Fetal ultrasound scans to guide management of gestational diabetes: Improved neonatal outcomes in routine clinical practice

Sarah J Davidson; Susan J de Jersey; Fiona L Britten; Penny Wolski; Renuka Sekar; Leonie K Callaway

doi:10.1016/j.diabres.2021.108696

Fetal ultrasound scans to guide management of gestational diabetes: Improved neonatal outcomes in routine clinical practice

Diabetes Res Clin Pract. 2021 Mar:173:108696. doi: 10.1016/j.diabres.2021.108696. Epub 2021 Feb 13.

Authors

Sarah J Davidson¹, Susan J de Jersey², Fiona L Britten³, Penny Wolski⁴, Renuka Sekar⁵, Leonie K Callaway³

Affiliations

¹ Women's & Newborn Services, Royal Brisbane & Women's Hospital, Cnr Butterfield St and Bowen Bridge Rd, Herston, Queensland 4029, Australia; Duke University School of Medicine, DUMC 3710, Durham, NC 27710, USA; Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918, Royal Brisbane & Women's Hospital Campus, Herston, Queensland 4029, Australia. Electronic address: sarahj.davidson@yahoo.com.
² Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918, Royal Brisbane & Women's Hospital Campus, Herston, Queensland 4029, Australia; Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Cnr Butterfield St and Bowen Bridge Rd, Herston, Queensland 4029, Australia.
³ Women's & Newborn Services, Royal Brisbane & Women's Hospital, Cnr Butterfield St and Bowen Bridge Rd, Herston, Queensland 4029, Australia; Faculty of Medicine, The University of Queensland, Mayne Medical Building, 288 Herston Road, Herston, Queensland 4006, Australia.
⁴ Women's & Newborn Services, Royal Brisbane & Women's Hospital, Cnr Butterfield St and Bowen Bridge Rd, Herston, Queensland 4029, Australia.
⁵ Maternal and Fetal Medicine Specialist, Royal Brisbane & Women's Hospital, Cnr Butterfield St and Bowen Bridge Rd, Herston, Queensland 4029, Australia.

PMID: 33592211
DOI: 10.1016/j.diabres.2021.108696

Abstract

Aims: Some guidelines recommend altering glycemic targets in gestational diabetes mellitus (GDM) based on ultrasound measurements of fetal growth, but the impact on outcomes in clinical practice is unknown. The aim of this study was to compare the effects of ultrasound-guided and non-ultrasound-guided management on neonatal outcomes.

Methods: This was a retrospective, observational study of a random sample of women with GDM and their infants. Outcomes were compared between those who had GDM management tailored according to fetal growth and those who did not.

Results: In the sample of 221 women, 134 had documentation of ultrasound-guided management while 87 did not. There was no significant difference in size-for-gestational age between groups. Fewer neonates in the ultrasound-guided management group were admitted to the Special Care or Intensive Care Nursery (29.1% vs. 48.3%, P = 0.004), had a prolonged hospital stay (3.7% vs. 13.8%, P = 0.006), or had hypoglycemia after birth (42.5% vs. 56.3%, P = 0.045). The reduction in admission rates and prolonged hospital stays remained significant after controlling for confounding variables.

Conclusions: Ultrasound-guided management was independently associated with improvements in some neonatal outcomes.

Keywords: Fetal growth; Gestational diabetes; Glycemic control; Neonatal outcome; Ultrasound.

MeSH terms

Adult
Diabetes, Gestational / diagnostic imaging*
Female
Humans
Pregnancy
Pregnancy Outcome
Retrospective Studies
Ultrasonography, Prenatal / methods*