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Routine ultrasound screening in diabetic pregnancies
Author(s) -
Wong S. F.,
Chan F. Y.,
Cincotta R. B.,
Oats J. J. N.,
Mcintyre H. D.
Publication year - 2002
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.0960-7692.2001.00560.x
Subject(s) - medicine , obstetrics , diabetes mellitus , fetus , incidence (geometry) , population , confidence interval , retrospective cohort study , fetal echocardiography , pregnancy , surgery , prenatal diagnosis , endocrinology , physics , environmental health , biology , optics , genetics
Objectives To assess the detection rate of congenital fetal malformations and specific problems related to routine ultrasound screening in women with pre‐existing diabetes. Methods A retrospective study was carried out to assess the performance of routine ultrasound screening in women with pre‐existing diabetes (Types 1 and 2) within a tertiary institution. The incidence, type and risk factors for congenital fetal malformations were determined. The detection rate of fetal anomalies for diabetic women was compared with that for the low‐risk population. Factors affecting these detection rates were evaluated. Results During the study period, 12 169 low‐risk pregnant women and 130 women with pre‐existing diabetes had routine ultrasound screening performed within the institution. A total of 10 major anomalies (7.7%) and three minor anomalies (2.3%) were present in the fetuses of the diabetic women. Central nervous system and cardiovascular system anomalies accounted for 60% of the major anomalies. Periconceptional hemoglobin A1c of more than 9% was associated with a high prevalence of major anomalies (143/1000). Women who had fetuses with major anomalies had a significantly higher incidence of obesity (78% vs. 37%; P < 0.05). Ultrasound examination of these diabetic pregnancies showed high incidences of suboptimal image quality (37%), incomplete examinations, and repeat examinations (17%). Compared to the ‘low‐risk’ non‐diabetic population from the same institution, the relative risk for a major congenital anomaly among the diabetic women was 5.9‐fold higher (95% confidence interval, 2.9–11.9). The detection rate for major fetal anomalies was significantly lower for diabetic women (30% vs. 73%; P < 0.01), and the mean body mass index for the diabetic group was significantly higher (29 vs. 23 kg/m 2 ; P < 0.001). Conclusion The incidence of congenital anomalies is higher in diabetic pregnancies. Unfortunately, the detection rate for fetal anomalies by antenatal ultrasound scan was significantly worse than that for the low‐risk population. This is likely to be related to the maternal body habitus and unsatisfactory examinations. Methods to overcome these difficulties are discussed. Copyright © 2002 ISUOG