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Poster Session 2

(395) Isolated large fetal abdominal circumference is associated with adverse perinatal outcomes in non-diabetic pregnancies

Thursday, January 30, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • Alexa L. Cohen, MD

    University of Miami Health System
    Miami, Florida, United States

    • Coauthor(s)

  • ES

    Eliane Shinder, MD

    Montefiore Medical Center, Albert Einstein College of Medicine
    New York, New York, United States

  • GL

    Grace M. Lee, MD

    Montefiore Medical Center, Albert Einstein College of Medicine
    New York, New York, United States

  • CP

    Chloe Porigow

    Montefiore Medical Center, Albert Einstein College of Medicine
    New York, New York, United States

  • Pe'er Dar, MD

    Professor and Director, Division of Fetal Medicine
    Montefiore Medical Center, Albert Einstein College of Medicine
    New York, New York, United States

  • Georgios Doulaveris, MD

    Assistant Professor
    Montefiore Medical Center, Albert Einstein College of Medicine
    New York, New York, United States

Objective: The Society of Maternal Fetal Medicine currently recognizes an association between large for gestational age (LGA), defined as estimated fetal weight (EFW) >90%, and adverse perinatal outcomes. Our study aimed to assess the impact of isolated large fetal abdominal circumference (AC) on maternal and neonatal outcomes in non-diabetic pregnancies.

Study Design:

Retrospective cohort analysis of patients at an urban academic institution who had ultrasonography between 35-36 weeks to estimate fetal weight. Those with multiple gestation, pregestational or gestational diabetes, prior cesarean delivery (CD) and contraindication to vaginal delivery were excluded. Outcomes were compared between three groups: a) appropriate for gestational age (AGA): AC and EFW between 10-90%, b) Isolated large AC: AC >90% and c) LGA: EFW >90%. Groups were matched by parity and gestational age by ultrasound. Primary outcome was primary CD. Secondary outcomes included shoulder dystocia, hemorrhage >1.5L, composite adverse maternal outcome (transfusion, infection, ICU admission, intubation, and mortality) and composite adverse neonatal outcome (APGAR < 7 at 5 min, NICU admission, neonatal morbidity and mortality). Analysis was performed using multivariate logistic regression.

Results:

765 patients were included: 255 in each group. There was no difference in age, parity, body mass index and hypertension among groups. Macrosomia ( >4000 grams) at birth was confirmed in 2.4% of AGA, 12.5% of large AC and 38.0% of LGA group (p< 0.01). Patients with isolated large AC were more likely to have primary CD (aOR 2.41, 95%CI 1.56-3.71, p< 0.01), hemorrhage (aOR 2.76, 95%CI 1.19-6.45, p=0.01) and composite adverse neonatal outcome (aOR 2.98, 95%CI 1.71-5.21, p< 0.01), when compared to AGA group. Outcomes were similar between large AC and LGA groups.

Conclusion:

Isolated large AC with normal EFW is associated with an increased risk of primary CD and adverse perinatal outcomes in non-diabetic pregnancies. Including isolated large AC in the definition of LGA may improve counseling, delivery planning, and perinatal management.