hypertensive disorders of pregnancy (HDP) is mostly based on temporal classification differentiating HDP according to early and late onset of the disease. However, epidemiological and clinical data suggest that there are two different clinical phenotypes of HDP that coexist at any gestational age: HDP associated to intrauterine growth restriction (HDP-IUGR) and HDP associated to appropriate for gestational age fetal growth (HDP-AGAf). The aim of the study was to evaluate the association of first trimester uterine arteries (UtA) by Doppler velocimetry, and maternal risk factors with HDP according to two different classifications: one based on gestational age at delivery (early- and late-HDP), and one based on longitudinal ultrasound evaluation of fetal growth (HDP-IUGR and HDP-AGAf), independently of the gestational age.

Methods: Maternal characteristics and mean pulsatility index (PI) of UtA were collected at 11–13 gestational weeks. A longitudinal ultrasound follow-up of fetal growth in each trimester and clinical outcome were obtained in 4290 singleton pregnancies.

Results: UtA-PI was significantly higher in women who developed HDP-IUGR (n?=?22) and the odds ratio (OR) to develop HDP-IUGR from 25 to 39 weeks was 8.6 (p?n?=?112) was significantly associated with a higher BMI, multiparity, and maternal age, but not with UtA-PI (OR 1.3; p?=?.2). In women with an abnormal UtA-PI, the odds of developing early (n?=?15) and late-HDP (n?=?119) were 3.0 (p?=?.03) and 1.7 (p?=?.002), respectively. The AUCs for HDP-IUGR and early-HDP were 0.84 and 0.71, respectively.

Discussion: UtA Doppler velocimetry in the first trimester was strongly associated with HDP-IUGR all along gestation, as a proxy of placental insufficiency, and showed no association with HDP-AGAf. Our findings suggest an efficacy of first trimester UtA Doppler velocimetry to identify HDP-IUGR independently of the gestational age, and a limited value for HDP not associated with intrauterine growth restriction (IUGR).     

Third trimester ultrasound for fetal macrosomia: optimal timing and institutional specific accuracy

Purpose: To determine the performance of third trimester ultrasound in women with suspected fetal macrosomia.

Materials and methods: We performed a retrospective cohort study of fetal ultrasounds from January 2004 to December 2014 with estimated fetal weight (EFW) between 4000 and 5000?g. We determined accuracy of birth weight prediction for ultrasound performed at less than and greater than 38 weeks, accounting for diabetic status and time between ultrasound and delivery.

Results: There were 405 ultrasounds evaluated. One hundred and twelve (27.7%) were performed at less than 38 weeks, 293 (72.3%) at greater than 38 weeks, and 91 (22.5%) were performed in diabetics. Sonographic identification of EFW over 4000?g at less than 38 weeks was associated with higher correlation between EFW and birth weight than ultrasound performed after 38 weeks (71.5 versus 259.4?g, p?Conclusions: Identification of EFW with ultrasound performed less than 38 weeks has greater reliability of predicting fetal macrosomia at birth than measurements performed later in gestation. EFW to birth weight correlation was more accurate than previous reports.     

The association between second trimester estimated fetal weight and small for gestational age at birth

Objective: To analyze diagnostic accuracy of second trimester ultrasound fetal growth parameters as predictors of small for gestational age (SGA) birth weight.

Methods: We reviewed the fetal biometry from 714 consecutive patients with second trimester ultrasounds. The estimated fetal weight (EFW) and abdominal circumference (AC) percentiles were tested as predictors of SGA at birth (<10‰).

Results: 87 (12.2%) patients had an SGA baby. Patients with a second trimester EFW?≤25‰ were significantly more likely to have SGA at birth (24.2% versus 10.3%, p?<?0.001). Similar results were seen for women with second trimester AC?≤25‰ (likelihood of SGA 21.9% versus 11.2%, p?=?0.013). A second trimester EFW?≤25‰ was a better predictor of SGA at birth than a second trimester EFW?≤?10‰ (Positive likelihood ratio 2.30 versus 2.09). In the second trimester, only 9 (1.3%) patients had an EFW 0–10‰, only 43 (6%) patients had an EFW 11–20‰, and only 46 (6.4%) patients had an EFW 91–99‰. Each other EFW centile had more than 10% of the patients.

Conclusions: The incidence of second trimester EFW or AC?≤10‰ is less common than expected from standard tables. An EFW?≤25‰ and an AC?≤25‰ should be considered the second trimester marker for risk of SGA at birth. However, due to the low likelihood ratio of, it is not clear if second trimester ultrasound should be used as a predictor of SGA at birth.     

Reference range for the fetal intracranial translucency measurement between 11 and 14 + 2 weeks of gestation in a Brazilian population

Objective: To establish a reference range for the fetal intracranial translucency (IT) measurement between 11 and 14?+?2 weeks in a Brazilian population.

Methods: A retrospective cross-sectional study was performed with 199 low-risk singleton pregnancies during the first trimester ultrasound exam. The IT (fourth ventricle width) measurement was performed in a mid-sagittal view of fetal profile defined by two echogenic borders – the dorsal part of the brain stem anteriorly and the choroid plexus of the fourth ventricle posteriorly. Polynomial regression was used to obtain the best fit using fetal IT measurements and crown-rump length (CRL). Percentiles 5th, 50th and 95th were determined for each gestational age.

Results: The mean of fetal IT ranged from 1.6 mm at CRL 45 to 2.0 mm at CRL 84 mm. A best fit curve was a first-degree polynomial regression: IT measurement?=?1.001?+?0.0124?×?CRL (R²=0.09).

Conclusion: Reference range for the fetal IT measurement between 11 and 14?+?2 weeks of gestation in a Brazilian population was established.     

Is low-dose aspirin therapy to prevent preeclampsia more efficacious in non-obese women or when initiated early in pregnancy?

Objective: Late timing of intervention and maternal obesity are potential explanations for the modest effect of aspirin for preeclampsia prevention. We explored whether low-dose aspirin (LDA) is more effective in women at increased risk when initiated before 16 weeks' gestation or given to non-obese women.

Methods: Secondary analysis of a trial to evaluate LDA (60?mg/d) for preeclampsia prevention in high-risk women. Participants were randomized to LDA or placebo between 13 and 26 weeks. We stratified the effect of LDA on preeclampsia by (a) timing of randomization (Results: Of 2503 women, 461 (18.4%) initiated LDA?p value for interaction?=?0.87). Similarly, LDA effect was not better in non-obese (RR: 0.91, 95% CI: 0.7–1.13) versus obese women (RR: 0.89, 95% CI: 0.7–1.13), (p value for interaction?=?0.85).

Conclusion: LDA for preeclampsia prevention was not more effective when initiated 相似文献   

The relationship between third trimester maternal hemoglobin and birth weight/length; results from the tertiary center in Turkey

Abstract

Objective: The aim of this study was to investigate the relationship between third trimester maternal hemoglobin values and fetal birth weight/length.

Methods: Retrospective study was conducted on 28?600 Turkish pregnant women who delivered between January 2010 and December 2011. Hemoglobin values at third trimester, all birth weights/lengths of newborns were retrospectively analyzed. Maternal third trimester hemoglobin values and birth weights/lengths were compared and correlated.

Results: The high hemoglobin concentrations at third trimester were associated with high birth weight (odds ratio 1.08; 95% confidence interval 1.05–1.11; p?=?0.00) and significant positive correlation was determined between maternal third trimester hemoglobin and birth weights/lengths (p?=?0.00). Low hemoglobin was associated with low length of newborns (p?=?0.00).

Conclusions: The low hemoglobin values at third trimester gestation were associated with low birth weight and length in Turkish women. The anemia can be a direct cause of deterioration of in utero fetal growth due to lack of oxygen flow to placental tissue or can be an indirect indicator of maternal nutrition deficit. In both circumstances this study reveals that treatment of anemia is directly correlated with better fetal outcomes.     

Ultrasound evaluation of intrauterine growth restriction therapy by a nitric oxide donor (L-arginine)

Objective: There are numerous methods available of treating intrauterine growth restriction but their results are still not satisfactory. Currently, we are conducting a research project whose main aim is based on the use of the nitric oxide (NO) donor L-arginine in growth restriction therapy. The main aim of this study was the ultrasound evaluation of the efficacy of this therapy based on biometric measurements (the estimated fetal weight) compared with the estimated weight of newborn children.

Study design: The investigated group comprised two randomly chosen groups of pregnant women with ultrasound-diagnosed intrauterine growth restriction (biometry <?10th centile for gestation age): 78 patients were treated by L-arginine 3?g daily orally for 20 days; and 30 patients, not treated, acted as the control group.

Results: The ultrasound estimation of fetal weight at the start and at the end of the treatment showed a mean increase of 642?g (SE 90?g) using the Shepard method, and 648?g (SE 94?g) using the Hadlock method, respectively. By comparison, within the control group a mean value increase of 395?g (SE 77?g) was found, using the Shepard method, and 404?g (SE 82?g) using the Hadlock method, respectively. There was a significant statistical difference when comparing the estimated fetal weight increase in both methods: p?=?0.008 for the Shepard calculation and p?=?0.012 for the Hadlock calculation. The weight of the newborn infants was also evaluated: in the treated group the mean value was 2823?g (SE 85?g) and in the untreated group the mean value was 2495?g (SE 147?g). There was a significant (p?=?0.027) difference, showing a positive effect of the treatment on the weight of newborns. In the treated group the percentage of growth-retarded newborns was 29% while in the untreated group it was 73%. A significant difference has been found (p?<?0.01) between both of the groups of newborns.

Conclusions: The ultrasound evaluation of the estimated fetal weight and the birth weight of the newborns showed an improvement: there was an acceleration of fetal development in the L-arginine-treated group of pregnant women as compared with the untreated group. The ultrasound evaluation of the estimated fetal weight is a good diagnostic tool, properly monitoring the efficacy of the L-arginine treatment of the growth-retarded fetuses.     

Composite neonatal and maternal morbidities with small- versus appropriate- for gestational age among uncomplicated obese women undergoing repeat cesarean delivery*

Purpose: Our goal was to compare composite neonatal and maternal morbidities (composite neonatal morbidity (CNM), composite maternal morbidity (CMM)) among deliveries with small for age (SGA) versus appropriate for gestational age (AGA; birthweight 10–89%) among obese versus non-obese women undergoing repeat cesarean delivery (CD).

Study design: This is a secondary analysis of a prospective observational study. Women who had elective CD ≥37 weeks were studied. We excluded multiple gestations, fetal anomalies,?>?1 prior CD, and medical diseases. Patients were divided into BMI ≥30 versus <30?kg/m². CNM included respiratory distress syndrome, necrotizing enterocolitis, severe intraventricular hemorrhage, seizure, or death; CMM included transfusion, hysterectomy, operative injury, coagulopathy, thromboembolism, pulmonary edema, or death. Multivariate logistic regression was used to control for confounding factors.

Results: Of 7561 women, we included 65% were obese and 35% were not. SGA rates differed significantly: 8 versus 12% (p?Conclusions: SGA occurred in 8% of low-risk obese women with prior CD. CNM of SGA babies in obese versus non-obese women were similar. Paradoxically, CMM was lower in obese cases, possibly reflecting the caution that obese patients receive preoperatively. Our findings may assist in counseling patients and designing trials.     

Early first-trimester crown-rump length measurements in male and female singleton fetuses in IVF pregnancies

Objectives: The generally higher birth-weight of male newborns compared to female newborns is attributed mainly to intrauterine exposure to testosterone. We aimed to determine if crown-rump length (CRL) differs between male and female fetuses early in the first trimester. Methods: A retrospective cohort study of 333 women with nondiabetic singleton IVF pregnancies attending a single university-affiliated tertiary medical center in 2000–2007 who underwent CRL measurement before 50 days of pregnancy (date of measurement minus oocyte retrieval date plus 14 days). Data on pregnancy outcome, including fetal sex, were collected by routine follow-up telephone interview and combined with the delivery data. Results: There were 169 female and 164 male fetuses according to the reported fetal sex at delivery. Most of the CRL measurements (68.7%) were performed at an actual gestational age of 43–45 days. On linear regression analysis, male fetal sex was a significant (p = 0.011) predictor of larger CRL: CRL (mm) = –23.851 + GA (days) × 0.621 + 0.334 × Sex (F = 1, M = 2), R² = 0.512, p <0.001. A general linear model, adjusted for gestational age (40–50 days), revealed that mean CRL was significantly higher in male than in female fetuses (4.58?±?0.09?mm, [95% CI: 4.3–4.7] vs 4.24?±?0.09?mm [4.0–4.4]; p < 0.001). Conclusions: Male fetuses are larger than female fetuses in the early first trimester. Given that gonadal differentiation has not yet occurred, still unidentified nonhormonal factors are apparently responsible for this difference.     

Correlation of nuchal translucency and thyroxine at 11–13 weeks of gestation

Abstract

Objective: Nuchal translucency (NT) thickness is one of the major screening markers during the first trimester that could be influenced by several factors. Here, we investigated the association between NT thickness and thyroid related hormones.

Methods: NT thickness was measured with transabdominal ultrasound in 643 pregnant women between 11 and 13 weeks of gestation. Maternal thyroxine (T4), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) were evaluated. Bivariate correlations were assessed and thyroid profile was subcategorized with regard to the calculated reference ranges.

Results: An inverse relation was found between serum levels of maternal T4 with NT thickness (r?=??0.128, p?=?0.001) and CRL (r?=??0.168, p?<?0.001). TSH and hCG were also found to be correlated (Spearman’s correlation coefficient?=??0.092, p?=?0.019). Prevalence of maternal hypothyroidism and subclinical hypothyroidism were 1.1% and 3.7%, respectively.

Conclusion: Thyroid function tests are found to independently influence NT measurements in the first trimester. Assessment of hormones such as thyroxine could optimize the interpretation of screening tests for pathological conditions during pregnancy.     

Obesity’s impact on intrapartum electronic fetal monitoring

Objective: The objective of this study is to evaluate the impact maternal obesity has on the percentage of unmonitored electronic fetal monitoring (EFM).

Study design: Women undergoing induction of labor at term were categorized into three groups: Group 1 (body mass index (BMI)?2), Group 2 (30?2), and Group 3 (BMI?≥?40?kg/m²). External EFM tracings were reviewed from the time of induction of labor until amniotomy; the percentage of time off of EFM was calculated. Statistical analysis was performed using commercially available software.

Results: Three hundred and thirty-seven patients were stratified into the following groups: 104 patients in Group 1, 156 patients in Group 2, and 77 in Group 3. No significant differences were found between groups when analyzed for gestational age, bishop score, parity, race, and 5?min APGAR less than 7 or admission to the NICU. The mean percentage unmonitored by EFM was 5% for Group 1, 7% for Group 2 and 11% for Group 3. There was a significant association between percent of time unmonitored by EFM and BMI (r?=?0.344 p?Conclusion: At term gestation, the fetuses of obese women spend more time unmonitored by external intrapartum EFM than non-obese women. This represents a disparity among a high-risk group that may result in poor pregnancy outcomes if fetal distress is present.     

Comparison of first trimester transvaginal anatomy scan to the second trimester structural survey in normal weight and obese populations: a pilot study

Purpose: To compare visualization of first trimester fetal anatomic transvaginal ultrasound (TVUS) to the second trimester transabdominal anatomic ultrasound (TAU) in normal weight and obese patients.

Materials and methods: In a prospective cross-sectional study design, 25 women underwent a TVUS between 12 and 14 weeks, and a TAU at 18–22 weeks. For each anatomic structure, the percentage of patients achieving optimal visualization was recorded. Risk ratios for visualizing a structure in the second trimester versus the first were calculated.

Results: Twenty-five patients underwent a TVUS and 24 completed the TAU. The average BMI in the obese and nonobese groups was 34?kg/m² and 23?kg/m², respectively. All structures were more consistently visualized during the TAU for the both groups. The cardiac views, hands and feet were more difficult to visualize in all the patients at both scan times but were more frequently visualized in the TAU. For the obese patients, hands, feet, cardiac and spine views were less frequently visualized in both the scans. The posterior fossa and profile views were more difficult to obtain in the TVUS.

Conclusions: The first trimester TVUS detects many of the structures assessed during an anatomic survey; however, it is not superior to the second trimester TAU in normal weight and obese patients.     

Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program

Abstract

Objectives: To determine whether changes in lifestyle in women with BMI?>?25 could decrease gestational weight gain and unfavorable pregnancy outcomes.

Methods: Women with BMI?>?25 were randomized at 1st trimester to no intervention or a Therapeutic Lifestyle Changes (TLC) Program including diet (overweight: 1700?kcal/day, obese: 1800?kcal/day) and mild physical activity (30?min/day, 3 times/week). At baseline and at the 36th week women filled-in a Food Frequency Questionnaire. Outcomes: gestational weight gain, gestational diabetes mellitus, gestational hypertension, preterm delivery. Data stratified by BMI categories.

Results: Socio-demographic features were similar between groups (TLC: 33 cases, Controls: 28 cases). At term, gestational weight gain in obese women randomized to TLC group was lower (6.7?±?4.3?kg) versus controls (10.1?±?5.6?kg, p?=?0.047). Gestational diabetes mellitus, gestational hypertension and preterm delivery were also significantly lower. TLC was an independent factor in preventing gestational weight gain, gestational diabetes mellitus, gestational hypertension. Significant changes in eating habits occurred in the TLC group, which increased the number of snacks, the intake of fruits–vegetables and decreased the consumption of sugar.

Conclusions: A caloric restriction associated to changes in eating behavior and constant physical activity, is able to reduce gestational weight gain and related pregnancy complications in obese women.