Fetal overgrowth in pregnancies complicated by diabetes: validation of a predictive index in an external cohort
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MATERNAL-FETAL MEDICINE
Fetal overgrowth in pregnancies complicated by diabetes: validation of a predictive index in an external cohort Tracy M. Tomlinson1 · Alexandra M. Johnson1 · Alexandra M. Edwards1 · Gilad A. Gross1 · Dorothea J. Mostello1 Received: 6 June 2020 / Accepted: 24 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To assess validity of a fetal overgrowth index in an external cohort of women with diabetes in pregnancy Methods We performed a retrospective analysis of data derived from women with singleton gestations complicated by diabetes who delivered January 2015–June 2018. The following index variables were used to calculate risk of fetal overgrowth as defined by a customized birthweight ≥ 90th centile: age, history of fetal overgrowth in a prior pregnancy, gestational weight gain, fetal abdominal circumference measurement and fasting glucose between 24 and 30 weeks. Results In our validation cohort, 21% of 477 pregnancies were complicated by fetal overgrowth. The predictive index had a bias-corrected bootstrapped area under receiver operating characteristic curve of 0.90 (95% CI 0.86–0.93). 55% of the cohort had a low-risk index (≤ 3) which had a negative predictive value of 97% (95% CI 94–98%), while 18% had a high-risk index (≥ 8) that had a positive predictive value of 74% (95% CI 66–81%). Conclusion The fetal overgrowth index incorporates five factors that are widely available in daily clinical practice prior to the period of maximum fetal growth velocity in the third trimester. Despite substantial differences between our cohort and the one studied for model development, we found the performance of the index was strong. This finding lends support for the general use of this tool that may aid counseling and allow for targeted allocation of healthcare resources among women with pregnancies complicated by diabetes. Keywords Birthweight · Accelerated fetal growth · Calculator · External validation · Large-for-gestational age · Macrosomia
Introduction The prevalence of diabetes in pregnancy has been increasing around the world, in part secondary to the development of insulin resistance at an earlier age, prior to childbearing [1]. One of the primary goals of diabetes management during pregnancy is to avoid accelerated fetal growth [2]. Hyperglycemia and fetal overgrowth are associated with adverse sequelae including cesarean delivery [3], shoulder dystocia [3, 4], late stillbirth [5, 6] and lifelong risk of obesity and the metabolic syndrome secondary to fetal programming [7, 8]. Identification of those pregnancies at highest risk * Tracy M. Tomlinson [email protected] 1
Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Women’s Health, Saint Louis University School of Medicine, 6420 Clayton Road, Suite 2800, Saint Louis, MO 63117, USA
of fetal overgrowth prior to the period of maximum fetal growth velocity in the third trimester may aid in counseling and allow for targeted allocation of valuable healt
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