{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:30:15Z","timestamp":1760059815521,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Pregnancies complicated by idiopathic polyhydramnios are linked to a heightened risk of numerous maternal and perinatal complications. We aim to study the implications of polyhydramnios in term pregnancies complicated with gestational diabetes mellitus (GDM). Methods: A prospective cohort study including 340 GDM cases was conducted. An ultrasound scan was conducted at term between 37 and 40 weeks and amniotic fluid volume (AFV) was assessed by measuring the amniotic fluid index (AFI) and the single deepest pocket (SDP). Maternal demographics and obstetric and perinatal outcomes were evaluated after delivery. We performed comparisons between groups with normal AFV and polyhydramnios (AFI \u2265 24 cm or SDP \u2265 8 cm), and between groups with normal and increased AFV (AFI or SDP \u2265 75th centile). A multivariate logistic regression analysis was performed to study association between AVF measurements and adverse maternal and perinatal outcomes. Results: We found that women with GDM and polyhydramnios at term had a higher risk of maternal (54.3 vs. 27.5%, p &lt; 0.001) and perinatal adverse outcomes (65.7% vs. 46.5%, p &lt; 0.03). The increased AFV group showed a higher risk of fetal overgrowth (LGA: 21.4% vs. 8.2%, p &lt; 0.001 and macrosomia: 19.8% vs. 5.4%, p &lt; 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 &lt; 0.001 and r = 0.28; p &lt; 0.001, respectively) and newborn centile (r = 0.26; p &lt; 0.001 and r = 0.26 for both). Subsequent to conducting a multivariate logistic regression analysis adjusted for pregestational BMI, nulliparity, and insulin treatment, both AFI and SDP were significantly associated with perinatal complications, but AFI showed a stronger association with fetal overgrowth (aOR 1.11; p = 0.004 for a LGA fetus and aOR 1.12; p = 0.002 for macrosomia) and with lower risk of delivering an SGA fetus (aOR 0.89; p = 0.009) or IUGR fetus (aOR 0.86; p = 0.03). ROC analysis showed a poor diagnostic performance of 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 a subgroup of women with gestational diabetes with higher risks of obstetric and perinatal complications. Cases with increased AFV (AFI \u2265 18 cm or SDP \u2265 6.5 cm) are also associated with an increased risk of fetal overgrowth and may require more intensive monitoring for management and optimal delivery timing, with the aim of improve perinatal outcomes.<\/jats:p>","DOI":"10.3390\/children12070920","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T15:19:31Z","timestamp":1752247171000},"page":"920","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Polyhydramnios at Term in Gestational Diabetes: Should We Be Concerned?"],"prefix":"10.3390","volume":"12","author":[{"given":"Mercedes","family":"Horcas-Mart\u00edn","sequence":"first","affiliation":[{"name":"Area of Obstetrics and Gynaecology, Department of Child and Mother Health and Radiology, School of Medicine, University of C\u00e1diz, 11009 C\u00e1diz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tania","family":"Luque-Pati\u00f1o","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Obstetrics and Gynecology Department, Puerta del Mar University Hospital, 11009 C\u00e1diz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Usandizaga-Prat","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Obstetrics and Gynecology Department, Puerta del Mar University Hospital, 11009 C\u00e1diz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"D\u00edaz-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Obstetrics and Gynecology Department, Puerta del Mar University Hospital, 11009 C\u00e1diz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Melero-Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Obstetrics and Gynecology Department, Puerta del Mar University Hospital, 11009 C\u00e1diz, Spain"},{"name":"Inflammation and Metabolic Syndrome in Pregnancy Group (CO25), Biomedical Research and Innovation Institute of C\u00e1diz (INiBICA), 11009 C\u00e1diz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0870-6935","authenticated-orcid":false,"given":"Luis","family":"V\u00e1zquez-Fonseca","sequence":"additional","affiliation":[{"name":"Inflammation and Metabolic Syndrome in Pregnancy Group (CO25), Biomedical Research and Innovation Institute of C\u00e1diz (INiBICA), 11009 C\u00e1diz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7834-0169","authenticated-orcid":false,"given":"Francisco","family":"Visiedo","sequence":"additional","affiliation":[{"name":"Inflammation and Metabolic Syndrome in Pregnancy Group (CO25), Biomedical Research and Innovation Institute of C\u00e1diz (INiBICA), 11009 C\u00e1diz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4214-0293","authenticated-orcid":false,"given":"Jos\u00e9 Rom\u00e1n","family":"Broull\u00f3n-Molanes","sequence":"additional","affiliation":[{"name":"Area of Obstetrics and Gynaecology, Department of Child and Mother Health and Radiology, School of Medicine, University of C\u00e1diz, 11009 C\u00e1diz, Spain"},{"name":"Division of Maternal-Fetal Medicine, Obstetrics and Gynecology Department, Puerta del Mar University Hospital, 11009 C\u00e1diz, Spain"},{"name":"Inflammation and Metabolic Syndrome in Pregnancy Group (CO25), Biomedical Research and Innovation Institute of C\u00e1diz (INiBICA), 11009 C\u00e1diz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roc\u00edo","family":"Quintero-Prado","sequence":"additional","affiliation":[{"name":"Area of Obstetrics and Gynaecology, Department of Child and Mother Health and Radiology, School of Medicine, University of C\u00e1diz, 11009 C\u00e1diz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Bugatto","sequence":"additional","affiliation":[{"name":"Area of Obstetrics and Gynaecology, Department of Child and Mother Health and Radiology, School of Medicine, University of C\u00e1diz, 11009 C\u00e1diz, Spain"},{"name":"Division of Maternal-Fetal Medicine, Obstetrics and Gynecology Department, Puerta del Mar University Hospital, 11009 C\u00e1diz, Spain"},{"name":"Inflammation and Metabolic Syndrome in Pregnancy Group (CO25), Biomedical Research and Innovation Institute of C\u00e1diz (INiBICA), 11009 C\u00e1diz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"B2","DOI":"10.1016\/j.ajog.2018.07.016","article-title":"SMFM Consult Series #46: Evaluation and management of polyhydramnios","volume":"219","author":"Dashe","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1097\/AOG.0000000000000245","article-title":"Fetal imaging: Executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American institute of Ultrasound in Medicine, ACOG, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal imaging workshop","volume":"123","author":"Reddy","year":"2014","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Whittington, J.R., Chauhan, S.P., Wendel, M.P., Ghahremani, T.L., Pagan, M.E., Carter, M.M., and Magann, E.F. (2024). Historical Assessment, Practical Management, and Future Recommendations for Abnormal Amniotic Fluid Volumes. J. Clin. Med., 13.","DOI":"10.3390\/jcm13164702"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1002\/uog.20272","article-title":"ISUOG Practice Guidelines: Ultrasound assessment of fetal biometry and growth","volume":"53","author":"Salomon","year":"2019","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1002\/jum.15116","article-title":"Accuracy of the Ultrasound Estimate of the Amniotic Fluid Volume (Amniotic Fluid Index and Single Deepest Pocket) to Identify Actual Low, Normal, and High Amniotic Fluid Volumes as Determined by Quantile Regression","volume":"39","author":"Hughes","year":"2020","journal-title":"J. Ultrasound Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"773","DOI":"10.2147\/IJWH.S316841","article-title":"Amniotic Fluid Volume Assessment: Eight Lessons Learned","volume":"13","author":"Magann","year":"2021","journal-title":"Int. J. Womens Health"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kechagias, K.S., Triantafyllidis, K.K., Zouridaki, G., and Savvidou, M. (2024). Obstetric and neonatal outcomes in pregnant women with idiopathic polyhydramnios: A systematic review and meta-analysis. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-54840-0"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1002\/uog.24973","article-title":"Idiopathic polyhydramnios and pregnancy outcome: Systematic review and meta-analysis","volume":"61","author":"Pagan","year":"2023","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2356031","DOI":"10.1080\/14767058.2024.2356031","article-title":"Gestational diabetes mellitus: Relationship of adverse outcomes with severity of disease","volume":"37","author":"Karkia","year":"2024","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1111\/1471-0528.12589","article-title":"Association and prediction of amniotic fluid measurements for adverse pregnancy outcome: Systematic review and meta-analysis","volume":"121","author":"Morris","year":"2014","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/S0002-9378(00)70343-7","article-title":"Correlation between amniotic fluid glucose concentration and amniotic fluid volume in pregnancy complicated by diabetes","volume":"182","author":"Dashe","year":"2000","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1002\/uog.27538","article-title":"ISUOG Practice Guidelines: Performance of third-trimester obstetric ultrasound scan","volume":"63","author":"Khalil","year":"2024","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"National Diabetes Data Group (1979). Classification and Diagnosis of Diabetes Mellitus and Other Categories of Glucose Intolerance. Diabetes, 28, 1039\u20131057.","DOI":"10.2337\/diab.28.12.1039"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.endinu.2021.12.014","article-title":"Diabetes mellitus and pregnancy. Updated clinical practice guideline 2021. Executive summary","volume":"70","author":"Goya","year":"2023","journal-title":"Endocrinol. Diabetes Y Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.ejogrb.2006.12.015","article-title":"Customized birthweight standards for a Spanish population","volume":"136","author":"Figueras","year":"2008","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1002\/uog.22134","article-title":"ISUOG Practice Guidelines: Diagnosis and management of small-for-gestational-age fetus and fetal growth restriction","volume":"56","author":"Lees","year":"2020","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s13679-025-00629-9","article-title":"When Weight Matters: How Obesity Impacts Reproductive Health and Pregnancy-A Systematic Review","volume":"14","author":"Barbouni","year":"2025","journal-title":"Curr. Obes. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Ramonien\u0117, G., Malakauskien\u0117, L., Savukyn\u0117, E., Maleckien\u0117, L., and Gruzdait\u0117, G. (2025). Pregnancy Complications and Outcomes in Obese Women with Gestational Diabetes. Med. Kaunas Lith., 61.","DOI":"10.3390\/medicina61010051"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"549.e1","DOI":"10.1016\/j.ajog.2023.06.002","article-title":"Predicting primary cesarean delivery in pregnancies complicated by gestational diabetes mellitus","volume":"229","author":"Ramos","year":"2023","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Chen, D., Gao, X., Yang, T., Xin, X., Wang, G., Wang, H., He, R., and Liu, M. (2025). Independent risk factors for placental abruption: A systematic review and meta-analysis. BMC Pregnancy Childbirth, 25.","DOI":"10.1186\/s12884-025-07482-7"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1055\/s-0037-1606186","article-title":"Polyhydramnios or Excessive Fetal Growth Are Markers for Abnormal Perinatal Outcome in Euglycemic Pregnancies","volume":"35","author":"Crimmins","year":"2018","journal-title":"Am. J. Perinatol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Zou, Y., Zhang, Y., Yin, Z., Wei, L., Lv, B., and Wu, Y. (2021). Establishment of a nomogram model to predict macrosomia in pregnant women with gestational diabetes mellitus. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-04049-0"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"101042","DOI":"10.1016\/j.ajogmf.2023.101042","article-title":"Prediction of birthweight and risk of macrosomia in pregnancies complicated by diabetes","volume":"5","author":"Shulman","year":"2023","journal-title":"Am. J. Obstet. Gynecol. MFM"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/7\/920\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:08:34Z","timestamp":1760033314000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/7\/920"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,11]]},"references-count":23,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["children12070920"],"URL":"https:\/\/doi.org\/10.3390\/children12070920","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2025,7,11]]}}}