RT journal article
T1 Polyhydramnios at Term in Gestational Diabetes: Should We Be Concerned?
A1 Horcas-Martín, Mercedes
A1 Luque-Patiño, Tania
A1 Usandizaga-Prat, Claudia
A1 Díaz-Fernández, Elena
A1 Melero Jiménez,  Victoria
A1 Vázquez Fonseca, Luis
A1 Visiedo García, Francisco Manuel
A1 Broullon Molanes, José Román
A1 Quintero Prado, Rocío
A1 Bugatto González, Fernando
A1 Horcas-Martín
A2 Anatomía y Embriología Humana
A2 BiomedicinaBiotecnología y Salud Pública
A2 Materno-Infantil y Radiología
K1 gestational diabetes
K1 polyhydramnios
K1 amniotic fluid volume
K1 adverse perinatal outcomes
K1 adverse maternal outcomes
K1 fetal overgrowth
K1 macrosomia
AB Background/Objectives: Pregnancies complicated by idiopathic polyhydramnios arelinked to a heightened risk of numerous maternal and perinatal complications. We aim tostudy the implications of polyhydramnios in term pregnancies complicated with gestationaldiabetes mellitus (GDM). Methods: A prospective cohort study including 340 GDM caseswas conducted. An ultrasound scan was conducted at term between 37 and 40 weeks andamniotic fluid volume (AFV) was assessed by measuring the amniotic fluid index (AFI)and the single deepest pocket (SDP). Maternal demographics and obstetric and perinataloutcomes were evaluated after delivery. We performed comparisons between groups withnormal AFV and polyhydramnios (AFI ≥ 24 cm or SDP ≥ 8 cm), and between groups withnormal and increased AFV (AFI or SDP ≥ 75th centile). A multivariate logistic regressionanalysis was performed to study association between AVF measurements and adversematernal and perinatal outcomes. Results: We found that women with GDM and polyhydramniosat term had a higher risk of maternal (54.3 vs. 27.5%, p < 0.001) and perinataladverse outcomes (65.7% vs. 46.5%, p < 0.03). The increased AFV group showed a higherrisk of fetal overgrowth (LGA: 21.4% vs. 8.2%, p < 0.001 and macrosomia: 19.8% vs. 5.4%,p < 0.001, respectively) and a lesser risk of delivering an SGA fetus (6.3% vs. 13.6%, respectively).Both AFI and SDP showed a significant correlation with newborn weight (r = 0.27;p < 0.001 and r = 0.28; p < 0.001, respectively) and newborn centile (r = 0.26; p < 0.001 andr = 0.26 for both). Subsequent to conducting a multivariate logistic regression analysisadjusted for pregestational BMI, nulliparity, and insulin treatment, both AFI and SDP weresignificantly associated with perinatal complications, but AFI showed a stronger associationwith fetal overgrowth (aOR 1.11; p = 0.004 for a LGA fetus and aOR 1.12; p = 0.002for macrosomia) and with lower risk of delivering an SGA fetus (aOR 0.89; p = 0.009) orIUGR fetus (aOR 0.86; p = 0.03). ROC analysis showed a poor diagnostic performanceof both AFI and SDP for identifying macrosomia (AUC 0.68 for AFI, and 0.65 for SDP).Conclusions: Detection of polyhydramnios at term, whether using AFI or SDP, identifies asubgroup of women with gestational diabetes with higher risks of obstetric and perinatalcomplications. Cases with increased AFV (AFI ≥ 18 cm or SDP ≥ 6.5 cm) are also associated with an increased risk of fetal overgrowth and may require more intensive monitoringfor management and optimal delivery timing, with the aim of improve perinatal outcomes.
PB Artur Beke
SN 2227-9067
YR 2025
FD 2025-07-11
LK http://hdl.handle.net/10498/37877
UL http://hdl.handle.net/10498/37877
LA eng
DS Repositorio Institucional de la Universidad de Cádiz
RD 07-nov-2026