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Discrepancy between pregnancy dating methods affects obstetric and neonatal outcomes: a population-based register cohort study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health). Region Vastmanland – Uppsala University, Center for Clinical Research, Hospital of Vastmanland Västerås, Sweden.
Department of Clinical Science, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. (Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden)ORCID iD: 0000-0002-6311-9506
(Center for Pharmacoepidemiology, Department of Medicine, Karolinska Institute, Solna, Sweden)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.ORCID iD: 0000-0002-4935-7532
(English)Manuscript (preprint) (Other academic)
Abstract [en]

To assess associations between discrepancy of pregnancy dating methods and adverse pregnancy, delivery, and neonatal outcomes, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for discrepancy categories among all singleton births from the Medical Birth Register (1995–2010) with estimated date of delivery (EDD) by last menstrual period (LMP) minus EDD by ultrasound (US) -20 to +20 days. Negative/positive discrepancy was a fetus smaller/larger than expected when dated by US (EDD postponed/changed to an earlier date). Large discrepancy was <10th or >90th percentile. Reference was median discrepancy ± 2 days. Odds for diabetes and preeclampsia were higher in pregnancies with negative discrepancy, and for most delivery outcomes in case of large positive discrepancy (+9 to +20 days): shoulder dystocia [OR 1.16 (95% CI 1.01–1.33)] and sphincter injuries [OR 1.13 (95% CI 1.09–1.17)]. Odds for adverse neonatal outcomes were higher in large negative discrepancy (–4 to –20 days): low Apgar score [OR 1.18 (95% CI 1.09–1.27)], asphyxia [OR 1.18 (95% CI 1.11–1.25)], fetal death [OR 1.47 (95% CI 1.32–1.64)], and neonatal death [OR 2.19 (95% CI 1.91–2.50)]. In conclusion, especially, large negative discrepancy was associated with increased risks of adverse perinatal outcomes. 

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-345955OAI: oai:DiVA.org:uu-345955DiVA, id: diva2:1189967
Projects
Discrepancy between pregnancy dating methods – correlates and outcomes
Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2018-03-15
In thesis
1. Discrepancy between pregnancy dating methods – correlates and outcomes
Open this publication in new window or tab >>Discrepancy between pregnancy dating methods – correlates and outcomes
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

With the introduction of obstetric ultrasound there has been a shift from last menstrual period-based to ultrasound-based estimation of gestational age. The choice of the method and timing of pregnancy dating is important because it can affect dating precision and perinatal outcomes.

First, when comparing two large population-based cohorts from the Medical Birth Register, from before and after the introduction of ultrasound-based pregnancy dating, male infants on the edge of prematurity did not benefit from progress in medical care as much as female infants in terms of prematurity-related outcomes. This might reflect a bias introduced by the ultrasound-based pregnancy dating method, because of a tendency to overestimate gestational age in pregnancies with a male fetus.

Second, in a large population-based cross-sectional study, the associations of discrepancies between last menstrual period-based and ultrasound-based estimates with variables such as fetal sex and maternal height, indicated that ultrasound-based pregnancy dating introduced systematic errors presumably related to the method’s use of fetal size as a proxy for gestational age. The largest effect estimates were found for maternal obesity in cases of large negative discrepancies.

Third, in a large population-based cohort study, discrepancies between last menstrual period-based and ultrasound-based estimates were associated with several adverse pregnancy, delivery, and neonatal outcomes. Most importantly, a large negative discrepancy was associated with higher odds for neonatal and intrauterine fetal death, as well as for an infant being small for gestational age.

Fourth, in a survey study there was overall good adherence to national guidelines, except for early pregnancy dating. However, the management of discrepancies between methods for pregnancy dating varied widely in clinical practice, which may be due to the lack of national guidelines.

In summary, ultrasound-based dating can be biased by maternal or fetal characteristics. Discrepancies between methods for pregnancy dating may indicate a need for closer monitoring to optimize perinatal care during pregnancy and childbirth.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 59
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1444
Keyword
pregnancy, gestational age, ultrasound, last menstrual period
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-345957 (URN)978-91-513-0277-5 (ISBN)
Public defence
2018-05-04, Samlingssalen, Psykiatricentrum, ingång 29, Västmanlands sjukhus, Västerås, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2018-04-11 Created: 2018-03-15 Last updated: 2018-04-24

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Kullinger, MeritGranfors, MichaelaSkalkidou, Alkistis

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