Document Detail


First-trimester detection of fetal anomalies in pregestational diabetes using nuchal translucency, ductus venosus Doppler, and maternal glycosylated hemoglobin.
MedLine Citation:
PMID:  23353022     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: The frequency of fetal anomalies in women with pregestational diabetes correlates with their glycemic control. This study aimed to assess the predictive performance of first trimester fetal nuchal translucency (NT), ductus venosus (DV) Doppler, and hemoglobin A1c (HbA1c) to predict fetal anomalies in women with pregestational diabetes. STUDY DESIGN: Prospective observational study of patients undergoing first trimester NT with DV Doppler. Screening performance was tested for first trimester parameters to detect fetal anomalies. RESULTS: Of 293 patients, 17 had fetal anomalies (11 cardiac/7 major/3 multisystem). All anomalous fetuses were suspected prenatally. One had an NT>95(th)centile, 2 had a reversed DV a-wave and 13 had a HbA1c >7.0%. The HbA1c was the primary determinant of anomalies (r(2) 0.15, p<0.001) and >8.35% was the optimal cutoff for prediction of anomalies with an area under the curve of 0.72 (95% CI 0.57-0.88). Therefore, first trimester prediction of anomalies was best in women with increased NT or HbA1c>8.3% (sensitivity 70.6%, specificity 77.4%, positive predictive value 16.2%, negative predictive value 97.7%, p<0.001). CONCLUSIONS: In women with pregestational diabetes and poor glycemic control an increased NT increases risks for major fetal anomalies. Second trimester follow-up is required to achieve accurate prenatal diagnosis.
Authors:
Jena L Miller; Margarita De Veciana; Sifa Turan; Michelle Kush; Anita Manogura; Christopher R Harman; Ahmet A Baschat
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-24
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  -     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Mosby, Inc. All rights reserved.
Affiliation:
Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland, Baltimore, Maryland, USA; Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA.
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