Journal
ARCHIVES OF GYNECOLOGY AND OBSTETRICS
Volume 303, Issue 4, Pages 877-884Publisher
SPRINGER HEIDELBERG
DOI: 10.1007/s00404-020-05768-z
Keywords
Birthweight; Accelerated fetal growth; Calculator; External validation; Large-for-gestational age; Macrosomia
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The study assessed the validity of a fetal overgrowth index for predicting risk in women with diabetes in pregnancy and found strong performance in an external cohort.
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.
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