Preliminary evaluation of foetal liver volume by three-dimensional ultrasound in women with gestational diabetes mellitus

• Published in: Journal of obstetrics and gynaecology Vol. 38; no. 7; pp. 922 - 926
• Main Authors: İlhan, Gülşah, Gültekin, Hüseyin, Kubat, Ayça, Gokmen Karasu, Ayse Filiz, Güngör, Emre Sinan, Zebitay, Galip Ali, Verit Atmaca, Fatma Ferda
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 03-10-2018; Taylor & Francis Ltd
• Subjects: Biometrics; foetal biometric measurements; foetal liver volume; Gestational diabetes; Gestational diabetes mellitus; Liver; oral glucose tolerance test; Pregnancy; screening; three-dimensional ultrasound; Ultrasonic imaging; Gestational diabetes mellitus; screening; oral glucose tolerance test; foetal liver volume; three-dimensional ultrasound; foetal biometric measurements
• ISSN: 0144-3615; 1364-6893
• DOI: 10.1080/01443615.2018.1434136

The aim of the study was to assess the standard foetal biometric measurements and foetal liver volume (FLV) in pregnancies complicated by gestational diabetes mellitus (GDM) at the time of GDM screening and to compare the results with foetuses in normal pregnancies. Ninety-seven pregnant women with normal singleton uncomplicated pregnancies between 24 and 28 weeks of gestation were allocated into GDM (+) (n: 33) and GDM (−) (n: 64) groups based on their 75 g oral glucose tolerance test results. Foetal biometric measurements and FLV measurements of the groups were compared. Although there were no significant differences in the standard biometric measurements between the two groups, FLV was significantly higher in the women with GDM (p < .01). The ROC analysis implied that with a cut-off value of FLV of 32.72 cm
3
for GDM prediction, the sensitivity was 78.8% and specificity was 56.3%. We suggest that FLV measurements during the second-trimester ultrasound scanning may be a tool for the prediction of GDM in the obstetric population.
Impact statement
What is already known on this subject? GDM is an important pregnancy disease, because of its possible foetal and maternal complications. Besides the standard biometric measurements, some other foetal body dimensions such as the anterior abdominal wall thickness, skinfold thickness, adipose tissue thickness, Wharton's jelly thickness, foetal liver length and foetal liver volume (FLV) have been evaluated as ultrasound parameters of glycaemic control. While the evaluation of foetal liver dimensions has a role in identifying foetal growth acceleration, previous studies addressed patients with insulin-dependent diabetes mellitus rather than gestational diabetes mellitus, utilised two-dimensional ultrasound and did not argue the diagnostic value of these findings.
What do the results of this study add? In our study, besides the standard biometric measurements, the FLV measurements were evaluated by a three-dimensional ultrasound. Although there were no significant differences in the standard biometric measurements between the GDM (+) and GDM (−) groups, the FLV was significantly higher in women with GDM. The FLV was found to be a potential predictive factor for GDM. The ROC analysis implied that as a cut-off value of FLV of 32.72 cm
3
for GDM prediction, the sensitivity was 78.8% and the specificity was 56.3%.
What are the implications of these findings for clinical practise and/or further research? Screening for GDM with oral glucose tolerance test within the limited weeks of gestation may not always be feasible. On the other hand, the mid-trimester ultrasound scanning is done almost in all pregnancies. Accordingly, FLV measurement might be an alternative method for the GDM diagnosis.