title: The effect of maternal obesity on sonographic fetal weight estimation and perinatal outcome in pregnancies complicated by fetal growth restriction.
abstract: OBJECTIVE
  Maternal obesity represents a challenge in the sonographic (US) assessment of fetal weight, and is a recognized risk factor for adverse pregnancy outcome. The objective of this secondary analysis of data from the Prospective Observational Trial to Optimize Pediatric Health in fetal growth restriction (FGR) Study (PORTO) was to describe the effect of maternal obesity on the accuracy of US in determining the estimated fetal weight (EFW) and the perinatal outcome of pregnancies affected by FGR.
  
  
  METHODS
  Between 2010 and 2012, 1,116 women with nonanomalous singleton pregnancies with an EFW in less than the tenth centile were recruited for the PORTO study. Maternal body mass index (BMI) was divided into five subcategories: normal (BMI < 24.9 kg/m(2) ), overweight (25-29.9), obese class 1 (30-34.9), obese class 2 (35-39.9), and obese class 3 (>40). The accuracy of the EFW was determined in women who delivered within 2 weeks of their last US scan. Perinatal outcomes were analyzed by BMI subcategory.
  
  
  RESULTS
  Of the 1,074 patients with complete records, 691 (64%) were of normal weight, 258 (24%) were overweight, 93 (9%) were in obese class 1, 32 (3%) were in obese class 2, and none were in obese class 3. Overall, the EFW determined prior to delivery was within 6% of the actual birth weight in all BMI subcategories. Overweight and obese women delivered more commonly by cesarean section and at earlier gestational ages than did women with a normal BMI (p = 0.0008), resulting in lower birth weights (p = 0.0031) and significantly increased composite perinatal morbidity (p < 0.0001) and mortality (p = 0.0215) rates.
  
  
  CONCLUSIONS
  US examination is reliable for assessing the weight of fetuses with FGR in overweight women. Maternal obesity, however, has a significant adverse effect on perinatal outcomes. Thus, health education should focus on awareness of this adverse effect, with optimization of prepregnancy weight as its main goal.
authors.affiliation: Rotunda Hospital, Dublin, Ireland.
authors.forename: Fiona
authors.initials: F
authors.lastname: Cody
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Julia
authors.initials: J
authors.lastname: Unterscheider
authors.affiliation: Coombe Women and Infants University Hospital, Dublin, Ireland.
authors.forename: Sean
authors.initials: S
authors.lastname: Daly
authors.affiliation: Rotunda Hospital, Dublin, Ireland.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Geary
authors.affiliation: UCD Center for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland.
authors.forename: Mairead M
authors.initials: MM
authors.lastname: Kennelly
authors.affiliation: UCD Obstetrics and Gynecology, School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland.
authors.forename: Fionnuala M
authors.initials: FM
authors.lastname: McAuliffe
authors.affiliation: University College Cork, Cork University Maternity Hospital, Cork, Ireland.
authors.forename: Keelin
authors.initials: K
authors.lastname: O'Donoghue
authors.affiliation: Royal Jubilee Maternity Hospital, Belfast, Ireland.
authors.forename: Alyson
authors.initials: A
authors.lastname: Hunter
authors.affiliation: National University of Ireland, Galway, Ireland.
authors.forename: John J
authors.initials: JJ
authors.lastname: Morrison
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Gerard
authors.initials: G
authors.lastname: Burke
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Dicker
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Tully
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Fergal D
authors.initials: FD
authors.lastname: Malone
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001835:Body Weight; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D020567:Fetal Weight; D006801:Humans; D009765:Obesity; D011247:Pregnancy; D011256:Pregnancy Outcome; D016216:Ultrasonography, Prenatal
keywords: fetal growth restriction; fetal weight estimation; maternal obesity; perinatal outcome; ultrasonography