Effect of Increased Body Mass Index on First-Trimester Ultrasound Examination for Aneuploidy Risk Assessment

Gandhi, Manisha; Fox, Nathan S.; Russo-Stieglitz, Karen; Hanley, Mary E.; Matthews, Gail; Rebarber, Andrei

doi:10.1097/aog.0b013e3181b6bfdc

Cited by 32 publications

(17 citation statements)

References 14 publications

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“…As demonstrated in multiple studies (15–19, 54) and visualized herein, maternal obesity decreases the practitioner’s ability to confidently recognize such markers, or accurately assess their dimensions. For example, from the representative images in obese women, please note the poor delineation of the boarders of the lateral ventricles and renal pelvis (which may lead to inaccurate assessment), alongside the decreased echogenicity of the intracardiac echogenic focus (which may lead to missed diagnosis).…”

Section: Figurementioning

confidence: 81%

“…The decreased ability to detect the nuchal translucency in the overweight and obese populations limits effectiveness of first trimester screening for Down syndrome and trisomy 18 (15). Additionally, an increased BMI has been shown to increase the frequency of inadequate nasal bone assessment, increased need for transvaginal ultrasound examination and an increased amount of time to obtain adequate ultrasound images (50, 54). Screening is less effective without a nuchal translucency and studies report up to a 20% failure rate in obtaining a nuchal translucency in morbidly obese populations (49,50).…”

Section: Prenatal Diagnosis: Limitations In An Obese and At Risk Popumentioning

confidence: 99%

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Obesity and the Risk and Detection of Fetal Malformations

Racusin

Stevens

Campbell

et al. 2012

Seminars in Perinatology

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The incidence of obesity in pregnancy has increased over the past two decades, with nearly 50% of U.S. women aged 15–49 are classified as overweight or obese. Obesity (independent of diabetes) among gravidae poses unique risks which extend towards the fetus, with several large population-based analyses demonstrating independent increased risks for fetal malformations including neural tube defects, cardiac anomalies, and orofacial clefts as well as stillbirth and macrosomia. Unfortunately, several lines of evidence also suggest that the quality of the prenatal fetal anatomic survey and certain aspects of prenatal diagnostic screening programs are significantly limited. The net effect is that among obese gravidae, the increased risk of fetal anomalies is further offset by a concomitant diminished ability to sonographically detect such malformation in the prenatal interval. The purpose of this summary review is to systematically examine the evidence suggesting an increased risk of fetal malformations in obese gravidae, the contributing role of diabetes, and the limitations of prenatal diagnostic and sonographic screening among this at-risk population.

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Section: Figurementioning

confidence: 81%

Section: Prenatal Diagnosis: Limitations In An Obese and At Risk Popumentioning

confidence: 99%

Obesity and the Risk and Detection of Fetal Malformations

Racusin

Stevens

Campbell

et al. 2012

Seminars in Perinatology

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“…Given these limitations in the sensitivity and specificity of first‐trimester sonography, our data reinforce the continuing need for second‐trimester anatomic evaluations. Additionally, maternal factors that can limit sonographic examinations, most notably the maternal body mass index and prior abdominal surgery, were not available and could not be factored into the feasibility of detecting limb abnormalities in the first trimester 52 , 53 . Clearly, larger prospective trials are needed to evaluate the assessment of abnormalities on first‐trimester sonography in general and fetal limbs in particular.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Fetal Limb Abnormalities Before 15 Weeks

Rice

Ballas

Lai

et al. 2011

J of Ultrasound Medicine

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Fetal limb abnormalities can be detected on sonography before 15 weeks' gestational age and are often associated with serious congenital conditions, especially trisomy 18. Transabdominal sonography alone can show most of these abnormalities, although transvaginal and 3-dimensional sonography can provide additional information. Targeted evaluation of fetal limbs during sonography before 15 weeks should be considered in high-risk populations.

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“…In another retrospective study of first-trimester ultrasound, Gandhi et al found an increased ultrasound examination time of 17.01 ± 7.97 min in obese women compared to 15.23 ± 8.09 min in normal-weight women [16]. Although the study did not find obesity to affect the completion rates of obtaining NT, it did find the need to perform transvaginal ultrasound examination to be significantly higher in obese women (41.8%) compared to normal-weight women (22.99%) (P < 0.001).…”

Section: First-trimester Ultrasoundmentioning

confidence: 94%