Effect of Maternal Body Mass Index on The Accuracy of Sonographic Estimation of Foetal Weight in Late Gestation

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https://ejmr.journals.ekb.eg/biometrics "BPD, HC, AC and FL", estimated fetal weight and actual birth weight between the six groups.There was no significant difference between the different groups of the study absolute error of change and mean percentage error of change between EFW and AFW.According to AFI, 21 (7.0%) of our participants were having oligohydramnios, 272 (90.7%) were having normal AFI and 7 (2.3%) were having polyhydramnios.Conclusion: There was a statistically significant relationship between mother body mass index and infant birth weight.The correlation between BMI and estimated and actual birth weight was positive.There is a strong correlation between maternal obesity and having a baby that is big for its gestational age.Furthermore, extremes in amniotic fluid content may influence sonographic assessment of baby weight in late pregnancy.

______________________________________________________________________________ 1. Introduction:
Weight in kilograms divided by the square of height in meters gives the body mass index (BMI), a basic measure of weight-forheight.[1].Pre-eclampsia, gestational hypertension, macrosomia, induction of labor, and caesarean sections are all connected with maternal obesity.This is true for both thin and overweight women.[2].
Based on their body mass index (BMI), women were divided into five categories (according to WHO and NIH recommendations from 2006) [3].Some research has linked being underweight to an increased chance of having a baby born prematurely, a low birth weight, and anemia, and a lower risk of developing preeclampsia, gestational diabetes, requiring obstetric intervention, or bleeding after giving birth.
As has been well reported, obesity is related with an increased risk of maternal morbidity and death.[4].Gestational diabetes, pregnancy-induced hypertension and preeclampsia, sepsis, venous thromboembolism, and spontaneous abortion are all serious maternal problems.[5].Obesity contributes to the deaths of more than a quarter of pregnant women in the United Kingdom.It is more https://ejmr.journals.ekb.eg/common for obese mothers to need medical intervention during labor and delivery, and these women also have a higher risk of problems during labor and delivery.[6].
Pregnancy weight at 20 weeks is a known risk factor for complications.Obstetric

Subjects & Methods:
Setting Study design: This was a prospective cohort study and was conducted at Obstetrics and Gynecology department at Beni-Suef General hospital starting from July 2019 till February 2020.

Study methodology:
A full detailed medical history was taken including the following: The significance level for each of these tests was set at the 5 percent level using the student t-test (t) and the probability (P value): If the p-value is more than 0.05, the findings are not significant.When the probability level is less than 5%, the findings are considered to be significant.
Results are statistically significant if the P value is less than 0.01.

Ethical considerations:
The Beni-Suef University School of Medicine Research Ethics Committee (FMBSUREC/05032019/ Mohammed) gave its stamp of approval to the study's methods.

Results:
This study included 300 women with mean age 32.3 ± 3.0 years and the mean gestational age 39.3 ± 1.1 weeks, maternal body mass index 27.6 ± 7.4 Kg/m2, the mean gravidity 2.7 ± 0.7, about half of the studied women underwent section (51.3%)

*P-value is significant
There was a significant difference between EFW and ABW among different groups of the study.
Showed in (Table 5).We compared the six groups and our results showed that regarding their ages, GA, gravidity, parity and mode of delivery.
Regarding maternal ages, our results showed that there was a statistically significant difference between the studied groups with p-value was 0.009.
The results of our investigation corroborated those of Kritzer et al., 2014, who used data from 1177 women to determine whether or not an increase in maternal BMI affects the precision with which sonographic estimates of fetal weight may be made [19].
While against our findings was Manzanares cross-sectional study that there was no statistically significant difference between their three groups (Low Body weight "BW", Normal BW and Macro BW) with p-value: 0.383 [22].While in disagreement with our findings was Kritzer et al., (2014) who reported that there was a statistically significant difference between their 5 groups with p-value: <0.01 [19].
Regarding gravidity and parity, our results showed that there was no statistically significant difference between the 6 groups of the study with p-value: 0.630 and 0.289 respectively.
In line with our findings was Al-Obaidly et al., 2015 who reported that regarding parity there was no statically significant difference between the three groups [21].Similar to these findings was Çintesun et al., (2021) who reported in their retrospective study that there was no statistically significant difference between their three groups (Low Body weight "BW", Normal BW and Macro BW) with p-value: 0.385 [22].
While in disagreement with our findings was Kritzer et al., (2014) who reported that regarding parity there was a statistically significant difference between their 5 groups with p-value: <0.01 [19].Similarly, was Manzanares et al., (2020) who reported that there was a statistically significant difference between women with normal BMI and those with increased BMI (obese) with p-value: < 0.001 [20].
Regarding mode of delivery, our results showed that there was no statistically significant difference between mode of delivery with increased incidence of caesarean section delivery in obese women but with no significant difference.
In partial agreement with our findings was Pettersen-Dahl et al., (2018), who found a strong correlation between maternal BMI and the need for cesarean section, and who found that 64% of primiparous women with a normal BMI gave birth naturally, but only 53% of women with a BMI 30 and 43% of women in the obesity class II gave birth naturally, and who concluded that a higher https://ejmr.journals.ekb.eg/maternal BMI before pregnancy is a significant and independent risk factor for delivery by cesarean section.In all subgroups of women, those with or without a history of cesarean delivery, the risk of CS was significantly higher among those with a BMI 30 compared to those with a normal weight [23].
Regarding fetal biometric measurements, our result showed that there a statistically  [13,11].
Regarding the difference between the EFW and ABW and a absolute error and mean percentage error.Our results showed that there was a statistically significant difference between the three groups.Our results were in agreement with Blitz et al., (2018) who reported that there was a statistically significant difference between the three groups as regard the difference between the EFW and ABW and absolute error [18].
Similar findings were reported by Ashwal et al., (2015) [11].While against our finding was Janas et al., (2019) who found a statistically significant difference between those with oligohydramnios and those with average AFI regarding absolute error and absolute percentage error [26].
In conclusion of this study, Maternal body mass index was shown to have an impact on both EFW and ABW, with an increase in both being associated with a higher average birth weight.There is a strong correlation between maternal obesity and having a baby that is big for its gestational age.It's possible that extremes in amniotic fluid volume might impact sonographic estimates of fetal weight during later stages of pregnancy.

Conflict of
sonography (US) results might be affected by a mother's weight.This secondary analysis of data from the PORTO study aimed to evaluate the impact of maternal obesity on the precision of US in estimating fetal weight (EFW) and the perinatal outcome of pregnancies affected by fetal growth restriction (FGR) [7].Obesity poses serious challenges to the quality and accuracy of obstetrical imaging, which plays a crucial role in the evaluation and therapy of these issues.In the context of maternal obesity, this review focuses on the most pressing issues for both expectant mothers and their healthcare professionals.[8].So, the aim of this study was to determine the effect of maternal body mass index (BMI) on the accuracy of sonographic estimated fetal weight (EFW) above 37 weeks' gestation in Egyptian women.
et al., (2020) who reported in their prospective cross-sectional study on 1064 singleton pregnant women classified according to body mass index (BMI) into two categories: normal (n = 863) and obese (n = 201), that there was no statistically significant difference between women with normal BMI and those with increased BMI (obese) with p-value: 0.180 [20].https://ejmr.journals.ekb.eg/Regarding GA at time of delivery, our findings showed that there was no statistical significance difference between study groups regarding GA at time of delivery with pvalue 0.351.Our findings were in agreement with Al-Obaidly et al., (2015) who reported in their retrospective cohort study, that there was no statically significant difference between the three groups (Normal, Overweight, and Obese) [21].Similar to these findings was Çintesun et al., (2021) who reported in their retrospective

Data Collection and Statistical analysis of the data: https://ejmr.journals.ekb.eg/
were recorded.There was a history of systemic illness and birth defects in the family.Age at menarche, cycle regularity, cycle length, last menstrual period, number of pregnancies, number of live births, projected date of delivery, and occurrence of pregnancy complications were all noted.Ultrasound to check fetal biometry; obstetric https://ejmr.journals.ekb.eg/three or more proportions using categorical data.In order to determine whether there was a statistically significant difference between the means of the two research groups, a Student T Test was performed.The statistical significance of a difference in a non-parametric variable between the two research groups was determined using the Mann Whitney Test (U test).The statistical significance of the difference between the means recorded twice for the same research group was determined using a paired t-test.

Table ( 2): Comparison of basic characteristics between studied patients groups (according to their BMI category):
There was a statistically significant difference between the studied groups as regard fetal biometrics "BPD, HC, AC and FL", estimated fetal weight and actual birth weight as shown in ( 3%) https://ejmr.journals.ekb.eg/

Table 3 ) . Table (3): Comparison of intrauterine fetal anthropometric measurements between studied groups (according to their BMI category):
There was no significant difference between the different groups of the study absolute error of change and mean percentage error of change between EFW and AFW.Showed in ( BPD: Bi-partial diameter; HC: Head circumference; AC: Abdominal circumference; FL: Femur length; EFW: Expected fetal weight; ABW: actual birth weight.*P-value is significant https://ejmr.journals.ekb.eg/

Table 4 ). Table (4): Change in fetal weight between EFW and birth weight between studied patients' groups (according to their BMI category): Variable Underweight Normal Overweight
Simple (Absolute) error equals absolute value of estimated fetal weight minus actual birth weight, Mean percentage error: sum of Absolute percent error., Absolute percent error: equals (absolute error divided by birth weight) times 100.

Table ( 5): Comparison between EFW and ABW among the study groups:
There was significant difference between EFW and ABW among different groups of the study shown in ( *P-value is significant * https://ejmr.journals.ekb.eg/

Table 6). Table (6): Comparison between EFW and ABW among the study groups:
results showed that the ages of our participants ranged between 30 -38 years https://ejmr.journals.ekb.eg/ Interest:The authors have no potential conflicts of interest to declare.