Measurement and evaluation of fetal fat layer in the prediction
of fetal macrosomia in pregnancies complicated by gestational
Ghada Abu Sheasha
Received: 22 April 2017 / Accepted: 12 June 2017 / Published online: 19 June 2017
Ó Springer-Verlag GmbH Germany 2017
Objectives To explore the predictive power of measuring
the abdominal fetal fat layer (FFL) as a soft tissue marker
at 31, 34, and 37 weeks’ gestation to improve the detection
of fetal macrosomia in pregnant women with GDM, in
addition to the biometric values with close monitoring of
maternal blood sugar level and BMI changes.
Methods We conducted a prospective observational study
at the Department of Obstetrics, University Hospitals,
Campus Kiel, Germany, in collaboration with diabetic
clinic staff. Participants underwent a third-trimester scan
and extra FFL measurements were performed at 31, 34, and
37 weeks of gestation. The clinical outcomes of pregnancy
and birth weight were collected from the obstetric record.
All of the enrolled women had an early pregnancy ultra-
sound scan to conﬁrm gestational age.
Results The FFL at 34 and 37 weeks, with respective cutoff
values of [0.48 cm and [0.59 cm, showed a very good
sensitivity of 60% for both gestational points, and speciﬁcity
of 89.3 and 90.6%, respectively. The probability of fetal
macrosomia could be more than doubled if the FFL at
34 weeks was more than 0.48 cm. However, the probability
of macrosomia dropped to 16% if the FFL was B0.48 cm.
The median FFLs of macrosomic fetuses at 34 and 37 weeks
were 0.50 (IQR 0.10) and 0.60 (IQR 0.25) cm, respectively.
The mean age of the study population (n = 80) was 32.26
(SD = 5.06) years. In our study population, ten newborns
were born with birth weight [4000 g. The body mass index
(BMI) for the mothers of later-onset macrosomic newborns
showed higher median values of 30 (IQR 8), 32 (IQR 5), and
33 (IQR 9) at 31, 34, and 37 weeks, respectively, in com-
parison to mothers of non-macrosomic newborn. However,
the BMI did not show any statistically signiﬁcant difference
from those with normal-weight newborn and did not show
any speciﬁc sensitivity for predicting macrosomia.
Conclusion Measuring the FFL at 34 and 37 weeks of
gestation, in addition to the standard measurement, might
be useful for predicting macrosomia and is worth further
Keywords Fetal macrosomia Á Gestational diabetes Á
Abdominal fetal fat layer (FFL) Á Soft-tissue marker
Gestational diabetes mellitus (GDM) has been associated
with increased birth weight and fetal macrosomia .
Macrosomic fetuses are at risk of a range of complications
at birth, including shoulder dystocia, obstructed labor, low
Apgar scores, poor postnatal glucose, and poor body tem-
perature control [2–4]. Many investigations of pregnancies
complicated with GDM have sought to reduce the rate of
The Hyperglycemia and Adverse Pregnancy Studies
Outcomes (HAPO) found that maternal glycemia was
associated with a birth weight [90th percentile and
neonatal adiposity measured using skin-fold calipers.
These ﬁndings conﬁrm the link between maternal glucose
& Mohamed Elessawy
Department of Gynecology and Obstetrics, University
Hospitals Schleswig–Holstein, Campus Kiel, Arnold-Heller
Strasse 3, Haus 24, 24105 Kiel, Germany
Diabetologikum, Kiel, Germany
Department of Biomedical Informatics and Medical
Statistics, Medical Research Institute, University of
Alexandria, Alexandria, Egypt
Arch Gynecol Obstet (2017) 296:445–453