BACKGROUND AND PURPOSE:

• Rekawek et al. (Ultrasound in Obstetrics & Gynecology, 2019) investigated the association between large for gestational age (LGA) diagnosed during second trimester ultrasound and
  • Development of gestational diabetes mellitus (GDM)
  • LGA at birth

METHODS:

• Retrospective cohort study
• Participants
  • Second trimester anatomy ultrasound between 18 and 22 weeks
  • Exclusion: Pregestational diabetes | Multiple gestation | Preterm delivery | Betamethasone use | Fetal anomalies
• LGA group
  • EFW >90th percentile and/or
  • AC >90th percentile
• AGA group
  • EFW >10th percentile but ≤89th percentile
• Data analysis
  • Multivariable logistic regression modeling
• Primary outcomes
  • Development of GDM
  • LGA at birth

RESULTS:

• 756 LGA | 756 AGA
• LGA diagnosed in the 2nd trimester
  • Incidence of GDM: 6%
  • Incidence of LGA at birth: 14.9%
  • Those who developed GDM or LGA at birth were significantly older
• Parity
  • Associated with neonatal LGA (P = 0.0003)
  • Not associated with GDM (P = 0.82)
• Second trimester LGA diagnosis was significantly associated with
  • GDM: Odds ratio (OR) 2.54 (95% CI, 1.29 to 5.03; p=0.007)
  • Neonatal LGA at birth: OR 6.85 (95% CI, 3.60 to 13.05; p<0.0001)
• Risk for developing GDM or neonatal LGA were independent other risk factors

CONCLUSION:

• An LGA diagnosis at second trimester ultrasound is associated with development of GDM and LGA at birth
• The authors state that

This may offer a unique opportunity to identify pregnancies at high risk of developing GDM and LGA at birth (with associated neonatal morbidity) as well as potential intervention with earlier screening for diabetes and serial ultrasound measurement for fetal weight

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Learn More – Primary Sources:

Large-for-gestational age diagnosed during second-trimester anatomy ultrasound and association with gestational diabetes and large-for-gestational age at birth

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