目的:比较超声评估的胎儿头围(HC),腹围(AC),HC/AC比,和估计的胎儿体重(EFW),用于预测受1型(T1DM)和2型(T2DM)糖尿病影响的孕妇出生时的大胎龄(LGA)。
方法:这项回顾性队列研究包括2010年至2019年在奥尔堡大学医院分娩的所有T1DM和T2DM妇女,丹麦。在妊娠16、20、28和34周进行超声扫描。LGA定义为出生体重与预期胎龄(≥90分)的偏差为15%或更大。通过对母体特征和糖化血红蛋白(HbA1c)和接受者工作特征曲线下面积(AUC)进行调整的逻辑回归评估LGA的预测。
结果:在180例T1DM妊娠中,118(66%)在出生时有LGA新生儿。怀孕28周时,预测结果为AUCHC/AC=0.67,AUCAC=0.85,AUCEFW=0.86.多变量分析没有改善HC/AC比率或AC的预测性能。在87例T2DM妊娠中,36例(41%)新生儿出生时患有LGA。28周时,预测结果为AUCHC/AC=0.73,AUCAC=0.83,AUCEFW=0.87.在T2DM中,多变量分析显著提高了妊娠20周时HC/AC比值和AC的预测性能.
结论:在T1DM和T2DM妊娠中,LGA的特征在于包括AC和HC的一般胎儿过度生长。因此,在LGA的预测中,AC和EFW的表现优于HC/AC比。在T2DM中,与T1DM相反,通过将母体特征和HbA1c纳入分析,预测性能得到改善.
OBJECTIVE: To compare ultrasound-assessed fetal head circumference (HC), abdominal circumference (AC), HC/AC ratio, and estimated fetal weight (EFW) in prediction of large-for-gestational-age (LGA) at birth in pregnancies affected by type 1 (T1DM) and type 2 (T2DM) diabetes.
METHODS: This retrospective cohort study included all women with T1DM and T2DM giving birth to singletons between 2010 and 2019 at Aalborg University Hospital, Denmark. Ultrasound scans were performed at 16, 20, 28 and 34 weeks of pregnancy. LGA was defined as birth weight deviation of 15% or greater from the expected for gestational age (≥90th centile). Prediction of LGA was assessed by logistic regression adjusted for maternal characteristics and glycated hemoglobin (HbA1c) and area under the receiver operating characteristics curve (AUC).
RESULTS: Among 180 T1DM pregnancies, 118 (66%) had an LGA neonate at birth. At 28 weeks of pregnancy, they were predicted with AUCHC/AC = 0.67, AUCAC = 0.85, and AUCEFW = 0.86. The multivariate analysis did not improve the predictive performance of the HC/AC ratio or AC. Among 87 T2DM pregnancies, 36 (41%) had an LGA neonate at birth. At 28 weeks, they were predicted with AUCHC/AC = 0.73, AUCAC = 0.83, and AUCEFW = 0.87. In T2DM, the multivariate analysis significantly improved the predictive performance for both HC/AC ratio and AC from 20 weeks of pregnancy.
CONCLUSIONS: In T1DM and T2DM pregnancies, LGA is characterized by a general fetal overgrowth including both AC and HC. Therefore, AC and EFW perform better than the HC/AC ratio in the prediction of LGA. In T2DM, as opposed to T1DM, the predictive performance was improved by the inclusion of maternal characteristics and HbA1c in the analysis.