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Licensed Unlicensed Requires Authentication Published by De Gruyter April 16, 2021

Diagnostic accuracy of modified Hadlock formula for fetal macrosomia in women with gestational diabetes and pregnancy weight gain above recommended

Boris Lovrić, Siniša Šijanović, Joško Lešin and Josip Juras



Women with gestational diabetes (GDM) and weight gain during pregnancy above recommended more often give birth to macrosomic children. The goal of this study was to evaluate the diagnostic accuracy of the modified formula for ultrasound assessment of fetal weight created in a pilot study using a similar specimen in comparison to the Hadlock-2 formula.


This is a prospective, cohort, applicative, observational, quantitative, and analytical study, which included 213 pregnant women with a singleton pregnancy, GDM, and pregnancy weight gain above recommended. Participants were consecutively followed in the time period between July 1st, 2016, and August 31st, 2020. Ultrasound estimations were made within three days before the delivery. Fetal weights estimated using both formulas were compared to the newborns’ weights.


A total of 133 fetal weight estimations were made. In comparison to the newborns’ weight modified formula had significantly smaller deviation in weight estimation compared to the Hadlock-2 formula, higher frequency of deviation within 5% of newborns weights (78.2% [95% CI=0.74–0.83] vs. 60.2%), smaller frequency of deviations from 5 to 10% (19.5 vs. 33.8%) and above 10%, which was even more significant among macrosomic children. There were 36/50 (72%) correctly diagnosed cases of macrosomia by modified and 33/50 (66%) by Hadlock-2 formula. Area under the curve (AUC) for the modified formula was 0.854 (95% CI=0.776–0.932), and for the Hadlock-2 formula 0.824 (95% CI=0.740–0.908). The positive predictive value of the modified formula was 81.81%, the negative 97.91%.


In cases of greater fetal weights, the modified formula showed greater precision.

Corresponding author: Asst. Prof. Josip Juras, MD, PhD, Department of Obstetrics and Gynecology, UHC Zagreb, School of Medicine, University of Zagreb, Petrova ulica 13, Zagreb, Croatia, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Permission of two Ethical Committees has been obtained before evolvement of first participant (Clinical Department and School of Medicine). This study is presented in accordance with guidelines for studies of diagnostic accuracy (STARD) [10].


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Supplementary Material

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Received: 2021-01-11
Accepted: 2021-03-31
Published Online: 2021-04-16
Published in Print: 2021-09-27

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