Sonographic birth-weight prediction in obese patients using the gestation-adjusted prediction method.

Abstract

Ultrasound birth-weight prediction may be more accurate if assessed at 34 to 36 + 6 weeks' gestation and extrapolated using the gestation-adjusted projection (GAP) method than if done at term. Because ultrasound is less accurate in women with elevated body mass index (BMI), we assessed the accuracy of GAP birth-weight prediction in obese as compared to non-obese women. We performed a retrospective review of 1382 women with singleton pregnancies who had undergone fetal ultrasound examination at between 34 + 0 and 36 + 6 weeks, subclassified by pre-pregnancy BMI. Analysis of variance was used to compare predicted and actual birth weight. 1025 controls and 357 obese women were included. The obese women were divided by BMI: 159 in Class I (BMI, 30-34.9 kg/m(2)); 105 in Class II (BMI, 35-40 kg/m(2)) and 93 in Class III (BMI > 40 kg/m(2)). Mean systematic (percent) birth-weight prediction error was within 4% for all groups, with a 95% error range between - 5% and + 5%. The GAP method was able to predict actual birth weight within 20% for all groups in over 90% of cases. For all groups, the GAP method correctly excluded the presence of macrosomia with >or= 90% specificity. Negative likelihood ratios for the prediction of macrosomia were between 0.4 and 0.6 for all groups, regardless of obesity. The GAP method of birth-weight prediction using ultrasound measurement at 34 to 36 + 6 weeks predicts birth weight within 20% error in over 90% of cases, and is able to exclude macrosomia with over 90% accuracy regardless of maternal BMI.