Agreement analysis between sonographic estimates and birth weight, by the WHO and intergrowth-21st tables, in newborns of diabetic mothers / Análise de concordância entre estimativas ultrassonográficas e peso ao nascer, pelas tabelas da OMS e Intergrowth-21st, em recém-nascidos de mães diabéticas

Abstract Objective To analyze the agreement, in relation to the 90th percentile, of ultrasound measurements of abdominal circumference (AC) and estimated fetal weight (EFW), between the World Health Organization (WHO) and the International Fetal and Newborn Growth Consortium for the 21st Century (intergrowth-21st) tables, as well as regarding birth weight in fetuses/newborns of diabetic mothers. Methods Retrospective study with data from medical records of 171 diabetic pregnant women, single pregnancies, followed between January 2017 and June 2018. Abdominal circumference and EFW data at admission (from 22 weeks) and predelivery (up to 3 weeks) were analyzed. These measures were classified in relation to the 90th percentile. The Kappa coefficient was used to analyze the agreement of these ultrasound variables between the WHO and intergrowth-21st tables, as well as, by reference table, these measurements and birth weight. Results The WHO study reported 21.6% large-for-gestational-age (LGA) newborns while the intergrowth-21st reported 32.2%. Both tables had strong concordances in the assessment of initial AC, final AC, and initial EFW (Kappa = 0.66, 0.72 and 0.63, respectively) and almost perfect concordance in relation to final EFW (Kappa = 0.91). Regarding birth weight, the best concordances were found for initial AC (WHO: Kappa = 0.35; intergrowth-21st: Kappa= 0.42) and with the final EFW (WHO: Kappa = 0.33; intergrowth- 21st: Kappa = 0.35). Conclusion The initial AC and final EFW were the parameters of best agreement regarding birth weight classification. The WHO and intergrowth-21st tables showed high agreement in the classification of ultrasound measurements in relation to the 90th

Resumo Objetivo Analisar a concordância, em relação ao percentil 90, das medidas ultrassonográficas da circunferência abdominal (CA) e peso fetal estimado (PFE), entre as tabelas da Organização Mundial de Saúde (OMS) e do International Fetal and Newborn Growth Consortium for the 21st Century integrowth-21st, bem como em relação ao peso ao nascer em fetos/recém-nascidos de mães diabéticas. Métodos Estudo retrospectivo com dados de prontuários de 171 gestantes diabéticas, com gestações únicas, seguidas entre Janeiro de 2017 e Junho de 2018. Foram analisados dados da CA e do PFE na admissão (a partir de 22 semanas) e no pré-parto (até 3 semanas). Essas medidas foram classificadas em relação ao percentil 90. O coeficiente Kappa foi utilizado para analisar a concordância entre as tabelas da OMS e Intergrowth-21st, assim como, por tabela de referência, entre as medidas e o peso ao nascer. Resultados O estudo da OMS relatou 21,6% dos recém nascidos grandes para a idade gestacional (GIG) enquanto que o estudo do intergrowth-21st relatou 32,2%. Ambas as tabelas tiveram fortes concordâncias na avaliação da CA inicial e final e PFE inicial (Kappa= 0,66, 0,72 e 0,63, respectivamente) e concordância quase perfeita em relação ao PFE final (Kappa= 0,91).Emrelação ao peso ao nascer, asmelhores concordâncias foram encontradas para aCAinicial (OMS: Kappa= 0,35; intergrowth-21st: Kappa= 0,42) e como PFE final (OMS: Kappa = 0,33; intergrowth-21st: Kappa= 0,35). Conclusão A CA inicial e o PFE final foram os parâmetros de melhor concordância em relação à classificação do peso ao nascer. As tabelas da OMS e intergrowth-21st mostraram alta concordância na classificação das medidas ultrassonográficas em relação ao percentil 90. Estudos são necessários para confirmar se alguma dessas tabelas é superior na previsão de resultados negativos a curto e longo prazo no grupo GIG.

Congenital heart disease in infants of diabetic mother's echocardiographic study

Study of neonates born to Mothers with diabetes mellitus [including Gestational diabetes] to detect the spectrum of congenital heart disease [CHD] using non-invasive echocardiographic screening. Between October2007 and January 2010, a prospective study of68 infants of diabetic mothers [IDMs] at Al-thawra teaching Hospital in Albaida-libya was arranged. .Family and maternal history included, cardiovascular system examination and echocardiography were performed. Total of 68 IDMs examined, Echocardiographic findings were: patent foramen oval [72%].PDA [53%], ventricular septal defect both muscular and membranous [10%], atrial septal defect [6%], and valvular pulmonary stenosis [<2%], peripheral pulmonary stenosis [6%] Hypertrophied interventricular septum was seen in 60% of cases. Tetrology of fallot [3%], Hypo plastic left heart syndrome one case [<2%], TGAnot seen in this group of study, other complex cardiac Topography account 1.5%, isolated coarctation of aorta<2%. Overall incidence of congenital heart disease was 25% [without PDA, PFO, septum hypertrophy, peripheral PS]. Maternal diabetes is a significant risk factor for CHD. Careful evaluation and early diagnosis of CHD in this high-risk group are highly recommended and there is a need for development of postnatal screening programs for CHD in this risk group in our population, also our policy of antenatal hyperglycemia control need to be reviewed

value of ultrasonic epiphyseal ossification centers and placental grading in the predication of fetal lung maturity in normal, preeclamptic and diabetic pregnancies

In the present study, a non-invasive method for assessment of fetal lung maturity via sonographic characterization of placental maturity and fetal epiphyseal ossification centers around the knee and shoulder was evaluated. These sonographic parameters were correlated with the amniocentesis phospholipid profile as an indicator of accuracy. They were studied in 40 normal pregnancies, 40 preeclamptic and 40 diabetic pregnancies with gestational ages ranging between 32-41 weeks. It was found that in normal pregnancies, the presence of grade 3 placenta, or DFE >/5 mm or PTE >/3 mm or the presence of PHE predicts a mature phospholipid profile in 100% of patients. However, in preeclamptic patients, the presence of grade 3 placenta is not a reliable predictor of lung maturity, but the presence of DFE >/5 mm or PTE >/3 mm or the presence of PHE has 100% positive predictive value of mature phospholipid profile. On the other hand, in diabetic pregnancies neither grade 3 placenta nor DFE >/ 5 mm are reliable indicators of fetal lung maturity. Finally, the identification of PTE >/5 mm or the presence of PHE can reliably identify a mature phospholipid profile in all studied groups with 100% accuracy. Such a perfect correlation between these epiphyseal ossification dimensions and fetal lung maturity favors the use of these selective noninvasive sonographic parameters as an alternative to invasive amniocentesis phospholipid profile in prediction of fetal lung maturity. This could save time, money, emotional investment, fetal and maternal morbidity