Agreement Analysis between Sonographic Estimates and Birth Weight, by the WHO and Intergrowth-21st Tables, in Newborns of Diabetic Mothers

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 21^st Century (intergrowth-21^st) 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-21^st 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-21^st 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-21^st: Kappa = 0.42) and with the final EFW (WHO: Kappa = 0.33; intergrowth- 21^st: Kappa = 0.35).

Conclusion The initial AC and final EFW were the parameters of best agreement regarding birth weight classification. The WHO and intergrowth-21^st tables showed high agreement in the classification of ultrasound measurements in relation to the 90th percentile. Studies are needed to confirm whether any of these tables are superior in predicting short- and long-term negative outcomes in the LGA group.

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 21^st Century integrowth-21^st, 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-21^st, 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-21^st 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). Em relação ao peso ao nascer, as melhores concordâncias foram encontradas para a CA inicial (OMS: Kappa = 0,35; intergrowth-21^st: Kappa = 0,42) e com o PFE final (OMS: Kappa = 0,33; intergrowth-21^st: 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-21^st 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.

Keywords

abdominal circumference - estimated fetal weight - birth weight - gestational diabetes - growth charts

Palavras-chave

circunferência abdominal - peso fetal estimado - peso ao nascer - diabetes gestacional - gráficos de crescimento

Contributions

Souza M. V. R. contributed by collecting data and writing the first draft; Cortez P. A. contributed by performing the statistical analysis and writing the first draft; Fróes L. P. and Rajão K. M. A. B. had the original idea for the present study, supervised the data collecton and reviewed the first draft; Aguiar R. A. L. and Lauria M. W. reviewed the first draft and the final version to be published.

Publication History

Received: 25 November 2019

Accepted: 17 September 2020

Article published online:
29 January 2021

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