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Morris RK, Johnstone E, Lees C, Morton V, Smith G. Investigation and Care of a Small-for-Gestational-Age Fetus and a Growth Restricted Fetus (Green-top Guideline No. 31). BJOG 2024. [PMID: 38740546 DOI: 10.1111/1471-0528.17814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Key recommendations
All women should be assessed at booking (by 14 weeks) for risk factors for fetal growth restriction (FGR) to identify those who require increased surveillance using an agreed pathway [Grade GPP]. Findings at the midtrimester anomaly scan should be incorporated into the fetal growth risk assessment and the risk assessment updated throughout pregnancy. [Grade GPP]
Reduce smoking in pregnancy by identifying women who smoke with the assistance of carbon monoxide (CO) testing and ensuring in‐house treatment from a trained tobacco dependence advisor is offered to all pregnant women who smoke, using an opt‐out referral process. [Grade GPP]
Women at risk of pre‐eclampsia and/or placental dysfunction should take aspirin 150 mg once daily at night from 12+0–36+0 weeks of pregnancy to reduce their chance of small‐for‐gestational‐age (SGA) and FGR. [Grade A]
Uterine artery Dopplers should be carried out between 18+0 and 23+6 weeks for women at high risk of fetal growth disorders [Grade B]. In a woman with normal uterine artery Doppler and normal fetal biometry at the midtrimester scan, serial ultrasound scans for fetal biometry can commence at 32 weeks. Women with an abnormal uterine artery Doppler (mean pulsatility index > 95th centile) should commence ultrasound scans at 24+0–28+6 weeks based on individual history. [Grade B]
Women who are at low risk of FGR should have serial measurement of symphysis fundal height (SFH) at each antenatal appointment after 24+0 weeks of pregnancy (no more frequently than every 2 weeks). The first measurement should be carried out by 28+6 weeks. [Grade C]
Women in the moderate risk category are at risk of late onset FGR so require serial ultrasound scan assessment of fetal growth commencing at 32+0 weeks. For the majority of women, a scan interval of four weeks until birth is appropriate. [Grade B]
Maternity providers should ensure that they clearly identify the reference charts to plot SFH, individual biometry and estimated fetal weight (EFW) measurements to calculate centiles. For individual biometry measurements the method used for measurement should be the same as those used in the development of the individual biometry and fetal growth chart [Grade GPP]. For EFW the Hadlock three parameter model should be used. [Grade C]
Maternity providers should ensure that they have guidance that promotes the use of standard planes of acquisition and calliper placement when performing ultrasound scanning for fetal growth assessment. Quality control of images and measurements should be undertaken. [Grade C]
Ultrasound biometry should be carried out every 2 weeks in fetuses identified to be SGA [Grade C]. Umbilical artery Doppler is the primary surveillance tool and should be carried out at the point of diagnosis of SGA and during follow‐up as a minimum every 2 weeks. [Grade B]
In fetuses with an EFW between the 3rd and 10th centile, other features must be present for birth to be recommended prior to 39+0 weeks, either maternal (maternal medical conditions or concerns regarding fetal movements) or fetal compromise (a diagnosis of FGR based on Doppler assessment, fetal growth velocity or a concern on cardiotocography [CTG]) [Grade C]. For fetuses with an EFW or abdominal circumference less than the 10th centile where FGR has been excluded, birth or the initiation of induction of labour should be considered at 39+0 weeks after discussion with the woman and her partner/family/support network. Birth should occur by 39+6 weeks. [Grade B]
Pregnancies with early FGR (prior to 32+0 weeks) should be monitored and managed with input from tertiary level units with the highest level neonatal care. Care should be multidisciplinary by neonatology and obstetricians with fetal medicine expertise, particularly when extremely preterm (before 28 weeks) [Grade GPP]. Fetal biometry in FGR should be repeated every 2 weeks [Grade B]. Assessment of fetal wellbeing can include multiple modalities but must include computerised CTG and/or ductus venous. [Grade B]
In pregnancies with late FGR, birth should be initiated from 37+0 weeks to be completed by 37+6 weeks [Grade A]. Decisions for birth should be based on fetal wellbeing assessments or maternal indication. [Grade GPP]
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Geerts L, Brink LT, Odendaal HJ. Selecting a birth weight standard for an indigenous population in a LMIC: A prospective comparative study. Int J Gynaecol Obstet 2024. [PMID: 38571441 DOI: 10.1002/ijgo.15519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/12/2024] [Accepted: 03/24/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES The aim of the present study was to compare birth weight (BW) distribution and proportion of BWs below or above specified percentiles in low-risk singleton pregnancies in healthy South African (SA) women of mixed ancestry with expected values according to four BW references and to determine the physiological factors affecting BW. METHODS This was an ancillary study of a prospective multinational cohort study, involving 7060 women recruited between August 2007 and January 2015 in two townships of Cape Town, characterized by low socioeconomic status, and high levels of drinking and smoking. Detailed information about maternal and pregnancy characteristics, including harmful exposures, was gathered prospectively, allowing us to select healthy women with uncomplicated pregnancies without any known harmful exposures. In this cohort we compared the median BW and the proportion of BWs P90, 95 and 97 according to four reference standards (INTERGROWTH-21st, customized according to the method described by Mickolajczyk, Fetal Medicine Foundation and revised Fenton reference) with expected values. Appropriate parametric and nonparametric tests were used, and sensitivity analysis was performed for infant sex, first trimester bookings and women of normal body mass index (BMI). Multiple regression was used to explore effects of confounders. Written consent and ethics approval was obtained. RESULTS The cohort included 739 infants. The INTERGROWTH-21st standard was closest for the actual BW-distribution and categories. Below-expected BW was associated with boys, younger, shorter, leaner women, lower parity and gravidity. Actual BW was significantly influenced by maternal weight, BMI, parity and gestational age. CONCLUSION Of the four references assessed in this study, the INTERGROWTH-21st standard was closest for the actual BW distribution. Maternal variables significantly influence BW.
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Affiliation(s)
- Lut Geerts
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Parow, South Africa
| | - Lucy T Brink
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Parow, South Africa
| | - Hein J Odendaal
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Parow, South Africa
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Gardosi J, Hugh O. Stillbirth risk and smallness for gestational age according to Hadlock, INTERGROWTH-21st, WHO, and GROW fetal weight standards: analysis by maternal ethnicity and body mass index. Am J Obstet Gynecol 2023; 229:547.e1-547.e13. [PMID: 37247647 DOI: 10.1016/j.ajog.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Appropriate growth charts are essential for fetal surveillance, to confirm that growth is proceeding normally and to identify pregnancies that are at risk. Many stillbirths are avoidable through antenatal detection of the small-for-gestational-age fetus. In the absence of an international consensus on which growth chart to use, it is essential that clinical practice reflects outcome-based evidence. OBJECTIVE This study investigated the performance of 4 internationally used fetal weight standards and their ability to identify stillbirth risk in different ethnic and maternal size groups of a heterogeneous population. STUDY DESIGN We analyzed routinely collected maternity data from more than 2.2 million pregnancies. Three population-based fetal weight standards (Hadlock, Intergrowth-21st, and World Health Organization) were compared with the customized GROW standard that was adjusted for maternal height, weight, parity, and ethnic origin. Small-for-gestational-age birthweight and stillbirth risk were determined for the 2 largest ethnic groups in our population (British European and South Asian), in 5 body mass index categories, and in 4 maternal size groups with normal body mass index (18.5-25.0 kg/m2). The differences in trend between stillbirth and small-for-gestational-age rates were assessed using the Clogg z test, and differences between stillbirths and body mass index groups were assessed using the chi-square trend test. RESULTS Stillbirth rates (per 1000) were higher in South Asian pregnancies (5.51) than British-European pregnancies (3.89) (P<.01) and increased in both groups with increasing body mass index (P<.01). Small-for-gestational-age rates were 2 to 3-fold higher for South Asian babies than British European babies according to the population-average standards (Hadlock: 26.2% vs 12.2%; Intergrowth-21st: 12.1% vs 4.9%; World Health Organization: 32.2% vs 16.0%) but were similar by the customized GROW standard (14.0% vs 13.6%). Despite the wide variation, each standard's small-for-gestation-age cases had increased stillbirth risk compared with non-small-for-gestation-age cases, with the magnitude of risk inversely proportional to the rate of cases defined as small for gestational age. All standards had similar stillbirth risk when the small-for-gestation-age rate was fixed at 10% by varying their respective thresholds for defining small for gestational age. When analyzed across body mass index subgroups, the small-for-gestation-age rate according to the GROW standard increased with increasing stillbirth rate, whereas small-for-gestation-age rates according to Hadlock, Intergrowth-21st, and World Health Organization fetal weight standards declined with increasing body mass index, showing a difference in trend (P<.01) to stillbirth rates across body mass index groups. In the normal body mass index subgroup, stillbirth rates showed little variation across maternal size groups; this trend was followed by GROW-based small-for-gestation-age rates, whereas small-for-gestation-age rates defined by each population-average standard declined with increasing maternal size. CONCLUSION Comparisons between population-average and customized fetal growth charts require examination of how well each standard identifies pregnancies at risk of adverse outcomes within subgroups of any heterogeneous population. In both ethnic groups studied, increasing maternal body mass index was accompanied by increasing stillbirth risk, and this trend was reflected in more pregnancies being identified as small for gestational age only by the customized standard. In contrast, small-for-gestation-age rates fell according to each population-average standard, thereby hiding the increased stillbirth risk associated with high maternal body mass index.
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Affiliation(s)
| | - Oliver Hugh
- Perinatal Institute, Birmingham, United Kingdom
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Genowska A, Strukcinskiene B, Bochenko-Łuczyńska J, Motkowski R, Jamiołkowski J, Abramowicz P, Konstantynowicz J. Reference Values for Birth Weight in Relation to Gestational Age in Poland and Comparison with the Global Percentile Standards. J Clin Med 2023; 12:5736. [PMID: 37685803 PMCID: PMC10488537 DOI: 10.3390/jcm12175736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Percentiles of birth weight by gestational age (GA) are an essential tool for clinical assessment and initiating interventions to reduce health risks. Unfortunately, Poland lacks a reference chart for assessing newborn growth based on the national population. This study aimed to establish a national reference range for birth weight percentiles among newborns from singleton deliveries in Poland. Additionally, we sought to compare these percentile charts with the currently used international standards, INTERGROWTH-21 and WHO. MATERIALS AND METHODS All singleton live births (n = 3,745,239) reported in Poland between 2010 and 2019 were analyzed. Using the Lambda Mu Sigma (LMS) method, the Generalized Additive Models for Location Scale, and Shape (GAMLSS) package, smoothed percentile charts (3-97) covering GA from 23 to 42 weeks were constructed. RESULTS The mean birth weight of boys was 3453 ± 540 g, and this was higher compared with that of girls (3317 ± 509 g). At each gestational age, boys exhibited higher birth weights than girls. The weight range between the 10th and 90th percentiles was 1061 g for boys and 1016 g for girls. Notably, the birth weight of Polish newborns was higher compared to previously published international growth standards. CONCLUSION The reference values for birth weight percentiles established in this study for Polish newborns differ from the global standards and are therefore useful for evaluating the growth of newborns within the national population. These findings hold clinical importance in identifying neonates requiring postbirth monitoring.
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Affiliation(s)
- Agnieszka Genowska
- Department of Public Health, Medical University of Bialystok, 15-295 Bialystok, Poland
| | | | | | - Radosław Motkowski
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland; (R.M.); (P.A.); (J.K.)
| | - Jacek Jamiołkowski
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland;
| | - Paweł Abramowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland; (R.M.); (P.A.); (J.K.)
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland; (R.M.); (P.A.); (J.K.)
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Kilpi F, Jones HE, Magnus MC, Santorelli G, Højsgaard Schmidt LK, Urhoj SK, Nelson SM, Tuffnell D, French R, Magnus PM, Nybo Andersen AM, Martikainen P, Tilling K, Lawlor DA. Association between perinatal mortality and morbidity and customised and non-customised birthweight centiles in Denmark, Finland, Norway, Wales, and England: comparative, population based, record linkage study. BMJ MEDICINE 2023; 2:e000521. [PMID: 37663045 PMCID: PMC10471867 DOI: 10.1136/bmjmed-2023-000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/17/2023] [Indexed: 09/05/2023]
Abstract
Objectives To compare the risk of adverse perinatal outcomes according to infants who are born small for gestational age (SGA; <10th centile) or large for gestational age (LGA; >90th centile), as defined by birthweight centiles that are non-customised (ie, standardised by sex and gestational age only) and customised (by sex, gestational age, maternal weight, height, parity, and ethnic group). Design Comparative, population based, record linkage study with meta-analysis of results. Setting Denmark, Finland, Norway, Wales, and England (city of Bradford), 1986-2019. Participants 2 129 782 infants born at term in birth registries. Main outcome measures Stillbirth, neonatal death, infant death, admission to neonatal intensive care unit, and low Apgar score (<7) at 5 minutes. Results Relative to those infants born average for gestational age (AGA), both SGA and LGA births were at increased risk of all five outcomes, but observed relative risks were similar irrespective of whether non-customised or customised charts were used. For example, for SGA versus AGA births, when non-customised and customised charts were used, relative risks pooled over countries were 3.60 (95% confidence interval 3.29 to 3.93) versus 3.58 (3.02 to 4.24) for stillbirth, 2.83 (2.18 to 3.67) versus 3.32 (2.05 to 5.36) for neonatal death, 2.82 (2.07 to 3.83) versus 3.17 (2.20 to 4.56) for infant death, 1.66 (1.49 to 1.86) versus 1.54 (1.30 to 1.81) for low Apgar score at 5 minutes, and (based on Bradford data only) 1.97 (1.74 to 2.22) versus 1.94 (1.70 to 2.21) for admission to the neonatal intensive care unit. The estimated sensitivity of combined SGA or LGA births to identify the three mortality outcomes ranged from 31% to 34% for non-customised charts and from 34% to 38% for customised charts, with a specificity of 82% and 80% with non-customised and customised charts, respectively. Conclusions These results suggest an increased risk of adverse perinatal outcomes of a similar magnitude among SGA or LGA term infants when customised and non-customised centiles are used. Use of customised charts for SGA/LGA births-over and above use of non-customised charts for SGA/LGA births-is unlikely to provide benefits in terms of identifying term births at risk of these outcomes.
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Affiliation(s)
- Fanny Kilpi
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hayley E Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Christine Magnus
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | - Stine Kjaer Urhoj
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Scott M Nelson
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | | | | | - Per Minor Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Pekka Martikainen
- Population Research Unit, University of Helsinki Faculty of Social Sciences, Helsinki, Uusimaa, Finland
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Kate Tilling
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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Jee G, Kotecha SJ, Chakraborty M, Kotecha S, Odd D. Early childhood parent-reported speech problems in small and large for gestational age term-born and preterm-born infants: a cohort study. BMJ Open 2023; 13:e065587. [PMID: 37105706 PMCID: PMC10151836 DOI: 10.1136/bmjopen-2022-065587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE (1) To assess if preterm and term small for gestational age (SGA) or large for gestational age (LGA) infants have more parent-reported speech problems in early childhood compared with infants with birth weights appropriate for gestational age (AGA). (2) To assess if preterm and term SGA and LGA infants have more parent-reported learning, behavioural, hearing, movement and hand problems in early childhood compared with AGA infants. DESIGN Cohort study. SETTING Wales, UK. PARTICIPANTS 7004 children with neurodevelopmental outcomes from the Respiratory and Neurological Outcomes of Children Born Preterm Study which enrolled 7129 children, born from 23 weeks of gestation onwards, to mothers aged 18-50 years of age were included in the analysis. OUTCOME MEASURES Parent-reported single-answer questionnaires were completed in 2013 to assess early childhood neurodevelopmental outcomes. The primary outcome was parent-reported speech problems in early childhood adjusted for clinical and demographic confounders in SGA and LGA infants compared with AGA infants. Secondary outcomes measured were parent-reported early childhood learning, behavioural, hearing, movement and hand problems. RESULTS Median age at the time of study was 5 years, range 2-10 years. Although the adjusted OR was 1.19 (0.92 to 1.55) for SGA infants and OR 1.11 (0.88 to 1.41) for LGA infants, this failed to reach statistical significance that these subgroups were more likely to have parent-reported speech problems in early childhood compared with AGA infants. This study also found parent-reported evidence suggestive of potential learning difficulties in early childhood (OR 1.51 (1.13 to 2.02)) and behavioural problems (OR 1.35 (1.01 to 1.79)) in SGA infants. CONCLUSION This study of 7004 infants in Wales suggests that infants born SGA or LGA likely do not have higher risks of parent-reported speech problems in early childhood compared with infants born AGA. To further ascertain this finding, studies with wider population coverage and longer-term follow-up would be needed.
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Affiliation(s)
- Gabrielle Jee
- Department of Paediatrics, University of Wales Hospital, Cardiff, UK
| | | | - Mallinath Chakraborty
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK
- Department of Neonatology, University of Wales Hospital, Cardiff, UK
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK
- Department of Neonatology, University of Wales Hospital, Cardiff, UK
| | - David Odd
- Department of Neonatology, University of Wales Hospital, Cardiff, UK
- Department of Population Health, Cardiff University School of Medicine, Cardiff, UK
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González González NL, González Dávila E, González Martín A, Armas M, Tascón L, Farras A, Higueras T, Mendoza M, Carreras E, Goya M. Abnormal Maternal Body Mass Index and Customized Fetal Weight Charts: Improving the Identification of Small for Gestational Age Fetuses and Newborns. Nutrients 2023; 15:nu15030587. [PMID: 36771294 PMCID: PMC9920601 DOI: 10.3390/nu15030587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/08/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Obesity and thinness are serious diseases, but cases with abnormal maternal weight have not been excluded from the calculations in the construction of customized fetal growth curves (CCs). METHOD To determine if the new CCs, built excluding mothers with an abnormal weight, are better than standard CCs at identifying SGA. A total of 16,122 neonates were identified as SGA, LGA, or AGA, using the two models. Logistic regression and analysis of covariance were used to calculate the OR and CI for adverse outcomes by group. Gestational age was considered as a covariable. RESULTS The SGA rates by the new CCs and by the standard CCs were 11.8% and 9.7%, respectively. The SGA rate only by the new CCs was 18% and the SGA rate only by the standard CCs was 0.01%. Compared to AGA by both models, SGA by the new CCs had increased rates of cesarean section, (OR 1.53 (95% CI 1.19, 1.96)), prematurity (OR 2.84 (95% CI 2.09, 3.85)), NICU admission (OR 5.41 (95% CI 3.47, 8.43), and adverse outcomes (OR 1.76 (95% CI 1.06, 2.60). The strength of these associations decreased with gestational age. CONCLUSION The use of the new CCs allowed for a more accurate identification of SGA at risk of adverse perinatal outcomes as compared to the standard CCs.
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Affiliation(s)
- Nieves Luisa González González
- Department of Obstetrics and Gynecology, University of La Laguna, Hospital Universitario de Canarias, 38200 Tenerife, Spain
- Correspondence: ; Tel.: +34-922678335
| | - Enrique González Dávila
- Department of Mathematics, Statistics and Operations Research, IMAULL, University of La Laguna, 38200 Tenerife, Spain
| | - Agustina González Martín
- Department of Obstetrics and Gynecology, Hospital Universitario Ntra Sra de Candenlaria, 38200 Tenerife, Spain
| | - Marina Armas
- Department of Pediatrics, Evangelisches Krakenhaus König Elisabeth Herzberge, 10365 Berlin, Germany
| | - Laura Tascón
- Department of Obstetrics and Gynecology, University of La Laguna, Hospital Universitario de Canarias, 38200 Tenerife, Spain
| | - Alba Farras
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Universitat Autónoma de Barcelona, Pg. de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - Teresa Higueras
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Universitat Autónoma de Barcelona, Pg. de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - Manel Mendoza
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Universitat Autónoma de Barcelona, Pg. de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - Elena Carreras
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Universitat Autónoma de Barcelona, Pg. de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - María Goya
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Universitat Autónoma de Barcelona, Pg. de la Vall d'Hebron, 119, 08035 Barcelona, Spain
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Adjusting growth standards for fetal sex improves correlation of small babies with stillbirth and adverse perinatal outcomes: A state-wide population study. PLoS One 2022; 17:e0274521. [PMID: 36215239 PMCID: PMC9551630 DOI: 10.1371/journal.pone.0274521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/28/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Sex impacts birthweight, with male babies heavier on average. Birthweight charts are thus sex specific, but ultrasound fetal weights are often reported by sex neutral standards. We aimed to identify what proportion of infants would be re-classified as SGA if sex-specific charts were used, and if this had a measurable impact on perinatal outcomes. METHODS Retrospective cohort study including all infants born in Victoria, Australia, from 2005-2015 (529,261 cases). We applied GROW centiles, either adjusted or not adjusted for fetal sex. We compared overall SGA populations, and the populations of males considered small by sex-specific charts only (SGAsex-only), and females considered small by sex-neutral charts only (SGAunadjust-only). RESULTS Of those <10th centile by sex-neutral charts, 39.6% were male and 60.5% female, but using sex-specific charts, 50.3% were male and 49.7% female. 19.2% of SGA females were reclassified as average for gestational age (AGA) using sex-specific charts. These female newborns were not at increased risk of stillbirth, combined perinatal mortality, NICU admissions, low Apgars or emergency CS compared with an AGA infant, but were at greater risk of being iatrogenically delivered on suspicion of growth restriction. 25.0% male infants were reclassified as SGA by sex-specific charts. These male newborns, compared to the AGAall infant, were at greater risk of stillbirth (RR 1.94, 95%CI 1.30-2.90), combined perinatal mortality (RR 1.80, 95%CI 1.26-2.57), NICU admissions (RR 1.38, 95%CI 1.12-1.71), Apgars <7 at 5 minutes (RR 1.40, 95%CI 1.25-1.56) and emergency CS (RR 1.12, 95%CI 1.06-1.18). CONCLUSIONS Use of growth centiles not adjusted for fetal sex disproportionately classifies female infants as SGA, increasing their risk of unnecessary intervention, and fails to identify a cohort of male infants at increased risk of adverse outcomes, including stillbirth. Sex-specific charts may help inform decisions and improve outcomes.
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Softa SM, Aldardeir N, Aloufi FS, Alshihabi SS, Khouj M, Redwan E. The Association of Maternal Height With Mode of Delivery and Fetal Birth Weight at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Cureus 2022; 14:e27493. [PMID: 36060402 PMCID: PMC9424784 DOI: 10.7759/cureus.27493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 12/02/2022] Open
Abstract
Study Objectives: The aim of this study was to find if there is an association between maternal height and mode of delivery, as well as an association between maternal height and baby’s weight as a secondary outcome. Method: This retrospective record review was performed at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, including patients admitted between January 2016 to December 2017. All nulligravida with singleton term pregnancies who gave birth were included in this study. Pregnant women with planned elective cesarean section (CS) and incomplete records were excluded. The maternal demographic and clinical data (age, height, weight, hypertension, gestational diabetes (GDM), body mass index (BMI), smoking status, gestational age, regional analgesia during delivery, type of delivery, postpartum hemorrhage (PPH), and episiotomy), neonatal birth weight, and Apgar score were obtained from KAUH computerized records. Our primary outcome was the mode of delivery. The secondary outcome was the classification of neonatal weight into small for gestational age (SGA), appropriate for gestational age (AGA), or large for gestational age (LGA). Maternal height was divided into seven groups. Descriptive statistics using mean and standard deviation were used for continuous variables. Frequencies and percentages were used for categorical variables. Student's t-test and chi-square tests were used to evaluate the differences between continuous and categorical variables. Result: A total of 1067 women were included in this study. Most were at 40 weeks of gestation age (14.9%) with a mean height of 156.4±6.2 cm. Of the total, 76.9% were spontaneous vaginal delivery without operative assistance, 15.9% were delivered via CS, and 7.2% delivered vaginally with the assistance of forceps or ventouse. The mean neonatal birth weight was 2994 ± 451 gms with most neonates (87.3%) having a birth weight between 2500 and 4000 gms. Most babies were of average weight for their gestational age at delivery. There was a significant negative association between maternal height with CS (p=0.017). Moreover, there was a correlation between maternal height and the baby’s birth weight (p=0.01), and we found that for every 1 cm increase in women’s height, the baby's weight increases by 12.8 gms. Conclusion: Our study didn’t find an association between maternal height and vaginal delivery or operative vaginal delivery. However, there was an impact of maternal height on CS delivery. Therefore, we suggest screening for short maternal height as they have an increased risk of having an emergency CS. In our secondary outcome, we found a positive association between maternal height and baby's birth weight.
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Kofman R, Farkash R, Rottenstreich M, Samueloff A, Wasserteil N, Kasirer Y, Grisaru Granovsky S. Parity-Adjusted Term Neonatal Growth Chart Modifies Neonatal Morbidity and Mortality Risk Stratification. J Clin Med 2022; 11:jcm11113097. [PMID: 35683486 PMCID: PMC9181536 DOI: 10.3390/jcm11113097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/08/2022] [Accepted: 05/26/2022] [Indexed: 12/10/2022] Open
Abstract
Objective: To investigate the impact of parity-customized versus population-based birth weight charts on the identification of neonatal risk for adverse outcomes in small (SGA) or large for gestational age (LGA) infants compared to appropriate for gestational age (AGA) infants. Study design: Observational, retrospective, cohort study based on electronic medical birth records at a single center between 2006 and 2017. Neonates were categorized by birth weight (BW) as SGA, LGA, or AGA, with the 10th and 90th centiles as boundaries for AGA in a standard population-based model adjusted for gestational age and gender only (POP) and a customized model adjusted for gestational age, gender, and parity (CUST). Neonates defined as SGA or LGA by one standard and not overlapping the other, are SGA/LGA CUST/POP ONLY. Analyses used a reference group of BW between the 25th and 75th centile for the population. Results: Overall 132,815 singleton, live, term neonates born to mothers with uncomplicated pregnancies were included. The customized model identified 53% more neonates as SGA-CUST ONLY who had significantly higher rates of morbidity and mortality compared to the reference group (OR = 1.33 95% CI [1.16−1.53]; p < 0.0001). Neonates defined as LGA by the customized model (LGA-CUST) and AGA by the population-based model LGA-CUST ONLY had a significantly higher risk for morbidity compared to the reference (OR = 1.36 95% CI [1.09−1.71]; p = 0.007) or the LGA POP group. Neonatal mortality only occurred in the SGA and AGA groups. Conclusions: The application of a parity-customized only birth weight chart in a population of singleton, term neonates is a simple platform to better identify birth weight related neonatal risk for morbidity and mortality.
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Affiliation(s)
- Roie Kofman
- Department of Internal Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, Jerusalem 91120, Israel;
| | - Rivka Farkash
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (R.F.); (A.S.); (S.G.G.)
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (R.F.); (A.S.); (S.G.G.)
- Correspondence: ; Tel.: +972-2-655-5562; Fax: +972-2-666-6053
| | - Arnon Samueloff
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (R.F.); (A.S.); (S.G.G.)
| | - Netanel Wasserteil
- Department of Pediatrics, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (N.W.); (Y.K.)
| | - Yair Kasirer
- Department of Pediatrics, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (N.W.); (Y.K.)
| | - Sorina Grisaru Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (R.F.); (A.S.); (S.G.G.)
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Dry C, Pedretti MK, Nathan E, Dickinson JE. A comparison of four fetal biometry growth charts within an Australian obstetric population. Australas J Ultrasound Med 2022; 25:5-19. [PMID: 35251898 PMCID: PMC8873619 DOI: 10.1002/ajum.12290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 11/05/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the applicability of four existing fetal growth charts to a local tertiary hospital obstetric population. METHOD Four existing fetal growth charts (the Raine study reference charts, INTERGROWTH-21st charts, World Health Organization (WHO) fetal growth study charts and Australasian Society for Ultrasound in Medicine (ASUM) endorsed Campbell Westerway charts were compared using data from 11651 singleton pregnancy ultrasound scans at King Edward Memorial Hospital (KEMH). The 3rd, 10th, 50th 90th and 97th percentile curves for abdominal circumference (AC) biometry for the KEMH data were calculated and the four primary correlation parameters from fitted 3rd order polynomials (a, b, c and d) were used to generate like-for-like comparisons for all charts. RESULTS The overall comparisons showed a significant variation with different growth charts, giving different percentiles for the same fetal AC measurement. INTERGROWTH-21st percentile curves tended to fall below those of other charts for AC measurements. Both the Raine Study charts and ASUM charts were the charts of closest overall fit to the local data. CONCLUSION Our data show the Raine Study charts are the most appropriate for our population compared with the other three charts assessed suggesting the 'one size fits all' model may not be appropriate. However, additional analysis of biometry measurements, primarily AC, is needed to address the deficiency of data at 14-18 weeks gestation which exists for the Raine Study data.A reasonable alternative may be to adopt the WHO charts with local calibration (including the 14 - 18 week gestation period).
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Affiliation(s)
- Candice Dry
- Department of Medical Imaging King Edward Memorial Hospital374 Bagot RoadSubiacoWA6008Australia
| | - Michelle K. Pedretti
- Department of Medical Imaging King Edward Memorial Hospital374 Bagot RoadSubiacoWA6008Australia,Division of Obstetrics and GynaecologyFaculty of Health and Medical SciencesThe University of Western Australia (M550)35 Stirling HighwayPerth6009Australia
| | - Elizabeth Nathan
- Division of Obstetrics and GynaecologyFaculty of Health and Medical SciencesThe University of Western Australia (M550)35 Stirling HighwayPerth6009Australia,Women and Infants Research Foundation Carson HouseKing Edward Memorial Hospital374 Bagot RoadSubiacoWA6008Australia
| | - Jan E. Dickinson
- Department of Medical Imaging King Edward Memorial Hospital374 Bagot RoadSubiacoWA6008Australia,Division of Obstetrics and GynaecologyFaculty of Health and Medical SciencesThe University of Western Australia (M550)35 Stirling HighwayPerth6009Australia
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The impact of birthweight on the development of cerebral palsy: A population-based matched case-control study. Early Hum Dev 2022; 165:105533. [PMID: 34973634 DOI: 10.1016/j.earlhumdev.2021.105533] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/26/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is a common cause of physical impairment in children, especially in newborns who are small for gestational age (SGA). AIMS The aim of our study was to investigate the association between birth weight and the risk of developing CP, controlling for gestational age and plurality. STUDY DESIGN This retrospective, observational, case-control study was based on Slovenian Registry of Cerebral Palsy (SRCP) and Slovenian National Perinatal Information System (NPIS) data for the period 2002 to 2010. SUBJECTS For each pregnancy that resulted in the birth of the newborn(s) who later developed CP (n = 254), three pregnancies with newborns who did not develop CP (n = 762) were selected and matched for gestational age and plurality. OUTCOME MEASURES Diagnosis of CP was made at age 5 years or older by a developmental pediatrician trained in child neurology or a child neurologist using standard measures. RESULTS Risk of CP increased progressively as birth weight percentiles fell below the 50th centile, with children in the lowest percentiles at greatest risk. Birth weight percentiles traditionally classified as SGA were an independent risk factor for developing CP, with an odds ratio of 2.43 (95% confidence interval 1.57, 3.73). CONCLUSIONS The results of this study suggest that the risk for developing CP is inversely related to birth weight, even at birth weights that do not meet the standard definitions of SGA. SYNOPSIS - STUDY QUESTION Does birth weight represent a potential risk factor for the development of cerebral palsy (CP) when controlling for gestational age and plurality? WHAT'S ALREADY KNOWN Newborns who are small for gestational age (SGA) are at higher risk of developing CP according to published studies. However, different definitions of SGA (birth weight below the 10th, 5th, or 3rd percentile for gestational age) have been used by researchers and clinicians, making it difficult to compare studies. WHAT THIS STUDY ADDS This study suggests that the risk of developing CP is inversely related to birth weight, even at birth weights that do not meet standard definitions of SGA.
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Impact of Selection of Growth Chart in the Diagnosis of Suboptimal Fetal Growth and Neonatal Birthweight and Correlation with Adverse Neonatal Outcomes in a Third Trimester South Indian Antenatal Cohort; A Prospective Cross-Sectional Study. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-021-00312-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Customized versus Population Growth Standards for Morbidity and Mortality Risk Stratification Using Ultrasonographic Fetal Growth Assessment at 22 to 29 Weeks' Gestation. Am J Perinatol 2021; 38:e46-e56. [PMID: 32198743 PMCID: PMC7537732 DOI: 10.1055/s-0040-1705114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of study is to compare the performance of ultrasonographic customized and population fetal growth standards for prediction adverse perinatal outcomes. STUDY DESIGN This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be, in which l data were collected at visits throughout pregnancy and after delivery. Percentiles were assigned to estimated fetal weights (EFWs) measured at 22 to 29 weeks using the Hadlock population standard and a customized standard (www.gestation.net). Areas under the curve were compared for the prediction of composite and severe composite perinatal morbidity using EFW percentile. RESULTS Among 8,701 eligible study participants, the population standard diagnosed more fetuses with fetal growth restriction (FGR) than the customized standard (5.5 vs. 3.5%, p < 0.001). Neither standard performed better than chance to predict composite perinatal morbidity. Although the customized performed better than the population standard to predict severe perinatal morbidity (areas under the curve: 0.56 vs. 0.54, p = 0.003), both were poor. Fetuses considered FGR by the population standard but normal by the customized standard had morbidity rates similar to fetuses considered normally grown by both standards.The population standard diagnosed FGR among black women and Hispanic women at nearly double the rate it did among white women (p < 0.001 for both comparisons), even though morbidity was not different across racial/ethnic groups. The customized standard diagnosed FGR at similar rates across groups. Using the population standard, 77% of FGR cases were diagnosed among female fetuses even though morbidity among females was lower (p < 0.001). The customized model diagnosed FGR at similar rates in male and female fetuses. CONCLUSION At 22 to 29 weeks' gestation, EFW percentile alone poorly predicts perinatal morbidity whether using customized or population fetal growth standards. The population standard diagnoses FGR at increased rates in subgroups not at increased risk of morbidity and at lower rates in subgroups at increased risk of morbidity, whereas the customized standard does not.
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Choi SKY, Gordon A, Hilder L, Henry A, Hyett JA, Brew BK, Joseph F, Jorm L, Chambers GM. Performance of six birth-weight and estimated-fetal-weight standards for predicting adverse perinatal outcome: a 10-year nationwide population-based study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:264-277. [PMID: 32672406 DOI: 10.1002/uog.22151] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/17/2020] [Accepted: 07/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate three birth-weight (BW) standards (Australian population-based, Fenton and INTERGROWTH-21st ) and three estimated-fetal-weight (EFW) standards (Hadlock, INTERGROWTH-21st and WHO) for classifying small-for-gestational age (SGA) and large-for-gestational age (LGA) and predicting adverse perinatal outcomes in preterm and term babies. METHODS This was a nationwide population-based study conducted on a total of 2.4 million singleton births that occurred from 24 + 0 to 40 + 6 weeks' gestation between 2004 and 2013 in Australia. The performance of the growth charts was evaluated according to SGA and LGA classification, and relative risk (RR) and diagnostic accuracy based on the areas under the receiver-operating-characteristics curves (AUCs) for stillbirth, neonatal death, perinatal death, composite morbidity and a composite of perinatal death and morbidity outcomes. The analysis was stratified according to gestational age at delivery (< 37 + 0 vs ≥ 37 + 0 weeks). RESULTS Following exclusions, 2 392 782 singleton births were analyzed. There were significant differences in the SGA and LGA classification and risk of adverse outcomes between the six BW and EFW standards evaluated. For the term group, compared with the other standards, the INTERGROWTH-21st BW and EFW standards classified half the number of SGA (< 10th centile) babies (3-4% vs 7-11%) and twice the number of LGA (> 90th centile) babies (24-25% vs 8-15%), resulting in a smaller cohort of term SGA at higher risk of adverse outcome and a larger LGA cohort at lower risk of adverse outcome. For term SGA (< 3rd centile) babies, the RR of perinatal death using the two INTERGROWTH-21st standards was up to 1.5-fold higher than those of the other standards (including the WHO-EFW and Hadlock-EFW), while the INTERGROWTH-21st -EFW standard indicated a 12-26% reduced risk of perinatal death for LGA cases across centile thresholds. Conversely, for the preterm group, the WHO-EFW and Hadlock-EFW standards identified a higher SGA classification rate than did the other standards (18-19% vs 10-11%) and a 20-65% increased risk of perinatal death in term LGA babies. All BW and EFW charts had similarly poor performance in predicting adverse outcomes, including the composite outcome (AUC range, 0.49-0.62) for both preterm (AUC range, 0.58-0.62) and term (AUC range, 0.49-0.50) cases and across centiles. Furthermore, specific centile thresholds for identifying adverse outcomes varied markedly by chart between BW and EFW standards. CONCLUSIONS This study addresses the recurrent problem of identifying fetuses at risk of morbidity and perinatal mortality associated with growth disorders and provides new insights into the applicability of international growth standards. Our findings of marked variation in classification and the similarly poor performance of prescriptive international standards and the other commonly used standards raise questions about whether the prescriptive international standards that were constructed for universal adoption are indeed applicable to a multiethnic population such as that of Australia. Thus, caution is needed when adopting universal standards for clinical and epidemiological use. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S K Y Choi
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - A Gordon
- Newborn Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - L Hilder
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - A Henry
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Women's and Children's Health, St George Hospital, Sydney, New South Wales, Australia
| | - J A Hyett
- Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - B K Brew
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - F Joseph
- Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - L Jorm
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - G M Chambers
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Rustogi D, Synnes A, Alshaikh B, Hasan S, Drolet C, Masse E, Murthy P, Shah PS, Yusuf K. Neurodevelopmental outcomes of singleton large for gestational age infants <29 weeks' gestation: a retrospective cohort study. J Perinatol 2021; 41:1313-1321. [PMID: 34035448 DOI: 10.1038/s41372-021-01080-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/05/2021] [Accepted: 04/28/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare neurodevelopmental outcomes of large and appropriate for gestational age (LGA, AGA) infants <29 weeks' gestation at 18-24 months of corrected age. STUDY DESIGN Retrospective cohort study using the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network databases. Primary outcome was a composite of death or significant neurodevelopmental impairment (NDI), defined as severe cerebral palsy, Bayley III cognitive, language and motor scores of <70, need for hearing aids or cochlear implant and bilateral visual impairment. Univariate and multivariable logistic analyses were applied for outcomes. RESULTS The study cohort comprised 170 LGA and 1738 AGA infants. There was no difference in significant NDI or individual components of the Bayley III between LGA and AGA groups. LGA was associated with the increased risk of death by follow-up, 44/170 (25.9%) vs. 320/1738 (18.4%) (aOR: 1.60 95% CI: 1.00-2.54). CONCLUSIONS Risk of NDI was similar between LGA and AGA infants.
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Affiliation(s)
- Deepika Rustogi
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Anne Synnes
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Belal Alshaikh
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Shabih Hasan
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Edith Masse
- CHU de Sherbrooke, University of Sherbrooke, Quebec, Canada
| | - Prashanth Murthy
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Kamran Yusuf
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.
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Kato DMP, Lorusso L, Bruns RF, Pinhat EC, Dalla Costa NRA, Pletsch L, Araujo Júnior E. Performance of a local reference curve for predicting small for gestational age fetuses in pregnant women with HIV/AIDS. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:322-327. [PMID: 33615495 DOI: 10.1002/jcu.22961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/06/2020] [Accepted: 11/26/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE To compare the performance of a local estimated fetal weight curve with curves established for other populations to predict small for gestational age (SGA) fetuses. METHODS A retrospective and cross-sectional study involving 231 fetuses in which the performance of a local curve (proposed model) was compared with the Hadlock and Intergrowth-21st curves in the prediction of SGA fetuses, by applying them to a population of high-risk pregnant woman with HIV/AIDS. For each model, a receiver operating characteristic curve was adjusted, considering the SGA classification by the neonatal Intergrowth method as the gold standard, and the area under the curve (AUC) was calculated. RESULTS The models presented linear correlations with each other. The agreement of the proposed model with Hadlock was very good (kappa = 0.83), whereas the proposed model and Intergrowth-21st had moderate agreement (kappa = 0.44). The SGA fetus detection sensitivities of the proposed model and Hadlock were 61.9% and 57.1%, with specificity of 84.1% and 86.2% and accuracy of 80.1% and 81%, respectively, without statistical difference. The sensitivity of the Intergrowth-21st model was 33.3%, while the accuracy was 85.7% and the specificity was 97.4%. The AUC estimated values for the Hadlock, proposed, and Intergrowth-21st models were 0.834, 0.832, and 0.835, respectively. CONCLUSION The proposed model and Hadlock were interchangeable in the prediction of SGA fetuses and superior to the Intergrowth-21st model.
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Affiliation(s)
| | - Liziane Lorusso
- Department of Obstetrics and Gynecology, Federal University of Paraná (UFPR), Curitiba, Brazil
| | - Rafael Frederico Bruns
- Department of Obstetrics and Gynecology, Federal University of Paraná (UFPR), Curitiba, Brazil
| | | | | | - Letícia Pletsch
- Department of Obstetrics and Gynecology, Federal University of Paraná (UFPR), Curitiba, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- Medical Course, Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo, Brazil
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Modzelewski J, Kajdy A, Muzyka-Placzyńska K, Sys D, Rabijewski M. Fetal Growth Acceleration-Current Approach to the Big Baby Issue. ACTA ACUST UNITED AC 2021; 57:medicina57030228. [PMID: 33801377 PMCID: PMC8001449 DOI: 10.3390/medicina57030228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Fetal overgrowth is related to many perinatal complications, including stillbirth, cesarean section, maternal and neonatal injuries, and shoulder dystocia. It is related to maternal diabetes, obesity, and gestational weight gain but also happens in low-risk pregnancies. There is ongoing discussion regarding definitions, methods of detection, and classification. The method used for detection is crucial as it draws a line between those at risk and low-risk popula-tions. Materials and Methods: For this narrative review, relevant evidence was identified through PubMed search with one of the general terms (macrosomia, large-for-gestational-age) combined with the outcome of interest. Results: This review summarizes evidence on the relation of fetal overgrowth with stillbirth, cesarean sections, shoulder dystocia, anal sphincter injury, and hem-orrhage. Customized growth charts help to detect mothers and fetuses at risk of those complica-tions. Relations between fetal overgrowth and diabetes, maternal weight, and gestational weight gain were investigated. Conclusions: a substantial proportion of complications are an effect of the fetus growing above its potential and should be recognized as a new dangerous condition of Fetal Growth Acceleration.
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Affiliation(s)
| | - Anna Kajdy
- Correspondence: (A.K.); (M.R.); Tel.: +48-22-255-9917 (A.K. & M.R.)
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Melamed N, Hiersch L, Aviram A, Keating S, Kingdom JC. Customized birth-weight centiles and placenta-related fetal growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:409-416. [PMID: 33073889 DOI: 10.1002/uog.23516] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/20/2020] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The value of using customized birth-weight centiles to improve the diagnostic accuracy for fetal growth restriction (FGR), in comparison with using population-based charts, remains a matter of debate. One potential explanation for the conflicting data is that most studies used measures of perinatal mortality and morbidity as proxies for placenta-mediated FGR, many of which are not specific and may be confounded by other factors such as prematurity. The aim of this study was to compare the diagnostic accuracy of small-for-gestational age (SGA) at birth, defined according to customized vs population-based charts, for associated abnormal placental pathology. METHODS This was a secondary analysis of data from a prospective cohort study on risk factors for placenta-mediated complications and abnormal placental pathology in low-risk nulliparous women. All placentae were sent for detailed histopathological examination by two perinatal pathologists. The primary exposure was SGA, defined as birth weight < 10th centile for gestational age using either a customized (SGAcust ) or a population-based (SGApop ) birth-weight reference. The outcomes of interest were one of three types of abnormal placental pathology associated with FGR: maternal vascular malperfusion (MVM), chronic villitis and fetal vascular malperfusion (FVM). Adjusted relative risks (aRR) with 95% CIs were estimated using modified Poisson regression analysis, with adjustment for smoking, body mass index and aspirin treatment. RESULTS A total of 857 nulliparous women met the study criteria. The proportions of infants identified as SGA based on the customized and population-based charts were 12.6% (108/857) and 11.4% (98/857), respectively. A diagnosis of SGA using either customized or population-based charts was associated with an increased risk of any placental pathology (aRR, 3.04 (95% CI, 2.29-4.04) and 1.60 (95% CI, 1.10-2.31), respectively) and MVM pathology (aRR, 12.33 (95% CI, 6.60-23.03) and 5.29 (95% CI, 2.87-9.76), respectively). SGAcust , but not SGApop , was also associated with an increased risk for chronic villitis (aRR, 1.85 (95% CI, 1.07-3.18)) and FVM pathology (aRR, 2.48 (95% CI, 1.25-4.93)). SGAcust had a higher detection rate for any placental pathology (30.3% vs 17.1%; P < 0.001), MVM pathology (63.2% vs 39.5%; P = 0.003) and chronic villitis (20.8% vs 8.3%; P = 0.007) than did SGApop , for a similar false-positive rate. This was mainly the result of a higher detection rate for abnormal pathology in the white and East-Asian subgroups and a lower false-positive rate for abnormal pathology in the South-Asian subgroup by SGAcust than by SGApop . In addition, pregnancies in the SGAcust group, but not those in the SGApop group, were more likely to be complicated by preterm birth and a low 5-min Apgar score than were the corresponding non-SGA group. CONCLUSION These findings suggest that customized birth-weight centiles may be superior to population-based birth-weight centiles in detecting FGR that is due to underlying placental disease. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N Melamed
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - L Hiersch
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - A Aviram
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - S Keating
- Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - J C Kingdom
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
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Simeone S, Vannuccini S, Proietto R, Serena C, Ottanelli S, Rambaldi MP, Lisi F, Clemenza S, Comito C, Cozzolino M, Petraglia F, Mecacci F. Fetal nondiabetic-macrosomia: risk factors for pregnancy adverse outcome and comparison of two growth curves in the prediction of cesarean section. J Matern Fetal Neonatal Med 2021; 35:5639-5646. [PMID: 33627015 DOI: 10.1080/14767058.2021.1888918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Randomized trials reported no difference whether induction or expectant management is performed in non-diabetic women with large for gestational age babies but no tool has been validated for the prediction of high risk cases. AIM Assessing the performance of different growth curves in the prediction of complications. METHODS Data from 1066 consecutive non-diabetic women who delivered babies ≥4000 g were collected. Logistic regression analysis was used to analyze the impact of the maternal variables on: instrumental delivery, shoulder dystocia (SD), perineal tears, cesarean section (CS), and postpartum hemorrhage. Intergrowth21 curves and customized Gardosi's curves were compared in terms of prediction of adverse outcomes. FINDINGS Induction of labor was performed in 23.1% cases. The rate of CS was 17%. Hemorrhage, fetal distress, and SD occurred in 2%, 1.3%, and 2.7% of cases, respectively. Induction was significantly associated with instrumental delivery (p < .001), CS (p = .001), third and fourth degree perineal tears (p = .031), and post-partum hemorrhage (p = .02). The cutoff of 90th percentile according to Intergrowth21 did not show significant performance in predicting CS, while the same cutoff according to the Gardosi curves showed an OR 1.92 (CI 1.30-2.84) (p = .0009). DISCUSSION Gardosi curves showed a better performance in predicting the risk of CS versus Intergrowth curves. Induction is significantly associated with adverse outcome in non-diabetic women with LGA babies.
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Affiliation(s)
- Serena Simeone
- Department of Mother and Child's Health, Careggi University Hospital, Florence, Italy
| | - Silvia Vannuccini
- Department of Mother and Child's Health, Careggi University Hospital, Florence, Italy
| | - Roberta Proietto
- Nutrition Sciences Degree, University of Florence, Florence, Italy
| | - Caterina Serena
- Department of Mother and Child's Health, Careggi University Hospital, Florence, Italy
| | - Serena Ottanelli
- Department of Mother and Child's Health, Careggi University Hospital, Florence, Italy
| | | | - Federica Lisi
- Department of Mother and Child's Health, Careggi University Hospital, Florence, Italy
| | - Sara Clemenza
- Department of Mother and Child's Health, Careggi University Hospital, Florence, Italy
| | - Chiara Comito
- Department of Mother and Child's Health, Careggi University Hospital, Florence, Italy
| | - Mauro Cozzolino
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.,Department of Obstetrics and Gynecology, Universidad Rey Juan Carlos, Madrid, Spain.,IVIRMA, IVI Foundation, Valencia, Spain
| | - Felice Petraglia
- Department of Biochemical, Experimental and Clinical Sciences "MarioSerio", University of Florence, Florence, Italy
| | - Federico Mecacci
- Department of Biochemical, Experimental and Clinical Sciences "MarioSerio", University of Florence, Florence, Italy
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Fernandez-Rodriguez B, de Alba C, Galindo A, Recio D, Villalain C, Pallas CR, Herraiz I. Obstetric and pediatric growth charts for the detection of late-onset fetal growth restriction and neonatal adverse outcomes. J Perinat Med 2021; 49:216-224. [PMID: 33027055 DOI: 10.1515/jpm-2020-0210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/11/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Late-onset fetal growth restriction (FGR) has heterogeneous prenatal and postnatal diagnostic criteria. We compared the prenatal and postnatal diagnosis of late-onset FGR and their ability to predict adverse perinatal outcomes. METHODS Retrospective cohort study of 5442 consecutive singleton pregnancies that delivered beyond 34 + 0 weeks. Prenatal diagnosis of FGR was based on customized fetal growth standards and fetal Doppler while postnatal diagnosis was based on a birthweight <3rd percentile according to newborn charts (Olsen's charts and Intergrowth 21st century programme). Perinatal outcomes were analyzed depending on whether the diagnosis was prenatal, postnatal or both. RESULTS A total of 94 out of 5442 (1.7%) were diagnosed as late-onset FGR prenatally. Olsen's chart and Intergrowth 21st chart detected that 125/5442 (2.3%) and 106/5442 (2.0%) of infants had a birthweight <3rd percentile, respectively. These charts identified 35/94 (37.2%) and 40/94 (42.6%) of the newborns with a prenatal diagnosis of late-onset FGR. Prenatally diagnosed late-onset FGR infants were at a higher risk for hypoglycemia, jaundice and polycythemia. Both prenatally and postnatally diagnosed as late-onset FGR had a higher risk for respiratory distress syndrome when compared to non-FGR. The higher risks for intensive care admission and composite adverse outcomes were observed in those with a prenatal diagnosis of late-onset FGR that was confirmed after birth. CONCLUSIONS Current definitions of pre- and postnatal late-onset FGR do not match in more than half of cases. Infants with a prenatal or postnatal diagnosis of this condition have an increased risk of neonatal morbidity even if these diagnoses are not coincident.
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Affiliation(s)
| | - Concepción de Alba
- Department of Neonatology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Alberto Galindo
- Department of Obstetrics and Gynaecology, Fetal Medicine Unit-SAMID, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - David Recio
- Department of Neonatology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Cecilia Villalain
- Department of Obstetrics and Gynaecology, Fetal Medicine Unit-SAMID, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Carmen Rosa Pallas
- Department of Neonatology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Ignacio Herraiz
- Department of Obstetrics and Gynaecology, Fetal Medicine Unit-SAMID, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
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Chen HY, Chauhan SP. Macrosomic Newborns Delivered at Term after Labor among Nondiabetic Women: Maternal and Neonatal Morbidities. Am J Perinatol 2021; 38:150-157. [PMID: 31430814 DOI: 10.1055/s-0039-1695013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to compare morbidities among nonmacrosomic versus macrosomic singleton live births of nondiabetic women who labored. STUDY DESIGN This retrospective study utilized the 2003 revision of U.S. birth certificate data of singleton live births (2011-2013) at 37 to 41 weeks who labored. The primary outcomes were composite maternal and neonatal morbidities (CMM and CNM, respectively). We compared these outcomes by birth weight, 2,500 to 3,999 g (group 1; reference), 4,000 to 4,449 g (group 2), and 4,500 to 5,999 g (group 3). We used multivariable Poisson regression analyses to examine the association between birth weight groups and the outcomes. RESULTS Among 6,691,338 live births, 92.0% were in group 1, 7.1% in group 2, and 0.9% in group 3. The overall CMM and CNM rates were 4.4 and 6.8 per 1,000 live births, respectively. Compared with group 1, the risk of CMM was significantly higher in group 2 (adjusted risk ratio [aRR] = 1.50; 95% confidence interval [CI]: 1.44-1.56) and group 3 (aRR = 2.00; 95% CI: 1.82-2.19). Likewise, the risk of CNM was significantly higher in group 2 (aRR = 1.38; 95% CI: 1.33-1.43) and group 3 (aRR = 2.57; 95% CI: 2.40-2.75) than in group 1. CONCLUSION Nondiabetic women who labor with a macrosomic newborns have a significantly higher rate of adverse outcomes than nonmacrosomic.
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Affiliation(s)
- Han-Yang Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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Ochieng Arunda M, Agardh A, Asamoah BO. Cesarean delivery and associated socioeconomic factors and neonatal survival outcome in Kenya and Tanzania: analysis of national survey data. Glob Health Action 2020; 13:1748403. [PMID: 32345146 PMCID: PMC7241493 DOI: 10.1080/16549716.2020.1748403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/24/2020] [Indexed: 01/06/2023] Open
Abstract
Background: The increasing trends in cesarean delivery are globally acknowledged. However, in many low-resource countries, socioeconomic disparities have created a pattern of underuse and overuse among lower and higher socioeconomic groups. The impact of rising cesarean delivery rates on neonatal survival is also unclear.Objective: To examine cesarean delivery and its associated socioeconomic patterns and neonatal survival outcome in Kenya and Tanzania.Methods: We employed binary logistic regression to analyze cross-sectional demographic and health survey data on neonates born in health facilities in Kenya (2014) and Tanzania (2016).Results: Cesarean delivery rates ranged from 5% among uneducated, rural Tanzanian women to 26% among educated urban women in Kenya to 37.5% among managers in urban Tanzania. Overall findings indicated higher odds of cesarean delivery among mothers from richest households, adjusted odds ratio (aOR) 1.4 (95% CI 1.2-1.8), those insured, aOR 1.6 (95% CI 1.3-1.9), highly educated, aOR 1.6 (95% CI 1.2-2.0) and managers aOR 1.7 (95% CI 1.3-2.2), compared to middle class, no insurance, primary education and unemployed, respectively. Overall, compared to normal births and while adjusting for maternal risk factors, cesarean delivery was significantly associated with neonatal mortality in Kenya and Tanzania, overall aOR 1.7 (95% CI 1.2-2.7). However, statistical significance ceased when fetal risk factors and number of antenatal care visits were further controlled for, aOR 1.6 (95% CI 0.9-2.6).Conclusion: Disproportionate access to cesarean delivery has widened in Kenya and Tanzania. Higher risks of cesarean-related neonatal deaths exist. Medically indicated or not, the safety and/or choice of cesarean delivery is best addressed on individual basis at the health-facility level. However, policy initiatives to eliminate incentives, improve equitable access and accountability to reduce unnecessary cesarean deliveries through well-informed decisions are needed. Efforts to prevent unintended pregnancies among adolescents as well as training of health workers and continuous research to improve neonatal outcomes are vital.
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Affiliation(s)
- Malachi Ochieng Arunda
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Benedict Oppong Asamoah
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Preventing term stillbirth: benefits and limitations of using fetal growth reference charts. Curr Opin Obstet Gynecol 2020; 31:365-374. [PMID: 31634162 DOI: 10.1097/gco.0000000000000576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review examines the variation in clinical practice with regards to ultrasound estimation of fetal weight, as well as calculation of fetal weight centiles. RECENT FINDINGS Placental dysfunction is associated with fetal smallness from intrauterine malnutrition as well as fetal disability and even stillbirth from hypoxemia. Although estimating fetal weight can be done accurately, the issue of which fetal weight centile chart should be used continues to be a contentious topic. The arguments against local fetal growth charts based on national borders and customization for variables known to be associated with disease are substantial. As for other human diseases such as hypertension and diabetes, there is a rationale for the use of an international fetal growth reference standard. Irrespective of the choice of fetal growth reference standard, a significant limitation of small for gestational age (SGA) detection programs to prevent stillbirth is that the majority of stillborn infants at term were not SGA at the time of demise. SUMMARY Placental dysfunction can present with SGA from malnutrition and/or stillbirth from hypoxemia depending on the gestational age of onset. Emerging data show that at term, fetal Doppler arterial redistribution is associated more strongly with perinatal death than fetal size. Properly conducted trials of the role for maternal characteristics, fetal size, placental biomarkers, and Doppler assessing fetal well-being are required urgently.
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Anggraini D, Abdollahian M, Marion K. The development of an alternative growth chart for estimated fetal weight in the absence of ultrasound: Application in Indonesia. PLoS One 2020; 15:e0240436. [PMID: 33048951 PMCID: PMC7553358 DOI: 10.1371/journal.pone.0240436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 09/27/2020] [Indexed: 11/30/2022] Open
Abstract
A fetal growth chart is a vital tool for assessing fetal risk during pregnancy. Since fetal weight cannot be directly measured, its reliable estimation at different stages of pregnancy has become an essential issue in obstetrics and gynecology and one of the critical elements in developing a fetal growth chart for estimated fetal weight. In Indonesia, however, a reliable model and data for fetal weight estimation remain challenging, and this causes the absence of a standard fetal growth chart in antenatal care practices. This study has reviewed and evaluated the efficacy of the prediction models used to develop the most prominent growth charts for estimated fetal weight. The study also has discussed the potential challenges when such surveillance tools are utilized in low resource settings. The study, then, has proposed an alternative model based only on maternal fundal height to estimate fetal weight. Finally, the study has developed an alternative growth chart and assessed its capability in detecting abnormal patterns of fetal growth during pregnancy. Prospective data from twenty selected primary health centers in South Kalimantan, Indonesia, were used for the proposed model validation, the comparison task, and the alternative growth chart development using both descriptive and inferential statistics. Results show that limited access to individual fetal biometric characteristics and low-quality data on personal maternal and neonatal characteristics make the existing fetal growth charts less applicable in the local setting. The proposed model based only on maternal fundal height has a comparable ability in predicting fetal weight with less error than the existing models. The results have shown that the developed chart based on the proposed model can effectively detect signs of abnormality, between 20 and 41 weeks, among low birth weight babies in the absence of ultrasound. Consequently, the developed chart would improve the quality of fetal risk assessment during pregnancy and reduce the risk of adverse neonatal outcomes.
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Affiliation(s)
- Dewi Anggraini
- Study Program of Statistics, Faculty of Mathematics and Natural Sciences, Lambung Mangkurat University, Banjarbaru, South Kalimantan, Indonesia
- * E-mail:
| | - Mali Abdollahian
- School of Science, College of Science, Engineering, and Health, RMIT University, Melbourne, Victoria, Australia
| | - Kaye Marion
- School of Science, College of Science, Engineering, and Health, RMIT University, Melbourne, Victoria, Australia
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Zakama AK, Weekes T, Kajubi R, Kakuru A, Ategeka J, Kamya M, Muhindo MK, Havlir D, Jagannathan P, Dorsey G, Gaw SL. Generation of a malaria negative Ugandan birth weight standard for the diagnosis of small for gestational age. PLoS One 2020; 15:e0240157. [PMID: 33007041 PMCID: PMC7531849 DOI: 10.1371/journal.pone.0240157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022] Open
Abstract
Objective Placental malaria is a known risk factor for small for gestational age (SGA) neonates. However, currently utilized international and African birthweight standards have not controlled for placental malaria and/or lack obstetrical ultrasound dating. We developed a neonatal birthweight standard based on obstetrically dated pregnancies that excluded individuals with clinical malaria, asymptomatic parasitemia, and placental malaria infection. We hypothesized that current curves underestimate true ideal birthweight and the prevalence of SGA. Study design Participants were pooled from two double-blind randomized control trials of intermittent preventive therapy during pregnancy in Uganda. HIV-negative women without comorbidities were enrolled from 12–20 weeks gestation. Gestational age was confirmed by ultrasound dating. Women were followed through pregnancy and delivery for clinical malaria, asymptomatic parasitemia, and placental malaria. Women without malaria, asymptomatic parasitemia, or placental malaria formed the malaria negative cohort and generated the Ugandan birthweight standard. The Ugandan standard was then used to estimate the prevalence of SGA neonates in the malaria positive cohort. These findings were compared to international (Williams, World Health Organization (WHO), and INTERGROWTH-21st) and regional standards (Tanzanian and Malawi). Results 926 women had complete delivery data; 393 (42.4%) met criteria for the malaria negative cohort and 533 (57.6%) were malaria positive. The Ugandan standard diagnosed SGA in 17.1% of malaria positive neonates; similar to the INTERGROWTH-21st and Schmiegelow curves. The WHO curve diagnosed SGA in significantly more neonates (32.1%, p = <0.001), and the Malawi curve diagnosed SGA in significantly fewer neonates (8.3%, p <0.001). Conclusion Exclusion of women with subclinical placental malaria in malaria-endemic areas created birth weight norms at higher values and increased the detection of SGA. Birth weight standards that fail to account for endemic illness may underestimate the true growth potential of healthy neonates.
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Affiliation(s)
- Arthurine K. Zakama
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Terik Weekes
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Richard Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - John Ategeka
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Moses Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | | | - Diane Havlir
- Department of Medicine, University of California, San Francisco, California, United States of America
| | - Prasanna Jagannathan
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, California, United States of America
| | - Stephanie L. Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, United States of America
- * E-mail:
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Hiersch L, Lipworth H, Kingdom J, Barrett J, Melamed N. Identification of the optimal growth chart and threshold for the prediction of antepartum stillbirth. Arch Gynecol Obstet 2020; 303:381-390. [PMID: 32803394 DOI: 10.1007/s00404-020-05747-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/10/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the effect of the choice growth chart and threshold used to define small for gestational age (SGA) on the predictive value of SGA for placenta-related or unexplained antepartum stillbirth. METHODS A retrospective cohort study of all women with a singleton pregnancy who gave birth > 24 week gestation in a single center (2000-2016). The exposure of interest was SGA, defined as birth weight < 10th or < 25th centile according to three fetal growth charts (Hadlock et al., Radiology 181:129-133, 1991; intergrowth-21st (IG21), WHO 2017, and a Canadian birthweight-based reference-Kramer et al., Pediatrics 108:E35, 2001). The outcome of interest was antepartum stillbirth due to placental dysfunction or unknown etiology. Cases of stillbirth attributed to other specific etiologies were excluded. RESULTS A total of 49,458 women were included in the cohort. There were 103 (0.21%) cases of stillbirth due to placental dysfunction or unknown etiology. For cases in the early stillbirth cluster (≤ 30 weeks), the detection rate was high and was similar for the three ultrasound-based fetal growth charts of Hadlock, IG21, and WHO (range 83.3-87.0%). In contrast, the detection rate of SGA for cases in the late stillbirth cluster (> 30 weeks) was low, being highest for WHO and Hadlock (36.7% and 34.7%, respectively), and lowest for IG21 (18.4%). Using a threshold of the 25th centile increased the detection rate for stillbirth by approximately 15-20% compared with that achieved by the 10th centile cutoff. CONCLUSION At > 30 week gestation, the Hadlock or WHO fetal growth charts provided the best balance between detection rate and false positive rate for stillbirth.
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Affiliation(s)
- Liran Hiersch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada. .,Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, M5G 1X8, Canada. .,Lis Hospital for Women, Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Hayley Lipworth
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - John Kingdom
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, M5G 1X8, Canada.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Jon Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, M5G 1X8, Canada
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Morales-Roselló J, Buongiorno S, Loscalzo G, Scarinci E, Giménez Roca L, Cañada Martínez AJ, Rosati P, Lanzone A, Perales Marín A. Birth-weight differences at term are explained by placental dysfunction and not by maternal ethnicity. Study in newborns of first generation immigrants. J Matern Fetal Neonatal Med 2020; 35:1419-1425. [PMID: 32372671 DOI: 10.1080/14767058.2020.1755651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The aim of the study was to investigate the influence of ethnicity and cerebroplacental ratio (CPR) on the birth weight (BW) of first generation Indo-Pakistan immigrants' newborns.Methods: This was a retrospective study in a mixed population of 620 term Caucasian and Indo-Pakistan pregnancies, evaluated in two reference hospitals of Spain and Italy. All fetuses underwent a scan and Doppler examination within two weeks of delivery. The influence of fetal gender, ethnicity, GA at delivery, CPR, maternal age, height, weight and parity on BW was evaluated by multivariable regression analysis.Results: Newborns of first generation Indo-Pakistan immigrants were smaller than local Caucasian newborns (mean BW mean= 3048 ± 435 g versus 3269 ± 437 g, p < .001). Multivariable regression analysis demonstrated that all studied parameters, but maternal age and ethnicity, were significantly associated with BW. The most important were GA at delivery (partial R2 = 0.175, p < .001), CPR (partial R2 = 0.032, p < .001), and fetal gender (partial R2 = 0,029, p < .001).Conclusions: The propensity to a lower BW, explained by placental dysfunction but not by maternal ethnicity is transmitted to newborns of first generation immigrants. Whatever are the factors implied they persist in the new residential setting.
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Affiliation(s)
- José Morales-Roselló
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain
| | - Silvia Buongiorno
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gabriela Loscalzo
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Elisa Scarinci
- Department of scienze della Salute della Donna, del Bambino e di Sanità Pubblica" della Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Laura Giménez Roca
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Paolo Rosati
- Department of scienze della Salute della Donna, del Bambino e di Sanità Pubblica" della Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Antonio Lanzone
- Department of scienze della Salute della Donna, del Bambino e di Sanità Pubblica" della Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Alfredo Perales Marín
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain
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Dall'Asta A, Rizzo G, Kiener A, Volpe N, Di Pasquo E, Roletti E, Mappa I, Makatsariya A, Maruotti GM, Saccone G, Sarno L, Papaccio M, Fichera A, Prefumo F, Ottaviani C, Stampalija T, Frusca T, Ghi T. Identification of large-for-gestational age fetuses using antenatal customized fetal growth charts: Can we improve the prediction of abnormal labor course? Eur J Obstet Gynecol Reprod Biol 2020; 248:81-88. [PMID: 32199297 DOI: 10.1016/j.ejogrb.2020.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Fetal overgrowth is an acknowledged risk factor for abnormal labor course and maternal and perinatal complications. The objective of this study was to evaluate whether the use of antenatal ultrasound-based customized fetal growth charts in fetuses at risk for large-for-gestational age (LGA) allows a better identification of cases undergoing caesarean section due to intrapartum dystocia. MATERIAL AND METHODS An observational study involving four Italian tertiary centers was carried out. Women referred to a dedicated antenatal clinic between 35 and 38 weeks due to an increased risk of having an LGA fetus at birth were prospectively selected for the study purpose. The fetal measurements obtained and used for the estimation of the fetal size were biparietal diameter, head circumference, abdominal circumference and femur length, were prospectively collected. LGA fetuses were defined by estimated fetal weight (EFW) >95th centile either using the standard charts implemented by the World Health Organization (WHO) or the customized fetal growth charts previously published by our group. Patients scheduled for elective caesarean section (CS) or for elective induction for suspected fetal macrosomia or submitted to CS or vacuum extraction (VE) purely due to suspected intrapartum distress were excluded. The incidence of CS due to labor dystocia was compared between fetuses with EFW >95th centile according WHO or customized antenatal growth charts. RESULTS Overall, 814 women were eligible, however 562 were considered for the data analysis following the evaluation of the exclusion criteria. Vaginal delivery occurred in 466 (82.9 %) women (435 (77.4 %) spontaneous vaginal delivery and 31 (5.5 %) VE) while 96 had CS. The EFW was >95th centile in 194 (34.5 %) fetuses according to WHO growth charts and in 190 (33.8 %) by customized growth charts, respectively. CS due to dystocia occurred in 43 (22.2 %) women with LGA fetuses defined by WHO curves and in 39 (20.5 %) women with LGA defined by customized growth charts (p 0.70). WHO curves showed 57 % sensitivity, 72 % specificity, 24 % PPV and 91 % NPV, while customized curves showed 52 % sensitivity, 73 % specificity, 23 % PPV and 91 % NPV for CS due to labor dystocia. CONCLUSIONS The use of antenatal ultrasound-based customized growth charts does not allow a better identification of fetuses at risk of CS due to intrapartum dystocia.
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Affiliation(s)
- Andrea Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy; Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom
| | - Giuseppe Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy; Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation
| | - Ariane Kiener
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Nicola Volpe
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Elvira Di Pasquo
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Enrica Roletti
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Ilenia Mappa
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
| | - Alexander Makatsariya
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy; Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Laura Sarno
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Marta Papaccio
- Department of Obstetrics and Gynaecology, University of Brescia, Spedali Civili Di Brescia, Brescia, Italy
| | - Anna Fichera
- Department of Obstetrics and Gynaecology, University of Brescia, Spedali Civili Di Brescia, Brescia, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, University of Brescia, Spedali Civili Di Brescia, Brescia, Italy
| | - Chiara Ottaviani
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy; Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy; Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy.
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Bicocca MJ, Le TN, Zhang CC, Blackburn B, Blackwell SC, Sibai BM, Chauhan SP. Identification of newborns with birthweight ≥ 4,500g: Ultrasound within one- vs. two weeks of delivery. Eur J Obstet Gynecol Reprod Biol 2020; 249:47-53. [PMID: 32353616 DOI: 10.1016/j.ejogrb.2020.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Our objective was to compare the diagnostic characteristics of sonographic estimated fetal weight (SEFW) done within 7 versus 8-14 days before delivery for detection of fetal macrosomia (birthweight ≥ 4500 g). STUDY DESIGN We performed a multicenter, retrospective cohort study of all non-anomalous singletons with SEFW ≥ 4000 g by Registered Diagnostic Medical Sonographers conducted within 14 days of delivery. Cohorts were grouped by time interval between ultrasound and delivery: 0-7 days versus 8-14 days. The detection rate (DR) and false positive rate (FPR) for detection of birthweight (BW) ≥ 4500 g were compared between groups with subgroup analysis for diabetic women. Area under the receiver operator curve (AUC) was calculated to analyze all possible SEFW cutoffs within our cohort. RESULTS A total of 330 patients met inclusion criteria with 250 (75.8 %) having SEFW within 7 days and 80 (24.2 %) with SEFW 8-14 days prior to delivery. The rate of macrosomia was 15.1 % (N = 51). The DR for macrosomia was significantly higher when SEFW was performed within 7 days of delivery compared to 8-14 days among non-diabetic (73.0 % vs 7.1 %; p < 0.001) and diabetic women (76.5 % vs 16.7 %; p = 0.02). There was no significant change in FPR in either group. The AUC for detection of macrosomia was significantly higher when SEFW was performed within 7 days versus 8-14 days (0.89 vs 0.63; p < 0.01). CONCLUSION With SEFW ≥ 4000 g, the detection of BW ≥ 4500 g is significantly higher when the sonographic examination is within 7 days of birth irrespective of maternal diabetes.
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Affiliation(s)
- Matthew J Bicocca
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.
| | - Tran N Le
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Caroline C Zhang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Bonnie Blackburn
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, United States
| | - Sean C Blackwell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Baha M Sibai
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
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31
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Erkamp JS, Voerman E, Steegers EAP, Mulders AGMGJ, Reiss IKM, Duijts L, Jaddoe VWV, Gaillard R. Second and third trimester fetal ultrasound population screening for risks of preterm birth and small-size and large-size for gestational age at birth: a population-based prospective cohort study. BMC Med 2020; 18:63. [PMID: 32252740 PMCID: PMC7137302 DOI: 10.1186/s12916-020-01540-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preterm birth, small size for gestational age (SGA) and large size for gestational age (LGA) at birth are major risk factors for neonatal and long-term morbidity and mortality. It is unclear which periods of pregnancy are optimal for ultrasound screening to identify fetuses at risk of preterm birth, SGA or LGA at birth. We aimed to examine whether single or combined second and third trimester ultrasound in addition to maternal characteristics at the start of pregnancy are optimal to detect fetuses at risk for preterm birth, SGA and LGA. METHODS In a prospective population-based cohort among 7677 pregnant women, we measured second and third trimester estimated fetal weight (EFW), and uterine artery pulsatility and umbilical artery resistance indices as placenta flow measures. Screen positive was considered as EFW or placenta flow measure < 10th or > 90th percentile. Information about maternal age, body mass index, ethnicity, parity, smoking, fetal sex and birth outcomes was available from questionnaires and medical records. Screening performance was assessed via receiver operating characteristic (ROC) curves and area under the curve (AUC) along with sensitivity at different false-positive rates. RESULTS Maternal characteristics only and in combination with second trimester EFW had a moderate performance for screening for each adverse birth outcome. Screening performance improved by adding third trimester EFW to the maternal characteristics (AUCs for preterm birth 0.64 (95%CI 0.61 to 0.67); SGA 0.79 (95%CI 0.78 to 0.81); LGA 0.76 (95%CI 0.75; 0.78)). Adding third trimester placenta measures to this model improved only screening for risk of preterm birth (AUC 0.72 (95%CI 0.66 to 0.77) with sensitivity 37% at specificity 90%) and SGA (AUC 0.83 (95%CI 0.81 to 0.86) with sensitivity 55% at specificity 90%). Combining second and third trimester fetal and placental ultrasound did not lead to a better performance as compared to using only third trimester results. CONCLUSIONS Combining single third trimester fetal and placental ultrasound results with maternal characteristics has the best screening performance for risks of preterm birth, SGA and LGA. As compared to second trimester screening, third trimester screening may double the detection of fetuses at risk of common adverse birth outcomes.
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Affiliation(s)
- Jan S Erkamp
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands.,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ellis Voerman
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands.,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands.,Department of Paediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands.,Department of Paediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands.,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands. .,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Rodriguez-Lopez M, Vergara-Sanchez C, Crispi F, Cepeda IL. Sources of heterogeneity when studying the cardiovascular effects of fetal growth restriction: an overview of the issues. J Matern Fetal Neonatal Med 2020; 35:1379-1385. [PMID: 32228109 DOI: 10.1080/14767058.2020.1749592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Intrauterine growth restriction (IUGR) has been repeatedly identified as a risk factor for cardiovascular disease (CVD). A possible explanation for this association is the effect of IUGR on cardiovascular structure and function. However, the specific changes observed are not consistent among studies. In this paper, we analyze several sources of heterogeneity within and between studies related to exposure, outcome and co-variables. A broad IUGR definition might include different phenotypes, expressing heterogeneity as an outcome. Outcome heterogeneity may also be the result of the postnatal effect modification that can be explored within studies. In order to do so, it is important to move beyond mean differences between groups, for example using unsupervised, stratified or interaction analysis. Different definitions of IUGR and the inclusion of different postnatal variables as confounders are potential sources of heterogeneity between studies. Researchers should be aware that postnatal variables may play different roles throughout a person's life and are not limited to behave as confounders. Therefore, their inclusion in the statistical model needs to be carefully considered. We discuss when sources of heterogeneity need to be controlled, and when they need to be identified and shown as a result.
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Affiliation(s)
- Merida Rodriguez-Lopez
- Pontificia Universidad Javeriana, Cali, Colombia.,Center for Interdisciplinary Health Studies, Pontificia Universidad Javeriana, Cali, Colombia
| | - Carlos Vergara-Sanchez
- Pontificia Universidad Javeriana, Cali, Colombia.,Center for Interdisciplinary Health Studies, Pontificia Universidad Javeriana, Cali, Colombia
| | - Fatima Crispi
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Vikraman SK, Elayedatt RA. Prospective Comparative Evaluation of Performance of Fetal Growth Charts in the Diagnosis of Suboptimal Fetal Growth During Third Trimester Ultrasound Examination in an Unselected South Indian Antenatal Population. JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-020-00244-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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34
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Kabiri D, Romero R, Gudicha DW, Hernandez-Andrade E, Pacora P, Benshalom-Tirosh N, Tirosh D, Yeo L, Erez O, Hassan SS, Tarca AL. Prediction of adverse perinatal outcome by fetal biometry: comparison of customized and population-based standards. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:177-188. [PMID: 31006913 PMCID: PMC6810752 DOI: 10.1002/uog.20299] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/09/2019] [Accepted: 04/12/2019] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To compare the predictive performance of estimated fetal weight (EFW) percentiles, according to eight growth standards, to detect fetuses at risk for adverse perinatal outcome. METHODS This was a retrospective cohort study of 3437 African-American women. Population-based (Hadlock, INTERGROWTH-21st , World Health Organization (WHO), Fetal Medicine Foundation (FMF)), ethnicity-specific (Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)), customized (Gestation-Related Optimal Weight (GROW)) and African-American customized (Perinatology Research Branch (PRB)/NICHD) growth standards were used to calculate EFW percentiles from the last available scan prior to delivery. Prediction performance indices and relative risk (RR) were calculated for EFW < 10th and > 90th percentiles, according to each standard, for individual and composite adverse perinatal outcomes. Sensitivity at a fixed (10%) false-positive rate (FPR) and partial (FPR < 10%) and full areas under the receiver-operating-characteristics curves (AUC) were compared between the standards. RESULTS Ten percent (341/3437) of neonates were classified as small-for-gestational age (SGA) at birth, and of these 16.4% (56/341) had at least one adverse perinatal outcome. SGA neonates had a 1.5-fold increased risk of any adverse perinatal outcome (P < 0.05). The screen-positive rate of EFW < 10th percentile varied from 6.8% (NICHD) to 24.4% (FMF). EFW < 10th percentile, according to all standards, was associated with an increased risk for each of the adverse perinatal outcomes considered (P < 0.05 for all). The highest RRs associated with EFW < 10th percentile for each adverse outcome were 5.1 (95% CI, 2.1-12.3) for perinatal mortality (WHO); 5.0 (95% CI, 3.2-7.8) for perinatal hypoglycemia (NICHD); 3.4 (95% CI, 2.4-4.7) for mechanical ventilation (NICHD); 2.9 (95% CI, 1.8-4.6) for 5-min Apgar score < 7 (GROW); 2.7 (95% CI, 2.0-3.6) for neonatal intensive care unit (NICU) admission (NICHD); and 2.5 (95% CI, 1.9-3.1) for composite adverse perinatal outcome (NICHD). Although the RR CIs overlapped among all standards for each individual outcome, the RR of composite adverse perinatal outcome in pregnancies with EFW < 10th percentile was higher according to the NICHD (2.46; 95% CI, 1.9-3.1) than the FMF (1.47; 95% CI, 1.2-1.8) standard. The sensitivity for composite adverse perinatal outcome varied substantially between standards, ranging from 15% for NICHD to 32% for FMF, due mostly to differences in FPR; this variation subsided when the FPR was set to the same value (10%). Analysis of AUC revealed significantly better performance for the prediction of perinatal mortality by the PRB/NICHD standard (AUC = 0.70) compared with the Hadlock (AUC = 0.66) and FMF (AUC = 0.64) standards. Evaluation of partial AUC (FPR < 10%) demonstrated that the INTERGROWTH-21st standard performed better than the Hadlock standard for the prediction of NICU admission and mechanical ventilation (P < 0.05 for both). Although fetuses with EFW > 90th percentile were also at risk for any adverse perinatal outcome according to the INTERGROWTH-21st (RR = 1.4; 95% CI, 1.0-1.9) and Hadlock (RR = 1.7; 95% CI, 1.1-2.6) standards, many times fewer cases (2-5-fold lower sensitivity) were detected by using EFW > 90th percentile, rather than EFW < 10th percentile, in screening by these standards. CONCLUSIONS Fetuses with EFW < 10th percentile or EFW > 90th percentile were at increased risk of adverse perinatal outcomes according to all or some of the eight growth standards, respectively. The RR of a composite adverse perinatal outcome in pregnancies with EFW < 10th percentile was higher for the most-stringent (NICHD) compared with the least-stringent (FMF) standard. The results of the complementary analysis of AUC suggest slightly improved detection of adverse perinatal outcome by more recent population-based (INTERGROWTH-21st ) and customized (PRB/NICHD) standards compared with the Hadlock and FMF standards. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Doron Kabiri
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI
- Corresponding authors: Roberto Romero, MD, D.Med.Sci., Perinatology Research Branch, NICHD/NIH/DHHS, Hutzel Women’s Hospital, 3990 John R Street, 4 Brush, Detroit, Michigan 48201; telephone: (313) 993-2700; fax: (313) 577-6294; . Adi L. Tarca, PhD, Perinatology Research Branch, NICHD/NIH/DHHS, Hutzel Women’s Hospital, 3990 John R Street, 4 Brush, Detroit, Michigan 48201; telephone: (313) 577-5305; fax: (313) 577-6294;
| | - Dereje W. Gudicha
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
| | - Edgar Hernandez-Andrade
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Neta Benshalom-Tirosh
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Dan Tirosh
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
- Maternity Department “D”, Division of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Sonia S. Hassan
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI
| | - Adi L. Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
- Department of Computer Science, Wayne State University College of Engineering, Detroit, MI
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Choi SKY, Henry A, Hilder L, Gordon A, Jorm L, Chambers GM. Adverse perinatal outcomes in immigrants: A ten-year population-based observational study and assessment of growth charts. Paediatr Perinat Epidemiol 2019; 33:421-432. [PMID: 31476081 DOI: 10.1111/ppe.12583] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/16/2019] [Accepted: 08/06/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maternity populations are becoming increasingly multiethnic. Conflicting findings exist regarding the risk of adverse perinatal outcomes among immigrant mothers from different world regions and which growth charts are most appropriate for identifying the risk of adverse outcomes. OBJECTIVE To evaluate whether infant mortality and morbidity, and the categorisation of infants as small for gestational age or large for gestational age (SGA or LGA) vary by maternal country of birth, and to assess whether the choice of growth chart alters the risk of adverse outcomes in infants categorised as SGA and LGA. METHODS A population cohort of 601 299 singleton infants born in Australia to immigrant mothers was compared with 1.7 million infants born to Australian-born mothers, 2004-2013. Infants were categorised as SGA and LGA according to a descriptive Australian population-based birthweight chart (Australia-2012 reference) and the prescriptive INTERGROWTH-21st growth standard. Propensity score reweighting was used for the analysis. RESULTS Compared to Australian-born infants, infants of mothers from Africa, Philippines, India, other Asia countries, and the Middle East had between 15.4% and 48.1% elevated risk for stillbirth, preterm delivery, or low Apgar score. The association between SGA and LGA and perinatal mortality varied markedly by growth chart and country of birth. Notably, SGA infants from African-born mothers had a relative risk of perinatal mortality of 6.1 (95% CI 4.3, 6.7) and 17.3 (95% CI 12.0, 25.0) by the descriptive and prescriptive charts, respectively. LGA infants born to Australian-born mothers were associated with a 10% elevated risk of perinatal mortality by the descriptive chart compared to a 15% risk reduction by the prescriptive chart. CONCLUSIONS Country-of-birth-specific variations are becoming increasingly important for providing ethnically appropriate and safe maternity care. Our findings highlight significant variations in risk of adverse perinatal outcomes in immigrant subgroups, and demonstrate how the choice of growth chart alters the quantification of risk associated with being born SGA or LGA.
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Affiliation(s)
- Stephanie K Y Choi
- Centre or Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Amanda Henry
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Women's and Children's Health, St. George Hospital, Sydney, NSW, Australia
| | - Lisa Hilder
- Centre or Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Adrienne Gordon
- Newborn Care, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Louisa Jorm
- Centre or Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Georgina M Chambers
- Centre or Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Erkamp JS, Jaddoe VWV, Mulders AGMGJ, Steegers EAP, Reiss IKM, Duijts L, Gaillard R. Customized versus population birth weight charts for identification of newborns at risk of long-term adverse cardio-metabolic and respiratory outcomes: a population-based prospective cohort study. BMC Med 2019; 17:186. [PMID: 31619225 PMCID: PMC6796410 DOI: 10.1186/s12916-019-1424-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Customized birth weight charts take into account physiological maternal characteristics that are known to influence fetal growth to differentiate between physiological and pathological abnormal size at birth. It is unknown whether customized birth weight charts better identify newborns at risk of long-term adverse outcomes than population birth weight charts. We aimed to examine whether birth weight classification according to customized charts is superior to population charts at identification of newborns at risk of adverse cardio-metabolic and respiratory health outcomes. METHODS In a population-based prospective cohort study among 6052 pregnant women and their children, we measured infant catch-up growth, overweight, high blood pressure, hyperlipidemia, liver steatosis, clustering of cardio-metabolic risk factors, and asthma at age 10. Small size and large size for gestational age at birth was defined as birth weight in the lowest or highest decile, respectively, of population or customized charts. Association with birth weight classification was assessed using logistic regression models. RESULTS Of the total of 605 newborns classified as small size for gestational age by population charts, 150 (24.8%) were reclassified as appropriate size for gestational age by customized charts, whereas of the total of 605 newborns classified as large size for gestational age by population charts, 129 (21.3%) cases were reclassified as appropriate size for gestational age by customized charts. Compared to newborns born appropriate size for gestational age, newborns born small size for gestational age according to customized charts had increased risks of infant catch-up growth (odds ratio (OR) 5.15 (95% confidence interval (CI) 4.22 to 6.29)), high blood pressure (OR 2.05 (95% CI 1.55 to 2.72)), and clustering of cardio-metabolic risk factors at 10 years (OR 1.66 (95% CI 1.18 to 2.34)). No associations were observed for overweight, hyperlipidemia, liver steatosis, or asthma. Newborns born large-size for gestational age according to customized charts had higher risk of catch-down-growth only (OR 3.84 (95% CI 3.22 to 4.59)). The direction and strength of the observed associations were largely similar when we used classification according to population charts. CONCLUSIONS Small-size-for-gestational-age newborns seem to be at risk of long-term adverse cardio-metabolic health outcomes, irrespective of the use of customized or population birth weight charts.
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Affiliation(s)
- Jan S Erkamp
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Division of Neonatology, Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Respiratory Medicine and Allergology, Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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A new customised placental weight standard redefines the relationship between maternal obesity and extremes of placental size and is more closely associated with pregnancy complications than an existing population standard. J Dev Orig Health Dis 2019; 11:350-359. [PMID: 31587680 DOI: 10.1017/s2040174419000576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Placental weight is a valuable indicator of its function, predicting both pregnancy outcome and lifelong health. Population-based centile charts of weight-for-gestational-age and parity are useful for identifying extremes of placental weight but fail to consider maternal size. To address this deficit, a multiple regression model was fitted to derive coefficients for predicting normal placental weight using records from healthy pregnancies of nulliparous/multiparous women of differing height and weight (n = 107,170 deliveries, 37-43 weeks gestation). The difference between actual and predicted placental weight generated a z-score/individual centile for the entire cohort including women with pregnancy complications (n = 121,591). The association between maternal BMI and placental weight extremes defined by the new customised versus population-based standard was investigated by logistic regression, as was the association between low placental weight and pregnancy complications. Underweight women had a greater risk of low placental weight [<10thcentile, OR 1.84 (95% CI 1.66, 2.05)] and obese women had a greater risk of high placental weight [>90th centile, OR 1.98 (95% CI 1.88, 2.10)] using a population standard. After customisation, the risk of high placental weight in obese/morbidly obese women was attenuated [OR 1.17 (95% CI 1.09, 1.25)]/no longer significant, while their risk of low placental weight was 59%-129% higher (P < 0.001). The customised placental weight standard was more closely associated with stillbirth, hypertensive disease, placental abruption and neonatal death than the population standard. Our customised placental weight standard reveals higher risk of relative placental growth restriction leading to lower than expected birthweights in obese women, and a stronger association between low placental weight and pregnancy complications generally. Further, it provides an alternative tool for defining placental weight extremes with implications for the placental programming of chronic disease.
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Fernandez-Rodriguez B, de Alba C, Villalain C, Pallás CR, Galindo A, Herraiz I. Obstetric and pediatric growth charts for the detection of fetal growth restriction and neonatal adverse outcomes in preterm newborns before 34 weeks of gestation. J Matern Fetal Neonatal Med 2019; 34:1112-1119. [PMID: 31146604 DOI: 10.1080/14767058.2019.1626368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Identification of fetal growth-restricted (FGR) infants depends on the fetal or newborn charts used to identify them. We aimed to compare the prenatal and postnatal diagnosis of FGR and their ability to predict adverse perinatal outcomes. METHODS Observational retrospective cohort study of 95 consecutive mother-infant pairs with preterm birth between 24 and 34 weeks (study period: January 2014 to December 2015). Prenatal sonographic diagnosis of FGR, based on customized fetal growth standards and fetal Doppler, was compared with the postnatal diagnosis of FGR based on a birthweight < 3rd percentile according to newborn charts (International Newborn size references for the Intergrowth twenty-first century program, and Olsen's charts). Neonatal mortality and adverse neonatal outcomes were compared among groups. RESULTS In 23/95 (24%) cases a prenatal diagnosis of early FGR was made. Postnatal FGR was confirmed in 11/23 (48%) cases using Olsen's charts and 8/23 (35%) using Intergrowth 21st charts. One postnatal FGR case was missed by prenatal ultrasound. Bronchopulmonary dysplasia, sepsis and hypoglycemia were more frequent in pre- and postnatal FGR versus non-FGR. After adjusting for gestational age and sex, only an increased relative risk of hypoglycemia (2.0, 95%CI 1.0-2.8) was observed in infants with pre- and postnatal FGR diagnosis. Nonsignificant differences on neonatal outcomes were identified between prenatal FGR cases with normal birthweight and the non-FGR group. CONCLUSION Only prenatal FGR cases in which a birthweight below the third percentile is confirmed by means of postnatal charts (Olsen or Intergrowth standard) are at higher risk of adverse postnatal outcome.
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Affiliation(s)
| | - Concepcion de Alba
- Department of Neonatology, University Hospital, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Cecilia Villalain
- Department of Obstetrics and Gynaecology, Fetal Medicine Unit, SAMID, University Hospital, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Carmen Rosa Pallás
- Department of Neonatology, University Hospital, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Alberto Galindo
- Department of Obstetrics and Gynaecology, Fetal Medicine Unit, SAMID, University Hospital, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Ignacio Herraiz
- Department of Obstetrics and Gynaecology, Fetal Medicine Unit, SAMID, University Hospital, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
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Stephens K, Al-Memar M, Beattie-Jones S, Dhanjal M, Mappouridou S, Thorne E, Lees C. Comparing the relation between ultrasound-estimated fetal weight and birthweight in cohort of small-for-gestational-age fetuses. Acta Obstet Gynecol Scand 2019; 98:1435-1441. [PMID: 31090917 DOI: 10.1111/aogs.13645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Small-for-gestational-age (SGA) confers a higher perinatal risk of adverse outcomes. Birthweight cannot be accurately measured until delivery, therefore accurate estimated fetal weight (EFW) based on ultrasonography is important in identifying this high-risk population. We aimed to establish the sensitivity of detecting SGA infants antenatally in a unit with a selective third-trimester ultrasound policy and to investigate the association between EFW and birthweight in these babies. MATERIAL AND METHODS A retrospective cohort study was conducted on non-anomalous singleton pregnancies delivered after 36 weeks of gestation where SGA (<10th percentile) was diagnosed at delivery. The EFW at the time of the third-trimester ultrasound scan was recorded using standard Hadlock formulae. RESULTS In 2017, there were 8392 non-anomalous singleton pregnancies live born after 36 weeks, excluding late bookers. 797 were live-born SGA <10th percentile for birthweight and 464 <5th percentile, who met our inclusion criteria. The antenatal detection rate of SGA was 19.6% for babies with birthweight <10th percentile and 24.1% <5th percentile. There was a significant correlation between the EFW and birthweight of fetuses undergoing ultrasound assessment within 2 weeks of delivery (P < .001, r = 0.73 (Pearson correlation). For these cases, EFW was greater than the birthweight in 65% of cases. After adjusting all EFWs using the discrepancy between EFW and actual birthweight for those babies born within 48 hours of the scan, the mean difference between the birthweight and adjusted EFW 7 days before delivery was 111 g (95% CI 87-136 g) and at 14 days was 200 g (95% CI 153-248 g). Despite adjusting the EFW, 61/213 cases (28.6%) apparently lost weight between the ultrasound scan and delivery. CONCLUSIONS Small-for-gestational-age infants with a birthweight <10th percentile are poorly identified antenatally with little improvement for those <5th percentile. In SGA babies, ultrasound EFW overestimated birthweight. Discrepancies between birthweight and EFW are not explicable only by the limitations of third-trimester sonography, a reduction in fetal weight close to delivery in a proportion of liveborn SGA babies is plausible.
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Affiliation(s)
| | | | | | | | | | | | - Christoph Lees
- Queen Charlotte's and Chelsea Hospital, London, UK.,Department of Obstetrics & Gynecology, KU Leuven, Leuven, Belgium
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Salomon LJ, Alfirevic Z, Da Silva Costa F, Deter RL, Figueras F, Ghi T, Glanc P, Khalil A, Lee W, Napolitano R, Papageorghiou A, Sotiriadis A, Stirnemann J, Toi A, Yeo G. ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:715-723. [PMID: 31169958 DOI: 10.1002/uog.20272] [Citation(s) in RCA: 253] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 05/09/2023]
Abstract
INTRODUCTION These Guidelines aim to describe appropriate assessment of fetal biometry and diagnosis of fetal growth disorders. These disorders consist mainly of fetal growth restriction (FGR), also referred to as intrauterine growth restriction (IUGR) and often associated with small‐for‐gestational age (SGA), and large‐for‐gestational age (LGA), which may lead to fetal macrosomia; both have been associated with a variety of adverse maternal and perinatal outcomes. Screening for, and adequate management of, fetal growth abnormalities are essential components of antenatal care, and fetal ultrasound plays a key role in assessment of these conditions. The fetal biometric parameters measured most commonly are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur diaphysis length (FL). These biometric measurements can be used to estimate fetal weight (EFW) using various different formulae1. It is important to differentiate between the concept of fetal size at a given timepoint and fetal growth, the latter being a dynamic process, the assessment of which requires at least two ultrasound scans separated in time. Maternal history and symptoms, amniotic fluid assessment and Doppler velocimetry can provide additional information that may be used to identify fetuses at risk of adverse pregnancy outcome. Accurate estimation of gestational age is a prerequisite for determining whether fetal size is appropriate‐for‐gestational age (AGA). Except for pregnancies arising from assisted reproductive technology, the date of conception cannot be determined precisely. Clinically, most pregnancies are dated by the last menstrual period, though this may sometimes be uncertain or unreliable. Therefore, dating pregnancies by early ultrasound examination at 8–14 weeks, based on measurement of the fetal crown–rump length (CRL), appears to be the most reliable method to establish gestational age. Once the CRL exceeds 84 mm, HC should be used for pregnancy dating2–4. HC, with or without FL, can be used for estimation of gestational age from the mid‐trimester if a first‐trimester scan is not available and the menstrual history is unreliable. When the expected delivery date has been established by an accurate early scan, subsequent scans should not be used to recalculate the gestational age1. Serial scans can be used to determine if interval growth has been normal. In these Guidelines, we assume that the gestational age is known and has been determined as described above, the pregnancy is singleton and the fetal anatomy is normal. Details of the grades of recommendation used in these Guidelines are given in Appendix 1. Reporting of levels of evidence is not applicable to these Guidelines.
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Affiliation(s)
- L J Salomon
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - F Da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - R L Deter
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - F Figueras
- Hospital Clinic, Obstetrics and Gynecology, Barcelona, Spain
| | - T Ghi
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - P Glanc
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - R Napolitano
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - A Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Nuffield Department of Obstetrics and Gynecology, University of Oxford, Women's Center, John Radcliffe Hospital, Oxford, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Stirnemann
- Obstetrics, University Paris Descartes, Hôpital Necker Enfants Malades, Paris, France
| | - A Toi
- Medical Imaging, Mount Sinai Hospital, Toronto, ON, Canada
| | - G Yeo
- Department of Maternal Fetal Medicine, Obstetric Ultrasound and Prenatal Diagnostic Unit, KK Women's and Children's Hospital, Singapore
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Rochow N, AlSamnan M, So HY, Olbertz D, Pelc A, Däbritz J, Hentschel R, Wittwer-Backofen U, Voigt M. Maternal body height is a stronger predictor of birth weight than ethnicity: analysis of birth weight percentile charts. J Perinat Med 2018; 47:22-29. [PMID: 29870393 DOI: 10.1515/jpm-2017-0349] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/27/2018] [Indexed: 11/15/2022]
Abstract
Background Anthropometric parameters such as birth weight (BW) and adult body height vary between ethnic groups. Ethnic-specific percentile charts are currently being used for the assessment of newborns. However, due to globalization and interethnic families, it is unclear which charts should be used. A correlation between a mother's height and her child's BW (1 cm accounts for a 17 g increase in BW) has been observed. The study aims to test differences in small for gestational age (SGA) and large for gestational age (LGA) rates, employing BW percentile charts based on maternal height between ethnic groups. Methods This retrospective study of 2.3 million mother/newborn pairs analyzed BW, gestational age, sex, maternal height and ethnicity from the German perinatal survey (1995-2000). These data were stratified for maternal height (≤157, 158-163, 164-169, 170-175, ≥176 cm) and region of origin (Germany, Central and Northern Europe, North America, Mediterranean region, Eastern Europe, Middle East and North Africa, and Asia excluding Middle East). Percentile charts were calculated for each maternal height group. Results The average BW and maternal height differ significantly between ethnic groups. On current percentile charts, newborns of taller mothers (≥176 cm) have a low rate of SGA and a high rate of LGA, whereas newborns of shorter mothers (≤157 cm) have a high rate of SGA and a low rate of LGA. When the BW data are stratified based on the maternal height, mothers of similar height from different ethnic groups show similar average BWs, SGA and LGA rates. Conclusion Maternal body height has a greater influence on BW than maternal ethnicity. The use of BW percentile charts for maternal height should be considered.
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Affiliation(s)
- Niels Rochow
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Malak AlSamnan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Hon Yiu So
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | - Anna Pelc
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Jan Däbritz
- Department of Pediatrics, University Medicine Rostock, Rostock, Germany
- Centre for Immunobiology, Blizard Institute, Barts Cancer Institute the Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Roland Hentschel
- Department of General Pediatrics, Division of Neonatology/Intensive Care Medicine, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Manfred Voigt
- Department of General Pediatrics, Division of Neonatology/Intensive Care Medicine, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Centre for Medicine and Society, University of Freiburg, Freiburg, Germany
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Finken MJJ, van der Steen M, Smeets CCJ, Walenkamp MJE, de Bruin C, Hokken-Koelega ACS, Wit JM. Children Born Small for Gestational Age: Differential Diagnosis, Molecular Genetic Evaluation, and Implications. Endocr Rev 2018; 39:851-894. [PMID: 29982551 DOI: 10.1210/er.2018-00083] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/21/2018] [Indexed: 12/25/2022]
Abstract
Children born small for gestational age (SGA), defined as a birth weight and/or length below -2 SD score (SDS), comprise a heterogeneous group. The causes of SGA are multifactorial and include maternal lifestyle and obstetric factors, placental dysfunction, and numerous fetal (epi)genetic abnormalities. Short-term consequences of SGA include increased risks of hypothermia, polycythemia, and hypoglycemia. Although most SGA infants show catch-up growth by 2 years of age, ∼10% remain short. Short children born SGA are amenable to GH treatment, which increases their adult height by on average 1.25 SD. Add-on treatment with a gonadotropin-releasing hormone agonist may be considered in early pubertal children with an expected adult height below -2.5 SDS. A small birth size increases the risk of later neurodevelopmental problems and cardiometabolic diseases. GH treatment does not pose an additional risk.
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Affiliation(s)
- Martijn J J Finken
- Department of Pediatrics, VU University Medical Center, MB Amsterdam, Netherlands
| | - Manouk van der Steen
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Carolina C J Smeets
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Marie J E Walenkamp
- Department of Pediatrics, VU University Medical Center, MB Amsterdam, Netherlands
| | - Christiaan de Bruin
- Department of Pediatrics, Leiden University Medical Center, RC Leiden, Netherlands
| | - Anita C S Hokken-Koelega
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Jan M Wit
- Department of Pediatrics, Leiden University Medical Center, RC Leiden, Netherlands
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Spada E, Chiossi G, Coscia A, Monari F, Facchinetti F. Effect of maternal age, height, BMI and ethnicity on birth weight: an Italian multicenter study. J Perinat Med 2018; 46:1016-1021. [PMID: 29257759 DOI: 10.1515/jpm-2017-0102] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 11/07/2017] [Indexed: 11/15/2022]
Abstract
AIM To assess the effect of maternal age, height, early pregnancy body mass index (BMI) and ethnicity on birth weight. SUBJECTS AND METHODS A cross-sectional study was conducted on more than 42,000 newborns. Ethnicity was defined by maternal country of birth or, when missing (<0.6% of records), by citizenship. The effect of maternal characteristics on birth weight was evaluated with general linear models. RESULTS Maternal height and BMI, although not age, significantly affected birth weight. Among Italian babies, 4.7% of newborns were classified as appropriate-for-gestational age (AGA) (birth weight between the 10th and the 90th centile) according to the country-specific Italian Neonatal Study (INeS) charts and were re-classified as either large-(LGA) (birth weight >90th centile) or small-(SGA) (birth weight <10th centile) for gestational age (GA) after adjustment for maternal characteristics. On the contrary, 1.6% of Italian newborns were classified as SGA or LGA according to the INeS charts and re-classified as AGA after adjustment. Maternal ethnicity had a significant impact on birth weight. Specifically, babies born to Senegalese mothers were the lightest, whilst babies born to Chinese mothers were the heaviest. CONCLUSIONS Maternal height and early pregnancy BMI, should be considered in the evaluation of birth weight. The effect of ethnicity suggests the appropriateness of ethnic-specific charts. Further studies are necessary to determine if changes in birth weight classification, may translate into improved detection of subjects at risk of adverse outcomes.
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Affiliation(s)
- Elena Spada
- University of Turin, Department of Public Health and Pediatrics, Neonatology Unit, Torino, Italy
| | - Giuseppe Chiossi
- University of Texas Medical Branch, Department of Obstetrics and Gynecology, Galveston, TX, USA
| | - Alessandra Coscia
- University of Turin, Department of Public Health and Pediatrics, Neonatology Unit, Torino, Italy
| | - Francesca Monari
- University of Modena and Reggio Emilia, Obstetric Unit, Mother-Infant Department, Modena, Italy
| | - Fabio Facchinetti
- University of Modena and Reggio Emilia, Obstetric Unit, Mother-Infant Department, Modena, Italy
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Morales-Roselló J, Dias T, Khalil A, Fornes-Ferrer V, Ciammella R, Gimenez-Roca L, Perales-Marín A, Thilaganathan B. Birth-weight differences at term are explained by placental dysfunction and not by maternal ethnicity. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:488-493. [PMID: 29418032 DOI: 10.1002/uog.19025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the influence of ethnicity, fetal gender and placental dysfunction on birth weight (BW) in term fetuses of South Asian and Caucasian origin. METHODS This was a retrospective study of 627 term pregnancies assessed at two public tertiary hospitals in Spain and Sri Lanka. All fetuses underwent biometry and Doppler examinations within 2 weeks of delivery. The influences of fetal gender and ethnicity, gestational age (GA) at delivery, cerebroplacental ratio (CPR) and maternal age, height, weight and parity on BW were evaluated by multivariable regression analysis. RESULTS Fetuses born in Sri Lanka were smaller than those born in Spain (mean BW = 3026 ± 449 g vs 3295 ± 444 g; P < 0.001). Multivariable regression analysis demonstrated that GA at delivery, maternal weight, CPR, maternal height and fetal gender (estimates = 0.168, P < 0.001; 0.006, P < 0.001; 0.092, P = 0.003; 0.009, P = 0.002; 0.081, P = 0.01, respectively) were associated significantly with BW. Conversely, no significant association was noted for maternal ethnicity, age or parity (estimates = -0.010, P = 0.831; 0.005, P = 0.127; 0.035, P = 0.086, respectively). The findings were unchanged when the analysis was repeated using INTERGROWTH-21st fetal weight centiles instead of BW (log odds, -0.175, P = 0.170 and 0.321, P < 0.001, respectively for ethnicity and CPR). CONCLUSION Fetal BW variation at term is less dependent on ethnic origin and better explained by placental dysfunction. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Morales-Roselló
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - T Dias
- Obstetrics and Gynecology Department, Colombo North Teaching Hospital, Ragama, Sri Lanka
- Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - V Fornes-Ferrer
- Data Science, Biostatistics and Bioinformatics, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - R Ciammella
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - L Gimenez-Roca
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - A Perales-Marín
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Bækgaard Thorsen LH, Bjørkholt Andersen L, Birukov A, Lykkedegn S, Dechend R, Stener Jørgensen J, Thybo Christesen H. Prediction of birth weight small for gestational age with and without preeclampsia by angiogenic markers: an Odense Child Cohort study. J Matern Fetal Neonatal Med 2018; 33:1377-1384. [PMID: 30173595 DOI: 10.1080/14767058.2018.1519536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To investigate the predictive performance of placental growth factor (PlGF) and soluble FMS-like kinase 1 (sFlt-1) on birth weight and small for gestational age (SGA), in a large, population-based cohort.Methods: Women enrolled in the population-based, prospective Odense Child Cohort Study with early (GA < 20 weeks) and/or late (≥20 weeks) pregnancy blood samples (n = 1937) were included. The association between log-transformed values of the biomarkers and birth weight Z-score was studied using multivariate regression models. The prediction of SGA overall, and in women developing preeclampsia, by biomarkers was evaluated using receiver operating characteristic analyses.Results: No substantial associations between early pregnancy biomarkers and SGA were seen. PlGF measured in late pregnancy demonstrated the strongest association with birth weight Z-score (adjusted β-coefficient = 0.43 [95%CI = 0.35; 0.50]). The area under curve (AUC) for predicting SGA was higher for sFlt-1/PlGF compared to sFlt-1 (0.74 versus 0.63, p = .006) and reached excellent prediction for SGA after preeclampsia (AUC 0.94). Optimal sFlt-1/PlGF ratio cut-offs had higher negative predictive value (NPV) and positive predictive value (PPV) for SGA (cut-off > 5.0; NPV = 99.1%, PPV = 5.4%) compared to each marker individually.Conclusion: The sFlt-1/PlGF ratio is a potential predictor of SGA in population-based screening, particularly when preeclampsia is also present.
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Affiliation(s)
- Lena Heidi Bækgaard Thorsen
- Hans Christian and Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Louise Bjørkholt Andersen
- Hans Christian and Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynecology, Herlev Hospital, Copenhagen, Denmark
| | - Anna Birukov
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Experimental and Clinical Research Center, Max-Delbrück Center and Charité University Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Sine Lykkedegn
- Hans Christian and Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Ralf Dechend
- Experimental and Clinical Research Center, Max-Delbrück Center and Charité University Berlin, Berlin, Germany
| | - Jan Stener Jørgensen
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Odense Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Henrik Thybo Christesen
- Hans Christian and Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Odense Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
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Abstract
Fetal growth restriction (FGR) continues to be a leading cause of preventable stillbirth and poor neurodevelopmental outcomes in offspring, and furthermore is strongly associated with the obstetrical complications of iatrogenic preterm birth and pre-eclampsia. The terms small for gestational age (SGA) and FGR have, for too long, been considered equivalent and therefore used interchangeably. However, the delivery of improved clinical outcomes requires that clinicians effectively distinguish fetuses that are pathologically growth-restricted from those that are constitutively small. A greater understanding of the multifactorial pathogenesis of both early- and late-onset FGR, especially the role of underlying placental pathologies, may offer insight into targeted treatment strategies that preserve placental function. The new maternal blood biomarker placenta growth factor offers much potential in this context. This review highlights new approaches to effective screening for FGR based on a comprehensive review of: etiology, diagnosis, antenatal surveillance and management. Recent advances in novel imaging methods provide the basis for stepwise multi-parametric testing that may deliver cost-effective screening within existing antenatal care systems.
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Al-Hafez L, Pirics ML, Chauhan SP. Sonographic Estimated Fetal Weight among Diabetics at ≥ 34 Weeks and Composite Neonatal Morbidity. AJP Rep 2018; 8:e121-e127. [PMID: 29896442 PMCID: PMC5995726 DOI: 10.1055/s-0038-1660433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/22/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives The objective was to assess the composite neonatal morbidity (CNM) among diabetic women with sonographic estimated fetal weight (SEFW) at 10 to 90th versus >90th percentile for gestational age (GA). Study Design The inclusion criteria for this retrospective study were singleton pregnancies at 34 to 41 weeks, complicated by diabetes, and that had SEFW within 4 weeks of delivery. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated. Results Among the 140 cohorts that met the inclusion criteria, 72% had SEFW at 10th to 90th percentile for GA, and 28% at >90th percentile. Compared with women with diabetes with last SEFW at 10th to 90th percentile, those with estimate > 90th percentile for GA had a significantly higher rate of CNM (13 vs. 28%; OR, 2.65; 95% CI, 1.07-6.59). Among 109 diabetic women who labored, the rate of shoulder dystocia was significantly higher with SEFW at >90th percentile for GA than those at 10th to 90th percentile (25 vs. 2%; p = 0.002); the corresponding rate of CNM was 29 versus 10% ( p = 0.02). Conclusion Among diabetic women with SEFW > 90th percentile for GA, CNM was significantly higher than in women with estimate at 10 to 90th percentile. Despite the increased risk of CNM, these newborns did not have long-term morbid sequela.
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Affiliation(s)
- Leen Al-Hafez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas
| | - Michael L. Pirics
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas
| | - Suneet P. Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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Kalafat E, Morales-Rosello J, Thilaganathan B, Dhother J, Khalil A. Risk of neonatal care unit admission in small for gestational age fetuses at term: a prediction model and internal validation. J Matern Fetal Neonatal Med 2018; 32:2361-2368. [DOI: 10.1080/14767058.2018.1437412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Erkan Kalafat
- Fetal Medicine Unit, St. George’s Hospital, St. George’s University of London, London, UK
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
- Department of Statistics, Middle East Technical University, Ankara, Turkey
| | - Jose Morales-Rosello
- Fetal Medicine Unit, St. George’s Hospital, St. George’s University of London, London, UK
| | - Basky Thilaganathan
- Fetal Medicine Unit, St. George’s Hospital, St. George’s University of London, London, UK
| | - Jasreen Dhother
- Fetal Medicine Unit, St. George’s Hospital, St. George’s University of London, London, UK
| | - Asma Khalil
- Fetal Medicine Unit, St. George’s Hospital, St. George’s University of London, London, UK
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Gardosi J, Francis A, Turner S, Williams M. Customized growth charts: rationale, validation and clinical benefits. Am J Obstet Gynecol 2018; 218:S609-S618. [PMID: 29422203 DOI: 10.1016/j.ajog.2017.12.011] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 11/28/2022]
Abstract
Appropriate standards for the assessment of fetal growth and birthweight are central to good clinical care, and have become even more important with increasing evidence that growth-related adverse outcomes are potentially avoidable. Standards need to be evidence based and validated against pregnancy outcome and able to demonstrate utility and effectiveness. A review of proposals by the Intergrowth consortium to adopt their single international standard finds little support for the claim that the cases that it identifies as small are due to malnutrition or stunting, and substantial evidence that there is normal physiologic variation between different countries and ethnic groups. It is possible that the one-size-fits-all standard ends up fitting no one and could be harmful if implemented. An alternative is the concept of country-specific charts that can improve the association between abnormal growth and adverse outcome. However, such standards ignore individual physiologic variation that affects fetal growth, which exists in any heterogeneous population and exceeds intercountry differences. It is therefore more logical to adjust for the characteristics of each mother, taking her ethnic origin and her height, weight, and parity into account, and to set a growth and birthweight standard for each pregnancy against which actual growth can be assessed. A customized standard better reflects adverse pregnancy outcome at both ends of the fetal size spectrum and has increased clinicians' confidence in growth assessment, while providing reassurance when abnormal size merely represents physiologic variation. Rollout in the United Kingdom has proceeded as part of the comprehensive Growth Assessment Protocol (GAP), and has resulted in a steady increase in antenatal detection of babies who are at risk because of fetal growth restriction. This in turn has been accompanied by a year-on-year drop in stillbirth rates to their lowest ever levels in England. A global version of customized growth charts with over 100 ethnic origin categories is being launched in 2018, and will provide an individualized, yet universally applicable, standard for fetal growth.
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Tarca AL, Romero R, Gudicha DW, Erez O, Hernandez-Andrade E, Yeo L, Bhatti G, Pacora P, Maymon E, Hassan SS. A new customized fetal growth standard for African American women: the PRB/NICHD Detroit study. Am J Obstet Gynecol 2018; 218:S679-S691.e4. [PMID: 29422207 DOI: 10.1016/j.ajog.2017.12.229] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The assessment of fetal growth disorders requires a standard. Current nomograms for the assessment of fetal growth in African American women have been derived either from neonatal (rather than fetal) biometry data or have not been customized for maternal ethnicity, weight, height, and parity and fetal sex. OBJECTIVE We sought to (1) develop a new customized fetal growth standard for African American mothers; and (2) compare such a standard to 3 existing standards for the classification of fetuses as small (SGA) or large (LGA) for gestational age. STUDY DESIGN A retrospective cohort study included 4183 women (4001 African American and 182 Caucasian) from the Detroit metropolitan area who underwent ultrasound examinations between 14-40 weeks of gestation (the median number of scans per pregnancy was 5, interquartile range 3-7) and for whom relevant covariate data were available. Longitudinal quantile regression was used to build models defining the "normal" estimated fetal weight (EFW) centiles for gestational age in African American women, adjusted for maternal height, weight, and parity and fetal sex, and excluding pathologic factors with a significant effect on fetal weight. The resulting Perinatology Research Branch/Eunice Kennedy Shriver National Institute of Child Health and Human Development (hereinafter, PRB/NICHD) growth standard was compared to 3 other existing standards--the customized gestation-related optimal weight (GROW) standard; the Eunice Kennedy Shriver National Institute of Child Health and Human Development (hereinafter, NICHD) African American standard; and the multinational World Health Organization (WHO) standard--utilized to screen fetuses for SGA (<10th centile) or LGA (>90th centile) based on the last available ultrasound examination for each pregnancy. RESULTS First, the mean birthweight at 40 weeks was 133 g higher for neonates born to Caucasian than to African American mothers and 150 g higher for male than female neonates; maternal weight, height, and parity had a positive effect on birthweight. Second, analysis of longitudinal EFW revealed the following features of fetal growth: (1) all weight centiles were about 2% higher for male than for female fetuses; (2) maternal height had a positive effect on EFW, with larger fetuses being affected more (2% increase in the 95th centile of weight for each 10-cm increase in height); and (3) maternal weight and parity had a positive effect on EFW that increased with gestation and varied among the weight centiles. Third, the screen-positive rate for SGA was 7.2% for the NICHD African American standard, 12.3% for the GROW standard, 13% for the WHO standard customized by fetal sex, and 14.4% for the PRB/NICHD customized standard. For all standards, the screen-positive rate for SGA was at least 2-fold higher among fetuses delivered preterm than at term. Fourth, the screen-positive rate for LGA was 8.7% for the GROW standard, 9.2% for the PRB/NICHD customized standard, 10.8% for the WHO standard customized by fetal sex, and 12.3% for the NICHD African American standard. Finally, the highest overall agreement among standards was between the GROW and PRB/NICHD customized standards (Cohen's interrater agreement, kappa = 0.85). CONCLUSION We developed a novel customized PRB/NICHD fetal growth standard from fetal data in an African American population without assuming proportionality of the effects of covariates, and without assuming that these effects are equal on all centiles of weight; we also provide an easy-to-use centile calculator. This standard classified more fetuses as being at risk for SGA compared to existing standards, especially among fetuses delivered preterm, but classified about the same number of LGA. The comparison among the 4 growth standards also revealed that the most important factor determining agreement among standards is whether they account for the same factors known to affect fetal growth.
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Affiliation(s)
- Adi L Tarca
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Computer Science, Wayne State University College of Engineering, Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI.
| | - Dereje W Gudicha
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI
| | - Offer Erez
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Edgar Hernandez-Andrade
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Lami Yeo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Gaurav Bhatti
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI
| | - Percy Pacora
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Eli Maymon
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Sonia S Hassan
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Physiology, Wayne State University School of Medicine, Detroit, MI
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