Obstet Gynecol Sci.  2025 Jan;68(1):69-78. 10.5468/ogs.24230.

Fetal biometry measurements in diabetic pregnant women and neonatal outcomes

• Heo A
• Chung J
• Lee S
• Cho H

• KMID: 2563939
• DOI: http://doi.org/10.5468/ogs.24230

Abstract

Objective
In this study, we aimed to investigate how fetal head and abdominal circumferences are related to the incidence of neonatal complications in mothers with gestational diabetes mellitus (GDM) and pre-gestational diabetes mellitus (PGDM) compared to normal pregnancies.
Methods
We retrospectively analyzed data of expectant mothers with GDM, PGDM, and normal pregnancies who delivered singleton full-term infants (≥37 weeks) at a tertiary center from January 2013 to December 2022. Ultrasonography-measured fetal weight, fetal head circumference, fetal abdominal circumference, difference between head and abdominal circumference, and head-to-abdominal circumference ratio were assessed. Neonatal outcomes were evaluated based on the rates of admission to the neonatal intensive care unit, intubation, and hypoglycemia. Statistical analyses, including univariate and multivariate analyses, were performed using the SPSS software (IBM Corp., Armonk, NY, USA).
Results
Among the 473 participants, 175 (37.0%) were mothers with diabetes (DM). A head-to-abdominal circumference ratio <0.95 and a difference of ≥2.5 cm were significantly associated with neonatal hypoglycemia in all mothers with DM, with statistical significance noted only in the PGDM group. No significant association was observed in normal pregnancies.
Conclusion
Our findings indicate that a head-to-abdominal circumference ratio <0.95 and a ≥2.5 cm difference in circumferences are associated with neonatal hypoglycemia in mothers with DM.

Keyword

Biometry; Fetal ultrasonography; Diabetes, gestational; Hyperinsulinemia hypoglycemia of infancy

Figure

• 

  Fig. 1. (A) Adjusted odds ratio between groups according to the HC-to-AC ratio. (B) Adjusted odds ratio between two DM groups according to the HC-to-AC ratio. The adjusted odds ratio was adjusted for mother’s BMI, age, gestational age at delivery, and parity. NICU, neonatal intensive care unit; CI, confidence interval; HC, head circumference; AC, abdominal circumference; GDM, gestational diabetes mellitus; DM, diabetes mellitus; BMI, body mass index.

• 

  Fig. 2. (A) Adjusted odds ratio between groups according to AC-HC (cm). (B) Adjusted odds ratio between two DM group according to AC-HC (cm). The adjusted odds ratio was adjusted for the mother’s BMI, age, gestational age at delivery, and parity. NICU, neonatal intensive care unit; CI, confidence interval; AC, abdominal circumference; HC, head circumference; GDM, gestational diabetes mellitus; DM, diabetes mellitus; BMI, body mass index.

Reference

References

1. Kim H, Cha HH, Seong WJ. Comparison of perinatal outcomes according to the majority of physicians: obstetrics versus endocrinology. J Korean Soc Matern Child Health. 2023; 27:167–72.

2. Mitanchez D, Yzydorczyk C, Simeoni U. What neonatal complications should the pediatrician be aware of in case of maternal gestational diabetes? World J Diabetes. 2015; 6:734–43.

3. Lappharat S, Rothmanee P, Jandee K, Suksai M, Liabsuetrakul T. A model for predicting gestational diabetes mellitus in early pregnancy: a prospective study in Thailand. Obstet Gynecol Sci. 2022; 65:156–65.

4. Gopinath S, Varalakshmi G, Manoj K. Glycemic control and fetal abdominal circumference. Indian J Endocrinol Metab. 2012; 16:S445–6.

5. Lee BH, Park TC, Lee HJ. Association between fetal abdominal circumference and birthweight in maternal hyperglycemia. Acta Obstet Gynecol Scand. 2014; 93:786–93.

6. Güemes M, Hussain K. Hyperinsulinemic hypoglycemia. Pediatr Clin North Am. 2015; 62:1017–36.

7. Blotsky AL, Rahme E, Dahhou M, Nakhla M, Dasgupta K. Gestational diabetes associated with incident diabetes in childhood and youth: a retrospective cohort study. CMAJ. 2019; 191:E410–7.

8. Won JS. Gestational diabetes mellitus and long-term prognosis of the offsprings. J Korean Diabetes. 2020; 21:81–7.

9. Ornoy A, Becker M, Weinstein-Fudim L, Ergaz Z. Diabetes during pregnancy: a maternal disease complicating the course of pregnancy with long-term deleterious effects on the offspring. A clinical review. Int J Mol Sci. 2021; 22:2965.

10. Abramowski A, Ward R, Hamdan AH. Neonatal hypoglycemia [Internet]. Treasure Island (FL): StatPearls Publishing;c2019. [cited 2023 Sep 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537105/.

11. De Angelis LC, Brigati G, Polleri G, Malova M, Parodi A, Minghetti D, et al. Neonatal hypoglycemia and brain vulnerability. Front Endocrinol (Lausanne). 2021; 12:634305.

12. Jazayeri A, Heffron JA, Phillips R, Spellacy WN. Macrosomia prediction using ultrasound fetal abdominal circumference of 35 centimeters or more. Obstet Gynecol. 1999; 93:523–6.

13. Coomarasamy A, Connock M, Thornton J, Khan KS. Accuracy of ultrasound biometry in the prediction of macrosomia: a systematic quantitative review. BJOG. 2005; 112:1461–6.

14. Dadkhah F, Kashanian M, Bonyad Z, Larijani T. Predicting neonatal weight of more than 4000 g using fetal abdominal circumference measurement by ultrasound at 38-40 weeks of pregnancy: a study in Iran. J Obstet Gynaecol Res. 2013; 39:170–4.

15. Gilby JR, Williams MC, Spellacy WN. Fetal abdominal circumference measurements of 35 and 38 cm as predictors of macrosomia. A risk factor for shoulder dystocia. J Reprod Med. 2000; 45:936–8.

16. De Reu PA, Smits LJ, Oosterbaan HP, Nijhuis JG. Value of a single early third trimester fetal biometry for the prediction of birth weight deviations in a low risk population. J Perinat Med. 2008; 36:324–9.

17. Bochner CJ, Medearis AL, Williams J 3rd, Castro L, Hobel CJ, Wade ME. Early third-trimester ultrasound screening in gestational diabetes to determine the risk of macrosomia and labor dystocia at term. Am J Obstet Gynecol. 1987; 157:703–8.

18. Antoniou MC, Gilbert L, Gross J, Rossel JB, Fumeaux CJF, Vial Y, et al. Main fetal predictors of adverse neonatal outcomes in pregnancies with gestational diabetes mellitus. J Clin Med. 2020; 9:2409.

19. Yang SW, Yuk JS, Seo YS. Diagnostic criteria of gestational diabetes: the international association of the diabetes and pregnancy study groups compared with Carpenter-Coustan criteria. Perinatology. 2023; 34:1–8.

20. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 173: fetal macrosomia. Obstet Gynecol. 2016; 128:e195–209.

21. Duewel AM, Doehmen J, Dittkrist L, Henrich W, Ramsauer B, Schlembach D, et al. Antenatal risk score for prediction of shoulder dystocia with focus on fetal ultrasound data. Am J Obstet Gynecol. 2022; 227:753.e1–8.

22. Choi JH, Lee KA, Moon JH, Chon S, Kim DJ, Kim HJ, et al. 2023 clinical practice guidelines for diabetes mellitus of the Korean Diabetes Association. Diabetes Metab J. 2023; 47:575–94.

23. Salomon LJ, Alfirevic Z, Berghella V, Bilardo CM, Chalouhi GE, Da Silva Costa F, et al. ISUOG practice guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2022; 59:840–56.

24. Reece EA, Homko CJ. Diabetes-related complications of pregnancy. J Natl Med Assoc. 1993; 85:537–45.

25. Ovesen PG, Jensen DM, Damm P, Rasmussen S, Kesmodel US. Maternal and neonatal outcomes in pregnancies complicated by gestational diabetes. A nation-wide study. J Matern Fetal Neonatal Med. 2015; 28:1720–4.

26. Alexopoulos AS, Blair R, Peters AL. Management of preexisting diabetes in pregnancy: a review. JAMA. 2019; 321:1811–9.

27. Mimouni F, Miodovnik M, Siddiqi TA, Khoury J, Tsang RC. Perinatal asphyxia in infants of insulin-dependent diabetic mothers. J Pediatr. 1988; 113:345–53.

28. Salvesen DR, Brudenell JM, Snijders RJ, Ireland RM, Nicolaides KH. Fetal plasma erythropoietin in pregnancies complicated by maternal diabetes mellitus. Am J Obstet Gynecol. 1993; 168:88–94.

29. Kawakita T, Bowers K, Hazrati S, Zhang C, Grewal J, Chen Z, et al. Increased neonatal respiratory morbidity associated with gestational and pregestational diabetes: a retrospective study. Am J Perinatol. 2017; 34:1160–8.

30. Becquet O, El Khabbaz F, Alberti C, Mohamed D, Blachier A, Biran V, et al. Insulin treatment of maternal diabetes mellitus and respiratory outcome in late-preterm and term singletons. BMJ Open. 2015; 5:e008192.

31. Chavan N, Jadhav A, Chun H, Monteagudo A. 287: utility of fetal abdominal circumference (AC) in predicting disease progression and perinatal outcomes in gestational diabetes mellitus (GDM). Am J Obstet Gynecol. 2013; 208:S129–30.

32. Garbagnati M, Aye CYL, Cavallaro A, Mathewlynn S, Ioannou C, Impey L. Ultrasound predictors of adverse outcome in pregnancy complicated by pre-existing and gestational diabetes. Acta Obstet Gynecol Scand. 2022; 101:787–93.

33. Zhao D, Liu D, Shi W, Shan L, Yue W, Qu P, et al. Association between maternal blood glucose levels during pregnancy and birth outcomes: a birth cohort study. Int J Environ Res Public Health. 2023; 20:2102.

34. Yew TW, Chi C, Chan SY, van Dam RM, Whitton C, Lim CS, et al. A randomized controlled trial to evaluate the effects of a smartphone application-based lifestyle coaching program on gestational weight gain, glycemic control, and maternal and neonatal outcomes in women with gestational diabetes mellitus: the SMART-GDM study. Diabetes Care. 2021; 44:456–63.

35. Prakash GT, Das AK, Habeebullah S, Bhat V, Shamanna SB. Maternal and neonatal outcome in mothers with gestational diabetes mellitus. Indian J Endocrinol Metab. 2017; 21:854–8.