Trajectory of serial amniotic fluid index measurements is associated with fetal growth, birth weight and neonatal adiposity.

Objective: Amniotic fluid volume, measured in terms of the amniotic fluid index (AFI), is used widely in prenatal care to assess fetal health and development. We investigated whether distinct longitudinal AFI trajectories exist during pregnancy and their association with fetal growth.

Methods: This secondary analysis of a randomized controlled trial included singleton pregnancies without pre-existing or gestational diabetes mellitus that received prenatal care at National Taiwan University Hospital in Taipei and its Hsin-Chu Branch in Hsinchu, Taiwan. Ultrasonography was performed at 22 + 0 to 24 + 6 weeks, 30 + 0 to 32 + 6 weeks, 35 + 0 to 37 + 6 weeks and at admission for delivery to measure fetal biometry and AFI. Neonatal anthropometrics and adiposity were measured at delivery. Group-based trajectory modeling was used to identify distinct AFI trajectory patterns during pregnancy. Regression analysis was used to determine differences in fetal and neonatal parameters between AFI trajectory groups, with adjustment for confounders.

Results: Overall, 802 pregnancies were included. Two AFI trajectory patterns were identified: one characterized by gradually decreasing AFI during gestation and the other by gradually increasing AFI. On linear regression analysis, compared with the decreasing AFI trajectory, increasing AFI was associated with higher gestational-age-specific Z-scores for abdominal circumference (P = 0.003) and estimated fetal weight (P = 0.036) at 30 + 0 to 32 + 6 weeks, as well as higher sex- and gestational-age-specific Z-scores for birth weight (P = 0.019), neonatal head circumference (P = 0.011), neonatal chest circumference (P = 0.009) and neonatal skinfold thickness (subscapular, P = 0.004; triceps, P = 0.002), after adjusting for maternal prepregnancy body mass index, history of gestational diabetes mellitus and fasting plasma glucose and triglyceride levels. The adjusted odds ratio of high neonatal adiposity for the increasing vs decreasing AFI trajectory was 2.47 ((95% CI, 1.21-5.11); P = 0.014).

Conclusion: An increasing AFI trajectory during pregnancy was associated with enhanced intrauterine fetal growth, higher birth weight and greater neonatal adiposity. This highlights the potential of AFI trajectory to serve as an indicator of fetal growth alongside fetal biometry. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.