Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

The impact of maternal obesity on midtrimester sonographic visualization of fetal cardiac and craniospinal structures

Abstract

OBJECTIVE: To examine the impact of maternal obesity on the rate of suboptimal ultrasound visualization (SUV) of fetal anatomy and determine the optimal timing of prenatal ultrasound examination for the obese gravida.

METHODS: A computerized ultrasound database was used to identify ultrasound examinations for singleton gestations performed between 140/7 and 236/7 weeks at a tertiary care, university-based hospital. Patients were divided into four groups and categorized based on body mass index (BMI): nonobese (BMI <30 kg/m2), class I obesity (30≤BMI<35 kg/m2), class II obesity (35≤BMI<40 kg/m2), and extreme obesity (BMI ≥40 kg/m2). The rates of SUV for fetal cardiac and craniospinal structures were calculated for each group and compared.

RESULTS: A total of 11 019 pregnancies were studied, of which 38.6% of the patients were obese. Overall, the rate of SUV of the fetal structures was higher for obese compared to nonobese women for both cardiac (37.3 [1723/4200] vs 18.7% [1275/6819]; P<0.0001) and craniospinal structures (42.8 [1798/4200] vs 29.5% [2012/6819]; P<0.0001). Increased severity of maternal obesity was associated with SUV rate for both the cardiac (nonobese 18.7% [1275/6819], class I 29.6% [599/2022], class II 39.0% [472/1123], and extreme obesity 49.3% [580/1055]; P<0.0001) and for the craniospinal structures: (nonobese 29.5% [2012/6819], class I 36.8% [744/2022], class II 43.3% [486/1123], and extreme obesity 53.4% [563/1055]; P<0.0001). With increasing gestational age at examination, the rate of SUV decreased for both obese and nonobese women. However, for obese women there was minimal improvement in visualization after 18–20 weeks. Even after adjustment for gestational age and the type of ultrasound machine, obese women (class I, class II, and extreme obesity) were still associated with increased odds for SUV of the fetal cardiac and craniospinal structures compared to nonobese women.

CONCLUSION: Maternal obesity increases the rate of SUV for the fetal cardiac structures by 49.8% and for the craniospinal structures by 31%. The optimal gestational age for visualization of fetal cardiac and craniospinal anatomy in obese patients may be after 18–20 weeks.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. March of Dimes. Nutrition Today Matters Tomorrow. March of Dimes Task Force on Nutrition and Optimal Human Development, March of Dimes Fulfillment Center: Wilkes-Barre, PA, 2002.

  2. Cnattingius S, Bergstrom R, Lipworth L, Kramer MS . Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med 1998; 338: 147–152.

    Article  CAS  Google Scholar 

  3. Hendricks KA, Nuno OM, Suarez L, Larsen R . Effects of hyperinsulinemia and obesity on risk of neural tube defects among Mexican Americans. Epidemiology 2001; 12: 630–635.

    Article  CAS  Google Scholar 

  4. Mikhail LN, Walker CK, Mittendorf R . Association between maternal obesity and fetal cardiac malformations in African Americans. J Natl Med Assoc 2002; 94: 695–700.

    PubMed  PubMed Central  Google Scholar 

  5. Queisser-Luft A, Kieninger-Baum D, Menger H, Stolz G, Schlaefer K, Merz E . Does maternal obesity increase the risk of fetal abnormalities? Analysis of 20 248 newborn infants of the Mainz Birth Register for detecting congenital abnormalities. Ultraschall Med 1998; 19: 40–44.

    Article  CAS  Google Scholar 

  6. Schaefer-Graf UM, Heuer R, Kilavuz O, Pandura A, Henrich W, Vetter K . Maternal obesity not maternal glucose values correlates best with high rates of fetal macrosomia in pregnancies complicated by gestational diabetes. J Perinat Med 2002; 30: 313–321.

    Article  Google Scholar 

  7. Shaw GM, Todoroff K, Finnell RH, Lammer EJ . Spina bifida phenotypes in infants or fetuses of obese mothers. Teratology 2000; 61: 376–381.

    Article  CAS  Google Scholar 

  8. Shaw GM, Velie EM, Schaffer D . Risk of neural tube defect-affected pregnancies among obese women. JAMA 1996; 275: 1093–1096.

    Article  CAS  Google Scholar 

  9. Waller DK, Mills JL, Simpson JL, Cunningham GC, Conley MR, Lassman MR, Rhoads GG . Are obese women at higher risk for producing malformed offspring? Am J Obstet Gynecol 1994; 170: 541–548.

    Article  CAS  Google Scholar 

  10. Watkins ML, Scanlon KS, Mulinare J, Khoury MJ . Is maternal obesity a risk factor for anencephaly and spina bifida? Epidemiology 1996; 7: 507–512.

    Article  CAS  Google Scholar 

  11. Wong SF, Chan FY, Cincotta RB, Oats JJ, McIntyre HD . Routine ultrasound screening in diabetic pregnancies. Ultrasound Obstet Gynecol 2002; 19: 171–176.

    Article  CAS  Google Scholar 

  12. Watkins ML, Rasmussen SA, Honein MA, Botto LD, Moore CA . Maternal obesity and risk for birth defects. Pediatrics 2003; 111: 1152–1158.

    PubMed  Google Scholar 

  13. Carvalho MH, Brizot ML, Lopes LM, Chiba CH, Miyadahira S, Zugaib M . Detection of fetal structural abnormalities at the 11–14 week ultrasound scan. Prenat Diagn 2002; 22: 1–4.

    Article  CAS  Google Scholar 

  14. Rosenberg JC, Guzman ER, Vintzileos AM, Knuppel RA . Transumbilical placement of the vaginal probe in obese pregnant women. Obstet Gynecol 1995; 85: 132–134.

    Article  CAS  Google Scholar 

  15. DeVore GR, Medearis AL, Bear MB, Horenstein J, Platt LD . Fetal echocardiography: factors that influence imaging of the fetal heart during the second trimester of pregnancy. J Ultrasound Med 1993; 12: 659–663.

    Article  CAS  Google Scholar 

  16. Wolfe HM, Sokol RJ, Martier SM, Zador IE . Maternal obesity: a potential source of error in sonographic prenatal diagnosis. Obstet Gynecol 1990; 76: 339–342.

    CAS  PubMed  Google Scholar 

  17. American Institute of Ultrasound in Medicine. Guidelines—Antepartum Obstetric. AIUM: Laurel, MD, 2003.

  18. National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. NIH Publication No. 98-4083. Department of Health and Human Services, National Institutes of Health: Bethesda, MD; 1998.

  19. Schwarzler P, Senat MV, Holden D, Bernard JP, Masroor T, Ville Y . Feasibility of the second-trimester fetal ultrasound examination in an unselected population at 18, 20 or 22 weeks of pregnancy: a randomized trial. Ultrasound Obstet Gynecol 1999; 14: 92–97.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to I Hendler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hendler, I., Blackwell, S., Bujold, E. et al. The impact of maternal obesity on midtrimester sonographic visualization of fetal cardiac and craniospinal structures. Int J Obes 28, 1607–1611 (2004). https://doi.org/10.1038/sj.ijo.0802759

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0802759

Keywords

This article is cited by

Search

Quick links