Prediction of birthweight from third-trimester ultrasound in morbidly obese women
Prediction of birthweight from third-trimester ultrasound in morbidly obese women
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DOI：
10.1016/j.ajog.2014.06.041
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发表时间：
2014-10-01
影响因子：
9.8
通讯作者：
Boyd, Brita Katherine
中科院分区：
文献类型：
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作者：
Ahmadzia, Homa Khorrami;Thomas, Samantha Marie;Boyd, Brita Katherine
目的：妊娠调整投影法（GAP法）使用妊娠晚期超声胎儿体重预测出生体重。我们的研究旨在评估差距方法在病态肥胖妇女中的准确性是否取决于（1）超声时间或（2）母体体重指数（BMI）的极端升高。我们从2007年到2012年对所有分娩时BMI 40 kg/m2的单胎妊娠进行了诊断准确性研究，胎儿生长评估在30_0和35+之间0周（早期）和大于35+0周（晚期）。接下来，将“参考”BMI组（30-35）与BMI >= 40的女性亚类进行比较。结果：共纳入第一目的妊娠235例，第二目的妊娠430例。两个时期之间的平均绝对百分比误差（早期7.9 +/-6.7%，晚期7.4 +/- 5.6%; P = 0.33）和BMI类别之间的平均绝对百分比误差（30-35：7.6 +/-6.3%，40-50：7.2 +/-5.7%，>50：7.8 +/- 6.0%; P = 0.79）相当。差距方法预测EARLY期巨大儿的敏感性和特异性为46%在40-50 BMI亚类中，分别为72%（47- 90）和96%（90-99）。在肥胖妇女中差距方法预测出生体重似乎不受超声检查时间或极端BMI的影响。在临床估计胎儿体重困难的人群中，差距方法可能有助于分娩计划。
OBJECTIVE: The gestation-adjusted projection method (GAP method) uses third trimester ultrasound fetal weight to predict birthweight. Our study sought to assess if the accuracy of the GAP method in morbidly obese women depended on (1) ultrasound timing or (2) extreme elevations in maternal body mass index (BMI).STUDY DESIGN: We conducted a diagnostic accuracy study from 2007 to 2012 of all singleton pregnancies with BMI40 kg/m(2) at the time of delivery that had fetal growth assessment between 30_0 and 35+0 weeks (EARLY) and greater than 35+0 weeks (LATE). Next, a 'reference' BMI group (30-35) was compared with subcategories of women with BMI >= 40. Paired t tests, chi(2) tests and analysis of variance were used to determine significance.RESULTS: A total of 235 pregnancies for the first objective and 430 for the second objective were included. The mean absolute percent error was comparable between the 2 periods (EARLY 7.9 +/- 6.7%, LATE 7.4 +/- 5.6%; P = .33) and across BMI categories (30-35: 7.6 +/- 6.3%, 40-50: 7.2 +/- 5.7%, >50: 7.8 +/- 6.0%; P = .79). The sensitivity and specificity of the GAP method to predict macrosomia during the EARLY time period was 46% (95% confidence interval 28e66) and 97% (94-99) and in the 40-50 BMI subcategory was 72% (47-90) and 96% (90-99), respectively.CONCLUSION: Prediction of birthweight using the GAP method in obese women does not appear to be influenced by timing of ultrasound or extreme BMI. In a population where clinical estimated fetal weight is difficult, the GAP method may aid in delivery planning.