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Melamed N, Baschat A, Yinon Y, Athanasiadis A, Mecacci F, Figueras F, Berghella V, Nazareth A, Tahlak M, McIntyre HD, Da Silva Costa F, Kihara AB, Hadar E, McAuliffe F, Hanson M, Ma RC, Gooden R, Sheiner E, Kapur A, Divakar H, Ayres‐de‐Campos D, Hiersch L, Poon LC, Kingdom J, Romero R, Hod M. FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction. Int J Gynaecol Obstet 2021; 152 Suppl 1:3-57. [PMID: 33740264 PMCID: PMC8252743 DOI: 10.1002/ijgo.13522] [Citation(s) in RCA: 187] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fetal growth restriction (FGR) is defined as the failure of the fetus to meet its growth potential due to a pathological factor, most commonly placental dysfunction. Worldwide, FGR is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Ongoing advances in clinical care, especially in definitions, diagnosis, and management of FGR, require efforts to effectively translate these changes to the wide range of obstetric care providers. This article highlights agreements based on current research in the diagnosis and management of FGR, and the areas that need more research to provide further clarification of recommendations. The purpose of this article is to provide a comprehensive summary of available evidence along with practical recommendations concerning the care of pregnancies at risk of or complicated by FGR, with the overall goal to decrease the risk of stillbirth and neonatal mortality and morbidity associated with this condition. To achieve these goals, FIGO (the International Federation of Gynecology and Obstetrics) brought together international experts to review and summarize current knowledge of FGR. This summary is directed at multiple stakeholders, including healthcare providers, healthcare delivery organizations and providers, FIGO member societies, and professional organizations. Recognizing the variation in the resources and expertise available for the management of FGR in different countries or regions, this article attempts to take into consideration the unique aspects of antenatal care in low-resource settings (labelled “LRS” in the recommendations). This was achieved by collaboration with authors and FIGO member societies from low-resource settings such as India, Sub-Saharan Africa, the Middle East, and Latin America.
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Affiliation(s)
- Nir Melamed
- Division of Maternal Fetal MedicineDepartment of Obstetrics and GynecologySunnybrook Health Sciences CentreUniversity of TorontoTorontoONCanada
| | - Ahmet Baschat
- Center for Fetal TherapyDepartment of Gynecology and ObstetricsJohns Hopkins UniversityBaltimoreMDUSA
| | - Yoav Yinon
- Fetal Medicine UnitDepartment of Obstetrics and GynecologySheba Medical CenterTel‐HashomerSackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and GynecologyAristotle University of ThessalonikiThessalonikiGreece
| | - Federico Mecacci
- Maternal Fetal Medicine UnitDivision of Obstetrics and GynecologyDepartment of Biomedical, Experimental and Clinical SciencesUniversity of FlorenceFlorenceItaly
| | - Francesc Figueras
- Maternal‐Fetal Medicine DepartmentBarcelona Clinic HospitalUniversity of BarcelonaBarcelonaSpain
| | - Vincenzo Berghella
- Division of Maternal‐Fetal MedicineDepartment of Obstetrics and GynecologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Amala Nazareth
- Jumeira Prime Healthcare GroupEmirates Medical AssociationDubaiUnited Arab Emirates
| | - Muna Tahlak
- Latifa Hospital for Women and ChildrenDubai Health AuthorityEmirates Medical AssociationMohammad Bin Rashid University for Medical Sciences, Dubai, United Arab Emirates
| | | | - Fabrício Da Silva Costa
- Department of Gynecology and ObstetricsRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoSão PauloBrazil
| | - Anne B. Kihara
- African Federation of Obstetricians and GynaecologistsKhartoumSudan
| | - Eran Hadar
- Helen Schneider Hospital for WomenRabin Medical CenterPetach TikvaIsrael
- Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Fionnuala McAuliffe
- UCD Perinatal Research CentreSchool of MedicineNational Maternity HospitalUniversity College DublinDublinIreland
| | - Mark Hanson
- Institute of Developmental SciencesUniversity Hospital SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of SouthamptonSouthamptonUK
| | - Ronald C. Ma
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong SARChina
| | - Rachel Gooden
- FIGO (International Federation of Gynecology and Obstetrics)LondonUK
| | - Eyal Sheiner
- Soroka University Medical CenterBen‐Gurion University of the NegevBe’er‐ShevaIsrael
| | - Anil Kapur
- World Diabetes FoundationBagsværdDenmark
| | | | | | - Liran Hiersch
- Sourasky Medical Center and Sackler Faculty of MedicineLis Maternity HospitalTel Aviv UniversityTel AvivIsrael
| | - Liona C. Poon
- Department of Obstetrics and GynecologyPrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong SAR, China
| | - John Kingdom
- Division of Maternal Fetal MedicineDepartment of Obstetrics and GynecologyMount Sinai HospitalUniversity of TorontoTorontoONCanada
| | - Roberto Romero
- Perinatology Research BranchEunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institutes of HealthU.S. Department of Health and Human ServicesBethesdaMDUSA
| | - Moshe Hod
- Helen Schneider Hospital for WomenRabin Medical CenterPetach TikvaIsrael
- Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
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Mikelson CK, Troisi J, LaLonde A, Symes SJK, Thurston SW, DiRe LM, David Adair C, Miller RK, Richards SM. Placental concentrations of essential, toxic, and understudied metals and relationships with birth outcomes in Chattanooga, TN. ENVIRONMENTAL RESEARCH 2019; 168:118-129. [PMID: 30296639 PMCID: PMC6288679 DOI: 10.1016/j.envres.2018.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Comprehensive examinations of placental metal concentrations and correlations with infant parameters are under-investigated. Chattanooga, Tennessee's consistently high incidence of low birth weight and potential for metal exposure provides an ideal opportunity to investigate potential correlations. OBJECTIVES To investigate the associations between a wide variety of metals in placental tissue and multiple infant parameters. METHODS A total of 31 elements were screened via ICP-MS in 374 individual placental samples. Of those, 14 were quantifiable in > 86% of the samples. We examined correlations between metal concentrations and infant parameters (birth weight, gestational age, birth weight centile, placental weight, birth length and head circumference). We fit multivariable regression models to estimate the covariate-adjusted associations of birth weight with ln-transformed concentrations of each of the 14 metals and used generalized additive models to examine nonlinear relationships. RESULTS Some of the strongest relationships with infant parameters came from several lesser-studied metals. Placental rhodium concentrations were negatively correlated with almost all infant parameters. In the fully adjusted regression model, birth weight was significantly associated with several metals. On an IQR (25th to the 75th percentile) basis, estimated changes in birthweight were: for cobalt (82.5 g, IQR=6.05 µg/kg, p = 0.006), iron (-51.5 g, IQR = 171800 µg/kg, p = 0.030), manganese (-27.2 g, IQR=152.1 µg/kg, p = 0.017), lead (-72.7 g, IQR=16.55 µg/kg, p = 0.004) and rhodium (-1365.5 g, IQR = 0.33 µg/kg, p < 0.001). Finally, a generalized additive model showed significant nonlinear relationships between birth weight and concentrations of Co and Rh. CONCLUSIONS Our comprehensive examination of placental metals illustrate many strong associations between lesser-studied metals and infant parameters. These data, in combination with our correlations of well-studied metals, illustrate a need to consider in utero exposure to a broad array of metals when considering fetal development.
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Affiliation(s)
- Colleen K Mikelson
- Department of Biology, Geology and Environmental Sciences, University of Tennessee Chattanooga, 615 McCallie Ave., Chattanooga, TN 37403, United States.
| | - Jacopo Troisi
- Department of Medicine, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, SA, Italy
| | - Amy LaLonde
- Department of Biostatistics and Computational Biology, University of Rochester, School of Medicine and Dentistry, 265 Crittenden Boulevard, Box 630, Rochester, NY 14642, United States
| | - Steven J K Symes
- Department of Chemistry and Physics, University of Tennessee Chattanooga, 615 McCallie Ave., Chattanooga, TN 37403, United States; University of Tennessee College of Medicine, Department of Obstetrics and Gynecology, Section on Maternal Fetal Medicine, 960 East Third Street, Suite 100, Chattanooga, TN 37403, United States
| | - Sally W Thurston
- Department of Biostatistics and Computational Biology, University of Rochester, School of Medicine and Dentistry, 265 Crittenden Boulevard, Box 630, Rochester, NY 14642, United States
| | - Lauren M DiRe
- College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, United States
| | - C David Adair
- University of Tennessee College of Medicine, Department of Obstetrics and Gynecology, Section on Maternal Fetal Medicine, 960 East Third Street, Suite 100, Chattanooga, TN 37403, United States
| | - Richard K Miller
- Departments of Obstetrics and Gynecology, of Environmental Medicine and of Pathology, University of Rochester, School of Medicine and Dentistry, 601 Elmwood Ave, Box 668, Rochester, NY 14642, United States
| | - Sean M Richards
- Department of Biology, Geology and Environmental Sciences, University of Tennessee Chattanooga, 615 McCallie Ave., Chattanooga, TN 37403, United States; University of Tennessee College of Medicine, Department of Obstetrics and Gynecology, 979 E. Third Street - Suite C720, Chattanooga, TN 37403, United States
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West J, Kelly B, Collings PJ, Santorelli G, Mason D, Wright J. Is small size at birth associated with early childhood morbidity in white British and Pakistani origin UK children aged 0-3? Findings from the born in Bradford cohort study. BMC Pediatr 2018; 18:22. [PMID: 29390971 PMCID: PMC5796403 DOI: 10.1186/s12887-018-0987-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/16/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Jane West
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Brian Kelly
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
| | - Paul J. Collings
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
| | - Gillian Santorelli
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
| | - Dan Mason
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
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Ghi T, Prefumo F, Fichera A, Lanna M, Periti E, Persico N, Viora E, Rizzo G. Development of customized fetal growth charts in twins. Am J Obstet Gynecol 2017; 216:514.e1-514.e17. [PMID: 28065816 DOI: 10.1016/j.ajog.2016.12.176] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/14/2016] [Accepted: 12/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Twin gestations are at significantly higher risk of fetal growth restriction in comparison with singletons. Using fetal biometric charts customized for obstetrical and parental characteristics may facilitate an accurate assessment of fetal growth. OBJECTIVE The objective of the study was to construct reference charts for the gestation of fetal biometric parameters stratified by chorionicity and customized for obstetrical and parental characteristics. STUDY DESIGN Fetal biometric measurements obtained from serial ultrasound examinations in uncomplicated twin pregnancies delivering after 36 weeks of gestation were collected by 19 Italian fetal medicine units under the auspices of the Società Italiana di Ecografia Ostetrica e Ginecologica. The measurements acquired in each fetus at each examination included biparietal diameter, head circumference, abdominal circumference, and femur length. Multilevel linear regression models were used to adjust for the serial ultrasonographic measurements obtained and the clustering of each fetus in twin pregnancy. The impact of maternal and paternal characteristics (height, weight, ethnicity), parity, fetal sex, and mode of conception was also considered. Models for each parameter were stratified by fetal chorionicity and compared with our previously constructed growth curves for singletons. RESULTS The data set included 1781 twin pregnancies (dichorionic, n = 1289; monochorionic diamniotic, n = 492) with 8923 ultrasonographic examinations with a median of 5 (range, 2-8) observations per pregnancy in dichorionic and 6 in (range, 2-11) monochorionic pregnancies. Growth curves of twin pregnancies differed from those of singletons, and differences were more marked in monochorionic twins and during the third trimester. A significant influence of parental characteristics was found. CONCLUSION Curves of fetal biometric measurements in twins are influenced by parental characteristics. There is a reduction in the growth rate during the third trimester. The reference limits for gestation constructed in this study may provide a useful tool for a more accurate assessment of fetal growth in twin pregnancies.
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Affiliation(s)
- Tullio Ghi
- Department of Obstetrics and Gynecology, University of Parma, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynecology, University of Brescia, Italy
| | - Anna Fichera
- Department of Obstetrics and Gynecology, University of Brescia, Italy
| | - Mariano Lanna
- Department of Obstetrics and Gynecology, University of Milan, Buzzi Children's Hospita, Italy
| | - Enrico Periti
- Department of Obstetrics and Gynecology, Presidio Ospedaliero Centro Piero Palagi, Firenze, Italy
| | - Nicola Persico
- Department of Obstetrics and Gynecology, L. Mangiagalli, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Elsa Viora
- Department of Obstetrics and Gynecology, Ospedale Sant'Anna, Turin, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy.
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Alves ALDF, Carvalho AAVD, Carvalho JABD, Figueiredo I. Evaluation of the adequacy of Hadlock's reference chart for identification of fetuses with growth restriction. J Matern Fetal Neonatal Med 2017; 31:967-971. [PMID: 28320232 DOI: 10.1080/14767058.2017.1300648] [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: 10/19/2022]
Abstract
OBJECTIVE This study aimed to verify whether Hadlock's reference values for fetal weight identify fetuses below the 10th percentile in our population correctly. METHODS The fitness of the Hadlock reference range to our study population was tested by assessment of Z scores. We evaluated differences between the reference weight ranges proposed in our study and those recommended by Hadlock. RESULTS Z scores for Hadlock reference values were non-normally distributed. The difference between the 50th percentile fetal weight proposed by our study model and that proposed by Hadlock was ≤1% at GAs ≥22 weeks and 2-3% at 19-21 weeks. For the 90th percentile level, the maximum difference at GAs ≥17 weeks was 1.5%. For the 10th percentile level, the differences were 2-4% in the third trimester, reaching 8% in week 20 and 13% at a GA of 14 weeks. CONCLUSIONS The weight reference ranges of this study virtually overlap with the Hadlock ranges. We believe that only at lower gestational ages in the second trimester might some FGR diagnoses be missed in the population study with Hadlock's reference.
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Affiliation(s)
| | | | | | - Israel Figueiredo
- b Maternal and Child Department , Universidade Federal Fluminense , Niterói , Brazil
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Urquia ML, Sørbye IK, Wanigaratne S. Birth-weight charts and immigrant populations: A critical review. Best Pract Res Clin Obstet Gynaecol 2015; 32:69-76. [PMID: 26453476 DOI: 10.1016/j.bpobgyn.2015.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/10/2015] [Accepted: 09/06/2015] [Indexed: 11/30/2022]
Abstract
There is an increasing body of literature focusing on differences in newborn size between different population subgroups defined by racial, ethnic, and immigration status. The interpretation of these differences as pathological or as merely reflecting normal variability is not straightforward and may have consequences for the provision of obstetric and neonatal care to minority populations. In this review, we critically assess some methodological issues affecting the assessment of newborn size and their potential implications for minority populations. In particular, we discuss the pros and cons of different types of newborn birth-weight (BW) charts (i.e., single local population-based references, minority-specific references, and a single international standard) to determine abnormal newborn size, with emphasis on immigrant populations. We conclude that size alone is not enough to inform clinical decisions and that all newborn size charts should be used as screening tools, not as diagnostic tools. Parental minority status may be regarded as a marker and used to further inquire about individual risk factors, particularly among immigrants who may not have a complete medical history in the new country. Finally, we outline areas for further research and recommendations for clinical practice.
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Affiliation(s)
- Marcelo L Urquia
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Ingvil K Sørbye
- Women and Children's Division, Oslo University Hospital, Oslo, Norway
| | - Susitha Wanigaratne
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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Norris T, Johnson W, Farrar D, Tuffnell D, Wright J, Cameron N. Small-for-gestational age and large-for-gestational age thresholds to predict infants at risk of adverse delivery and neonatal outcomes: are current charts adequate? An observational study from the Born in Bradford cohort. BMJ Open 2015; 5:e006743. [PMID: 25783424 PMCID: PMC4368928 DOI: 10.1136/bmjopen-2014-006743] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Construct an ethnic-specific chart and compare the prediction of adverse outcomes using this chart with the clinically recommended UK-WHO and customised birth weight charts using cut-offs for small-for-gestational age (SGA: birth weight <10th centile) and large-for-gestational age (LGA: birth weight >90th centile). DESIGN Prospective cohort study. SETTING Born in Bradford (BiB) study, UK. PARTICIPANTS 3980 White British and 4448 Pakistani infants with complete data for gestational age, birth weight, ethnicity, maternal height, weight and parity. MAIN OUTCOME MEASURES Prevalence of SGA and LGA, using the three charts and indicators of diagnostic utility (sensitivity, specificity and area under the receiver operating characteristic (AUROC)) of these chart-specific cut-offs to predict delivery and neonatal outcomes and a composite outcome. RESULTS In White British and Pakistani infants, the prevalence of SGA and LGA differed depending on the chart used. Increased risk of SGA was observed when using the UK-WHO and customised charts as opposed to the ethnic-specific chart, while the opposite was apparent when classifying LGA infants. However, the predictive utility of all three charts to identify adverse clinical outcomes was poor, with only the prediction of shoulder dystocia achieving an AUROC>0.62 on all three charts. CONCLUSIONS Despite being recommended in national clinical guidelines, the UK-WHO and customised birth weight charts perform poorly at identifying infants at risk of adverse neonatal outcomes. Being small or large may increase the risk of an adverse outcome; however, size alone is not sensitive or specific enough with current detection to be useful. However, a significant amount of missing data for some of the outcomes may have limited the power needed to determine true associations.
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Affiliation(s)
- T Norris
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - W Johnson
- MRC Unit for Lifelong Health & Ageing, University College London, London, UK
| | - D Farrar
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - D Tuffnell
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, UK
| | - J Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - N Cameron
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Bartsch E, Booth M, Park AL, Ray JG. A survey of birthweight percentile curves used in hospitals across Ontario. Paediatr Child Health 2014; 19:e119-20. [PMID: 25414588 DOI: 10.1093/pch/19.9.e119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Marilyn Booth
- Provincial Council for Maternal & Child Health, St Michael's Hospital, University of Toronto, Toronto, Ontario
| | - Alison L Park
- Institute for Clinical Evaluative Sciences, St Michael's Hospital, University of Toronto, Toronto, Ontario
| | - Joel G Ray
- Departments of Medicine, Health Policy Management and Evaluation, and Obstetrics and Gynecology, St Michael's Hospital, University of Toronto, Toronto, Ontario
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Urquia ML, Berger H, Ray JG. Risk of adverse outcomes among infants of immigrant women according to birth-weight curves tailored to maternal world region of origin. CMAJ 2014; 187:E32-E40. [PMID: 25384653 DOI: 10.1503/cmaj.140748] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Infants of immigrant women in Western nations generally have lower birth weights than infants of native-born women. Whether this difference is physiologic or pathological is unclear. We determined whether the use of birth-weight curves tailored to maternal world region of origin would discriminate adverse neonatal and obstetric outcomes more accurately than a single birth-weight curve based on infants of Canadian-born women. METHODS We performed a retrospective cohort study of in-hospital singleton live births (328,387 to immigrant women, 761,260 to nonimmigrant women) in Ontario between 2002 and 2012 using population health services data linked to the national immigration database. We classified infants as small for gestational age (<10th percentile) or large for gestational age (≥90th percentile) using both Canadian and world region-specific birth-weight curves and compared associations with adverse neonatal and obstetric outcomes. RESULTS Compared with world region-specific birth-weight curves, the Canadian curve classified 20 431 (6.2%) additional newborns of immigrant women as small for gestational age, of whom 15,467 (75.7%) were of East or South Asian descent. The odds of neonatal death were lower among small-for-gestational-age infants of immigrant women than among those of nonimmigrant women based on the Canadian birth-weight curve (adjusted odds ratio [OR] 0.83, 95% confidence interval [CI] 0.72-0.95), but higher when small for gestational age was defined by the world region-specific curves (adjusted OR 1.24, 95% CI 1.08-1.42). Conversely, the odds of some adverse outcomes were lower among large-for-gestational-age infants of immigrant women than among those of nonimmigrant women based on world region-specific birth-weight curves, but were similar based on the Canadian curve. INTERPRETATION World region-specific birth-weight curves seemed to be more appropriate than a single Canadian population-based curve for assessing the risk of adverse neonatal and obstetric outcomes among small- and large-for-gestational-age infants born to immigrant women, especially those from the East and South Asian regions.
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Affiliation(s)
- Marcelo L Urquia
- Centre for Research on Inner City Health (Urquia), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Medicine (Berger, Ray), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Urquia, Ray), Dalla Lana School of Public Health (Urquia), Faculty of Medicine (Berger, Ray), University of Toronto, Toronto, Ont.
| | - Howard Berger
- Centre for Research on Inner City Health (Urquia), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Medicine (Berger, Ray), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Urquia, Ray), Dalla Lana School of Public Health (Urquia), Faculty of Medicine (Berger, Ray), University of Toronto, Toronto, Ont
| | - Joel G Ray
- Centre for Research on Inner City Health (Urquia), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Medicine (Berger, Ray), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Urquia, Ray), Dalla Lana School of Public Health (Urquia), Faculty of Medicine (Berger, Ray), University of Toronto, Toronto, Ont
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Gardosi J. Customized Charts and Their Role in Identifying Pregnancies at Risk Because of Fetal Growth Restriction. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:408-415. [DOI: 10.1016/s1701-2163(15)30587-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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