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Kong L, Nivins S, Chen X, Liang Y, Gissler M, Lavebratt C. Association of preterm birth and birth size status with neurodevelopmental and psychiatric disorders in spontaneous births. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02489-5. [PMID: 38866929 DOI: 10.1007/s00787-024-02489-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/28/2024] [Indexed: 06/14/2024]
Abstract
Preterm birth (PTB) or small birth size are risk factors for certain neurodevelopmental disorders. The magnitude of these associations in spontaneous births, and of associations for combined PTB and birth size status on neurodevelopmental and psychiatric disorders is unexplored. We investigated whether PTB and small/large for gestational age (SGA/LGA), separately or combined, in spontaneous births, are associated with a wide spectrum of neurodevelopmental and psychiatric disorders. In this population-based registry cohort study, all singleton spontaneous births in Finland from 1996 to 2014 were followed until 2018 (n = 819 764). We show that PTB across gestational ages, and SGA, were associated with higher risks for anxiety disorders, intellectual disabilities, specific developmental disorders (SDD), autism spectrum disorders (ASD), attention-deficit/hyperactivity disorders (ADHD) and other emotional and behavioural disorders (F98). Most of these associations were not attributed to familial factors. Larger effect sizes were observed with lower gestational ages. Extremely PTB was associated at highest risks with intellectual disabilities (HR, 10.70 [95%CI, 8.69-13.17]) and SDD (HR, 8.91 [95%CI, 8.18-9.71]). Moreover, very preterm birth combined with SGA was associated with a higher risk for SDD (HR, 7.55 [95%CI, 6.61-8.62]) than that of very preterm or SGA birth alone. Conversely, LGA birth lowered the risk for SDD and other emotional and behavioural disorders among individuals born very preterm. In conclusion, PTB along with SGA is associated with higher risks for SDD than one exposure alone, whereas LGA lowers the risks for SDD and other emotional and behavioural disorders in individuals born spontaneously.
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Affiliation(s)
- Linghua Kong
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Shandong, China
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Samson Nivins
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Xinxia Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Shandong, China
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Yajun Liang
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mika Gissler
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.
- Translational Psychiatry Unit, Centre for Molecular Medicine, L8:00, Karolinska University Hospital, 171 76, Stockholm, Sweden.
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Axelsson Fisk S, Alex-Petersen J, Rostila M, Liu C, Juárez SP. Social inequalities in the risk of giving birth to a small for gestational age child in Sweden 2010-16: a cross-sectional study adopting an intersectional approach. Eur J Public Health 2024; 34:22-28. [PMID: 37878824 PMCID: PMC10843954 DOI: 10.1093/eurpub/ckad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Well-established associations exist between the risk of small for gestational age (SGA) and unidimensional sociodemographic factors. We investigated social inequalities in SGA risk and adopted an intersectional approach that simultaneously considers different social categories. By doing so, we could assess heterogeneities in SGA risk within unidimensional sociodemographic categories. METHODS We included all live 679 694 singleton births in Sweden between 2010 and 2016. The outcome was SGA, and the exposures were age, maternal educational level, dichotomous migration status and civil status. Thirty-six possible combinations of these factors constituted the exposure in an intersectional model. We present odds ratios (ORs) with 95% confidence intervals (95% CIs) and the area under the receiver operating characteristic curve (AUC)-a measurement of discriminatory accuracy (i.e. the ability to discriminate the babies born SGA from those who are not). RESULTS Women with low education and women born outside Sweden had ORs of 1.46 (95% CI 1.38-1.54) and 1.50 (95% CI 1.43-1.56) in unidimensional analyses, respectively. Among women aged under 25 with low education who were born outside Sweden and unmarried, the highest OR was 3.06 (2.59-3.63). The discriminatory accuracy was low for both the unidimensional model that included all sociodemographic factors (AUC 0. 563) and the intersectional model (AUC 0.571). CONCLUSIONS The intersectional approach revealed a complex sociodemographic pattern of SGA risk. Sociodemographic factors have a low accuracy in identifying SGA at the individual level, even when quantifying their multi-dimensional intersections. This cautions against interventions targeted to individuals belonging to socially defined groups to reduce social inequalities in SGA risk.
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Affiliation(s)
- Sten Axelsson Fisk
- Department of Clinical Sciences Lund, Obstetrics and Gynaecology, Lund University, Lund, BMC C14. Lund, 22185, Sweden
- Department of Obstetrics and Gynaecology, Ystad Hospital, Ystad, Sweden
| | | | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society (NVS), Aging Research Center (ARC), Karolinska Institutet/Stockholm University, Stockholm, Sweden
| | - Can Liu
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sol Pia Juárez
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
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Morkuniene R, Cole TJ, Jakimaviciene EM, Bankauskiene A, Isakova J, Drazdiene N, Basys V, Tutkuviene J. Regional references vs. international standards for assessing weight and length by gestational age in Lithuanian neonates. Front Pediatr 2023; 11:1173685. [PMID: 37388293 PMCID: PMC10303945 DOI: 10.3389/fped.2023.1173685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction There is no global consensus as to which standards are the most appropriate for the assessment of birth weight and length. The study aimed to compare the applicability of regional and global standards to the Lithuanian newborn population by sex and gestational age, based on the prevalence of small or large for gestational age (SGA/LGA). Materials and Methods Analysis was performed on neonatal length and weight data obtained from the Lithuanian Medical Birth Register from 1995 to 2015 (618,235 newborns of 24-42 gestational weeks). Their distributions by gestation and sex were estimated using generalized additive models for location, scale, and shape (GAMLSS), and the results were compared with the INTERGROWTH-21st (IG-21) standard to evaluate the prevalence of SGA/LGA (10th/90th centile) at different gestational ages. Results The difference in median length at term between the local reference and IG-21 was 3 cm-4 cm, while median weight at term differed by 200 g. The Lithuanian median weight at term was higher than in IG-21 by a full centile channel width, while the median length at term was higher by two channel widths. Based on the regional reference, the prevalence rates of SGA/LGA were 9.7%/10.1% for boys and 10.1%/9.9% for girls, close to the nominal 10%. Conversely, based on IG-21, the prevalence of SGA in boys/girls was less than half (4.1%/4.4%), while the prevalence of LGA was double (20.7%/19.1%). Discussion Regional population-based neonatal references represent Lithuanian neonatal weight and length much more accurately than the global standard IG-21 which provides the prevalence rates for SGA/LGA that differ from the true values by a factor of two.
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Affiliation(s)
- Ruta Morkuniene
- Department of Anatomy, Histology and Anthropology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tim J. Cole
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Egle Marija Jakimaviciene
- Department of Anatomy, Histology and Anthropology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Agne Bankauskiene
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jelena Isakova
- Health Information Center, Institute of Hygiene, Vilnius, Lithuania
| | - Nijole Drazdiene
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Vytautas Basys
- Division of Biological, Medical and Geosciences, Lithuanian Academy of Sciences, Vilnius, Lithuania
| | - Janina Tutkuviene
- Department of Anatomy, Histology and Anthropology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 04/12/2023] [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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Grantz KL, Hinkle SN, He D, Owen J, Skupski D, Zhang C, Roy A. A new method for customized fetal growth reference percentiles. PLoS One 2023; 18:e0282791. [PMID: 36928064 PMCID: PMC10019672 DOI: 10.1371/journal.pone.0282791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Customized fetal growth charts assume birthweight at term to be normally distributed across the population with a constant coefficient of variation at earlier gestational ages. Thus, standard deviation used for computing percentiles (e.g., 10th, 90th) is assumed to be proportional to the customized mean, although this assumption has never been formally tested. METHODS In a secondary analysis of NICHD Fetal Growth Studies-Singletons (12 U.S. sites, 2009-2013) using longitudinal sonographic biometric data (n = 2288 pregnancies), we investigated the assumptions of normality and constant coefficient of variation by examining behavior of the mean and standard deviation, computed following the Gardosi method. We then created a more flexible model that customizes both mean and standard deviation using heteroscedastic regression and calculated customized percentiles directly using quantile regression, with an application in a separate study of 102, 012 deliveries, 37-41 weeks. RESULTS Analysis of term optimal birthweight challenged assumptions of proportionality and that values were normally distributed: at different mean birthweight values, standard deviation did not change linearly with mean birthweight and the percentile computed with the normality assumption deviated from empirical percentiles. Composite neonatal morbidity and mortality rates in relation to birthweight < 10th were higher for heteroscedastic and quantile models (10.3% and 10.0%, respectively) than the Gardosi model (7.2%), although prediction performance was similar among all three (c-statistic 0.52-0.53). CONCLUSIONS Our findings question normality and constant coefficient of variation assumptions of the Gardosi customization method. A heteroscedastic model captures unstable variance in customization characteristics which may improve detection of abnormal growth percentiles. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00912132.
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Affiliation(s)
- Katherine L. Grantz
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
| | - Stefanie N. Hinkle
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Dian He
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
- The Prospective Group, Inc., Fairfax, Virginia, United States of America
| | - John Owen
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Heersink School of Medicine, Birmingham, Alabama, United States of America
| | - Daniel Skupski
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Weill Cornell Medicine and New York Presbyterian Queens, New York, New York, United States of America
| | - Cuilin Zhang
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anindya Roy
- Department of Mathematics and Statistics, University of Maryland Baltimore County, Baltimore, Maryland, United States of America
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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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Blue NR, Mele L, Grobman WA, Bailit JL, Wapner RJ, Thorp JM, Caritis SN, Prasad M, Tita ATN, Saade GR, Rouse DJ, Blackwell SC. Predictive performance of newborn small for gestational age by a United States intrauterine vs birthweight-derived standard for short-term neonatal morbidity and mortality. Am J Obstet Gynecol MFM 2022; 4:100599. [PMID: 35183799 PMCID: PMC9097811 DOI: 10.1016/j.ajogmf.2022.100599] [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: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of birthweight standards to define small for gestational age may fail to identify neonates affected by poor fetal growth as they include births associated with suboptimal fetal growth. OBJECTIVE This study aimed to compare intrauterine vs birthweight-derived standards to define newborn small for gestational age to predict neonatal morbidity and mortality. STUDY DESIGN This was a secondary analysis of a multicenter observational study of 118,422 births. Live-born singleton, nonanomalous newborns born at 23 to 41 weeks of gestation were included. Those with missing gestational age estimation or without a first- or second-trimester ultrasound to confirm dating, birthweight, or neonatal outcome data were excluded. Birthweight percentile was computed using an intrauterine standard (Hadlock) and a birthweight-derived standard (Olsen). We compared the test characteristics of small for gestational age (birthweight of <10th percentile) by each standard to predict a composite neonatal morbidity and mortality outcome (death before discharge, neonatal intensive care unit admission >48 hours, respiratory distress syndrome, sepsis, necrotizing enterocolitis, grade 3 or 4 intraventricular hemorrhage, or seizures). Severe composite morbidity was analyzed as a secondary outcome and was defined as death, neonatal intensive care unit admission >7 days, necrotizing enterocolitis, grade 3 or 4 intraventricular hemorrhage, or seizures. The areas under the curve using receiver-operating characteristic methodology and proportions of the primary outcome by small for gestational age status were compared by gestational age category at birth (<34, 34 0/7 to 36 6/7, ≥37 weeks). RESULTS Of 115,502 mother-newborn dyads in the parent study, 78,203 (67.7%) were included, with most exclusions occurring because of missing or inadequate dating information, multiple gestations, or delivery outside the gestational age range. The primary composite outcome occurred in 9.5% (95% confidence interval, 9.3-9.7), and the severe composite outcome occurred in 5.3% (95% confidence interval, 5.1-5.4). Small for gestational age was diagnosed by intrauterine and birthweight-derived standards in 14.8% and 7.4%, respectively (P<.001). Neonates considered small for gestational age only by the intrauterine standard experienced the primary outcome more than twice as often as those considered non-small for gestational age by both standards (18.4% vs 7.9%; P<.001). For the prediction of the primary outcome, small for gestational age by the intrauterine standard had higher sensitivity (29% vs 15%; P<.001) but lower specificity (87% vs 93%; P<.001) than by the birthweight standard. Both standards had weak performance overall, although the intrauterine standard had a higher area under the curve (0.58 vs 0.53; P<.001). When subanalyzed by gestational age at birth, the difference in areas under the curve was only present among preterm deliveries 34 to 36 competed weeks. Neither standard demonstrated any discrimination for morbidity prediction among term births (area under the curve, 0.50 for both). When the prediction of severe morbidity was compared, the intrauterine still had better overall prediction than the birthweight standard (areas under the curve, 0.65 vs 0.57; P<.001), although this also varied by gestational age at birth. CONCLUSION Among nonanomalous neonates, neither intrauterine nor birthweight-derived standards for small for gestational age accurately predicted neonatal morbidity and mortality, with no discriminatory ability at term. Small for gestational age intrauterine standards performed better than birthweight standards.
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Prediction of Late-Onset Small for Gestational Age and Fetal Growth Restriction by Fetal Biometry at 35 Weeks and Impact of Ultrasound-Delivery Interval: Comparison of Six Fetal Growth Standards. J Clin Med 2021; 10:jcm10132984. [PMID: 34279466 PMCID: PMC8269193 DOI: 10.3390/jcm10132984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 12/02/2022] Open
Abstract
Small-for-gestational-age (SGA) infants have been associated with increased risk of adverse perinatal outcomes (APOs). In this work, we assess the predictive ability of the ultrasound-estimated percentile weight (EPW) at 35 weeks of gestational age to predict late-onset SGA and APOs, according to six growth standards, and whether the ultrasound–delivery interval influences the detection rate. To this purpose, we analyze a retrospective cohort study of 9585 singleton pregnancies. EPWs at 35 weeks were calculated to the customized Miguel Servet University Hospital (MSUH) and Figueras standards and the non-customized MSUH, Fetal Medicine Foundation (FMF), INTERGROWTH-21st, and WHO standards. As results of our analysis, for a 10% false positive rate, the detection rates for SGA ranged between 48.9% with the customized Figueras standard (AUC 0.82) and 60.8% with the non-customized FMF standard (AUC 0.87). Detection rates to predict SGA by ultrasound–delivery interval (1–6 weeks) show higher detection rates as intervals decrease. APOs detection rates ranged from 27.0% with FMF to 7.9% with the Figueras standard. In conclusion, the ability of EPW to predict SGA at 35 weeks is good for all standards, and slightly better for non-customized standards. The APO detection rate is significantly greater for non-customized standards.
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Abstract
Three modern cohort studies have an advantage over historical fetal growth references because they included diverse populations. Despite similar inclusion criteria, estimated fetal weight percentiles for gestational age varied among studies, which result in different proportions of fetuses as being classified below or above a cutoff point. A universal reference would make comparison of fetal growth simpler for clinical use and for comparison across populations but may misclassify small-for-gestational-age or large-for-gestational-age fetuses. It is important to know how a growth reference performs in a local population in relation to fetal morbidity and mortality when implementing in clinical practice.
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Affiliation(s)
- Katherine L Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20892, USA.
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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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Selvaratnam RJ, Wallace EM, Hunt RW, Davey MA. Preventing harm: A balance measure for improving the detection of fetal growth restriction. Aust N Z J Obstet Gynaecol 2021; 61:715-721. [PMID: 33772758 DOI: 10.1111/ajo.13340] [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] [Received: 10/29/2020] [Accepted: 02/23/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Increasing the detection of fetal growth restriction (FGR), while reducing stillbirth, also leads to unnecessary early intervention, and associated morbidity, for normally grown babies who are incorrectly suspected of FGR. AIMS We sought to design a balance measure that addresses the specificity of FGR detection. METHODS A retrospective cohort study on all singleton births ≥32 weeks gestation in 2016 and 2017 in Victoria. We compared two balance measures for the detection of FGR, defined as the proportion of all babies iatrogenically delivered before 39 weeks gestation for suspected FGR that had a birthweight ≥10th centile (balance measure 1) or ≥25th centile (balance measure 2). Hospital level performance on each balance measure was derived and compared to an existing performance measure for severe FGR detection in Victoria. RESULTS Of the 38 hospitals analysed, 12 (32%) had a favourable performance on an existing indicator of FGR detection, seven (18%) hospitals had a favourable performance on balance measure 1, and 15 (39%) had a favourable performance on balance measure 2. There was a moderate correlation between hospital performance on the existing indicator and on balance measure 1 (r = 0.447, P = 0.005) but not balance measure 2 (r = -0.063, P = 0.71). There was no difference in perinatal mortality between high performing hospitals and low performing hospitals. CONCLUSION Introducing a balance measure into routine reporting may bring greater awareness to the unintended harm associated with increased detection of FGR.
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Affiliation(s)
- Roshan J Selvaratnam
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
| | - Rodney W Hunt
- Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Neonatal Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Monash Newborn, Monash Health, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
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12
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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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13
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Visser GHA, Nicholson WK, Barnea ER, Ramasauskaite D, Nassar AH. FIGO position paper on reference charts for fetal growth and size at birth: Which one to use? Int J Gynaecol Obstet 2020; 152:148-151. [PMID: 33247958 DOI: 10.1002/ijgo.13500] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/27/2020] [Accepted: 11/24/2020] [Indexed: 11/06/2022]
Abstract
Publication of the Intergrowth-21st and WHO growth charts raises the question of which growth data prenatal providers should use in clinical practice. Is it better to use a universal chart applied globally, or metrics based on local or regional growth patterns? And what about customized charts versus local charts? FIGO has reviewed the different growth charts and studies assessing their reproducibility and predictive values for small- and large-for-gestational age newborns and, where available, adverse fetal outcomes. It concludes that local or regional charts are likely to be best for identifying the 10th percentile of newborns at highest risk. However, international standards for growth may also be used when coupled with locally appropriate thresholds for risk interpretation.
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Affiliation(s)
- Gerard H A Visser
- Department of Obstetrics, University Medical Center, Utrecht, The Netherlands
| | - Wanda K Nicholson
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, USA
| | - Eytan R Barnea
- SIEP, The Society for the Investigation of Early Pregnancy, New York, NY, USA
| | - Diana Ramasauskaite
- Center of Obstetrics and Gynaecology, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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- Committee for Safe Motherhood and Newborn Health, FIGO, London, UK
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Gibbons KS, McIntyre HD, Mamun A, Chang AMZ. Development of the Birthweight Appropriateness Quotient: A New Measure of Infant's Size. Matern Child Health J 2020; 24:1202-1211. [PMID: 32794153 DOI: 10.1007/s10995-020-02994-4] [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: 10/23/2022]
Abstract
INTRODUCTION The customised birthweight model can be used to improve detection of babies that may be at risk of adverse outcomes associated with abnormal growth, however it is currently used in conjunction with either an intrauterine growth standard or the individualised birthweight ratio (IBR), both of which have significant methodological flaws. Our aim was to investigate the statistical validity of the IBR and attempt to develop a new measurement to represent the appropriateness of an infant's size at birth that will support clinicians in identifying infants requiring further attention. METHODS Routinely collected hospital maternity and neonatal data on singleton, term births from a tertiary Australian hospital were extracted for the time period 1998-2009. The relationships between birthweight, customised birthweight and IBR are investigated using correlation, regression analysis and division of births into groups of < 2500 g, 2500-4000 g and > 4000 g. A new measure, the Birthweight Appropriateness Quotient (BAQ), is developed. The utility of the BAQ is compared with IBR and birthweight to identify infants with a composite neonatal morbidity outcome. RESULTS Statistical flaws with the IBR due to significant correlation between birthweight and customised birthweight and a heterogenous relationship between these two measurements across the range of birthweight are present. BAQ is uncorrelated with birthweight. Comparison of BAQ and IBR as indicators of adverse neonatal outcome demonstrates that BAQ identifies babies at risk due to their small size and those babies at risk due to inappropriate size. CONCLUSIONS FOR PRACTICE BAQ is a customised measurement of an infant's size free of the statistical flaws experienced by the IBR with the ability to identify at-risk infants.
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Affiliation(s)
- Kristen S Gibbons
- Mothers and Babies Research, Mater Research Institute - The University of Queensland, South Brisbane, Australia. .,Level 4, Centre for Children's Health Research, 62 Graham St, South Brisbane, QLD, 4101, Australia.
| | - H David McIntyre
- Mothers and Babies Research, Mater Research Institute - The University of Queensland, South Brisbane, Australia.,UQ/Mater Clinical School, The University of Queensland, Brisbane, Australia
| | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Allan M Z Chang
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Shatin, Hong Kong
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15
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Savirón-Cornudella R, Esteban LM, Aznar-Gimeno R, Pérez-López FR, Ezquerro MC, Pérez PD, Maza JMC, Sanz G, Larraz BC, Tajada-Duaso M. A cohort study of fetal growth in twin pregnancies by chorionicity: comparison with European and American standards. Eur J Obstet Gynecol Reprod Biol 2020; 253:238-248. [PMID: 32898769 DOI: 10.1016/j.ejogrb.2020.08.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/03/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To develop fetal growth standards for twin gestations by placental chorionicity in a Spanish population and compare them with European and American standards to estimate the suitability of their use in clinical practice. STUDY DESIGN This was a retrospective cohort study of 518 twin pregnancies, 435 dichorionic-diamniotic and 83 monochorionic-diamniotic, performed between January 2012 and December 2017. A total of 4,783 and 1,455 estimated fetal weights were considered from the 17th to the 37th week of gestation, using multilevel models, to build dichorionic-diamniotic and monochorionic-diamniotic standards, respectively. The percentages of small and large for gestational age were calculated as a model adjustment measure and adjustment to the studied data and the values provided by our model were compared against those of six European and American twin standards and three singleton standards. Correlation analyses between percentile predictions were performed using Cohen kappa coefficient. The predictive ability to detect small for gestational age was also provided by the sensitivity and positive predictive value. RESULTS We found slight differences between standards by chorionicity, being dichorionic-diamniotic percentiles slightly higher than monochorionic-diamniotic ones from the 17th to 37th weeks' gestation. For dichorionic-diamniotic cases, both our standard (9.8-8.2) and that of Grantz (8.2-10.5) showed good adjustments for the 10th and 90th percentiles while the other compared standards underestimated or overestimated them. For monochorionic-diamniotic cases, both our standard (10.2-8.5) and that of Shivkumar (11.4-6.8) had the most suitable adjustment. The correlation analysis between small and large for gestational age cases provided by standards, showed clear differences among them. Kappa's coefficient showed a substantial agreement between both Ananth (0.7) and Stirrup (0.69) dichorionic-diamniotic cases and our standard. There was also a substantial agreement between the Shivkumar (0.77) standard and our results for monochorionic-diamniotic cases. The correlation was moderate for all other comparisons. CONCLUSIONS Our model showed a good adjustment to the studied population. There are clear differences among small and large for gestational age cases provided by twin standards in our studied population. The twin growth standards depend on the population characteristics and model structure. We found the use of singleton standards for twin pregnancies inadequate.
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Affiliation(s)
- Ricardo Savirón-Cornudella
- Department of Obstetrics and Gynecology, Villalba General Hospital, Camino de Moralzarzal M-608 Km, Calle Alpedrete 41, 28400 Collado Villalba, Madrid, Spain.
| | - Luis M Esteban
- Department of Applied mathematics, Escuela Universitaria Politécnica de La Almunia, Universidad de Zaragoza, Calle Mayor 5, 50100, La Almunia de Doña Godina, Zaragoza, Spain.
| | - Rocío Aznar-Gimeno
- Deparment of BigData and Cognitive systems. Instituto Tecnológico de Aragon, ITAINNOVA, María de Luna 7-8, 50018, Zaragoza, Spain.
| | - Faustino R Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza, Faculty of Medicine and Instituto de Investigación Sanitaria Aragón, Domingo Miral s/n, 50009, Zaragoza, Spain.
| | - Marta Chóliz Ezquerro
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Isabel La Católica 3, 50009, Zaragoza, Spain.
| | - Peña Dieste Pérez
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Isabel La Católica 3, 50009, Zaragoza, Spain.
| | - José M Campillos Maza
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Isabel La Católica 3, 50009, Zaragoza, Spain.
| | - Gerardo Sanz
- Department of Statistical Methods and Institute for Biocomputation and Physics of Complex Systems-BIFI, University of Zaragoza, Calle Pedro Cerbuna 12, 50009, Zaragoza, Spain.
| | - Berta Castán Larraz
- Department of Obstetrics and Gynecology, San Pedro Hospital, Calle Piqueras 98, 26006, Logroño, La Rioja, Spain.
| | - Mauricio Tajada-Duaso
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Isabel La Católica 3, 50009, Zaragoza, Spain.
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16
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Selvaratnam RJ, Davey MA, Wallace EM. The pitfalls of using birthweight centile charts to audit care. PLoS One 2020; 15:e0235113. [PMID: 32574213 PMCID: PMC7310721 DOI: 10.1371/journal.pone.0235113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/09/2020] [Indexed: 01/20/2023] Open
Abstract
Objectives Timely delivery of fetal growth restriction (FGR) is important in reducing stillbirth. However, targeted earlier delivery of FGR preferentially removes smaller babies from later gestations, thereby right-shifting the distribution of birthweights at term. This artificially increases the birthweight cutoffs defining the lower centiles and redefines normally grown babies as small by population-based birthweight centiles. Our objective was to compare updated Australian national population-based birthweight centile charts over time with the prescriptive INTERGROWTH-21st standard. Methods A retrospective descriptive study of all singleton births ≥34 weeks’ gestation in Victoria, Australia in five two-year epochs: 1983–84, 1993–94, 2003–04, 2013–14, and 2016–17. The birthweight cutoffs defining the 3rd and 10th centile from three Australian national population-based birthweight centile charts, for births in 1991–1994, in 1998–2007, and 2004–2013 respectively, were applied to each epoch to calculate the proportion of babies with birthweight <3rd and <10th centile. The same analysis was done using the INTERGROWTH-21st birthweight standard. To assess change over gestation, proportions were also calculated at preterm, early term and late term gestations. Results From 1983–84 to 2016–17, the proportion of babies with birthweight <3rd fell across all birthweight centile charts, from 3.1% to 1.7% using the oldest Australian chart, from 3.9% to 1.9% using the second oldest Australian chart, from 4.3% to 2.2% using the most recent Australian chart, and from 2.0% to 0.9% using the INTERGROWTH-21st standard. A similar effect was evident for the <10th centile. The effect was most obvious at term gestations. Updating the Australian population birthweight chart progressively right-shifted the birthweight distribution, changing the definition of small over time. The birthweight distribution of INTERGROWTH-21st was left-shifted compared to the Australian charts. Conclusions Locally-derived population-based birthweight centiles are better for clinical audit of care but should not be updated. Prescriptive birthweight standards are less useful in defining ‘small’ due to their significant left-shift.
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Affiliation(s)
- Roshan John Selvaratnam
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Victoria, Australia
- Department of Health and Human Services, Safer Care Victoria, Victorian Government, Melbourne, Victoria, Australia
- * E-mail:
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Victoria, Australia
- Department of Health and Human Services, Safer Care Victoria, Victorian Government, Melbourne, Victoria, Australia
| | - Euan Morrison Wallace
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Victoria, Australia
- Department of Health and Human Services, Safer Care Victoria, Victorian Government, Melbourne, Victoria, Australia
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17
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Cartwright RD, Anderson NH, Sadler LC, Harding JE, McCowan LME, McKinlay CJD. Neonatal morbidity and small and large size for gestation: a comparison of birthweight centiles. J Perinatol 2020; 40:732-742. [PMID: 32080336 DOI: 10.1038/s41372-020-0631-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/20/2020] [Accepted: 02/11/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To compare rates of small- and large-for-gestational age (SGA and LGA) neonates using four different weight centiles, and to relate these classifications to neonatal morbidity. STUDY DESIGN Neonates born at 33-40 weeks' gestation in a multiethnic population were classified as SGA or LGA by population reference (Fenton), population standard (INTERGROWTH), fetal growth curves (WHO), and customized (GROW) centiles. Likelihood of composite morbidity was determined compared with a common appropriate-for-gestational age referent group. RESULT Among 45,505 neonates, SGA and LGA rates varied up to threefold by different centiles. Those most likely to develop neonatal morbidity were SGA or LGA on both the population reference and an alternative centile. Customized centiles identified over twice as many at-risk SGA neonates. CONCLUSIONS Customized centiles were most useful in identifying neonates at increased risk of morbidity, and those that were small on both customized and population reference centiles were at the highest risk.
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Affiliation(s)
| | - Ngaire H Anderson
- Waitemata District Health Board, Auckland, New Zealand.,Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Lynn C Sadler
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.,National Women's Health, Auckland City Hospital, Auckland, New Zealand.,Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.,National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Christopher J D McKinlay
- Liggins Institute, University of Auckland, Auckland, New Zealand. .,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand. .,Kidz First Neonatal Care, Counties Manukau Health, Auckland, New Zealand.
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18
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Selvaratnam RJ, Davey MA, Mol BW, Wallace EM. Increasing obstetric intervention for fetal growth restriction is shifting birthweight centiles: a retrospective cohort study. BJOG 2020; 127:1074-1080. [PMID: 32180311 DOI: 10.1111/1471-0528.16215] [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] [Accepted: 03/09/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the impact of increasing obstetric intervention on birthweight centiles. DESIGN Retrospective cohort study of births in five 2-year epochs: 1983-84, 1993-94, 2003-2004, 2013-2014 and 2016-2017. POPULATION 665 205 singleton births at ≥32 weeks' gestation. SETTING All maternity services in Victoria, Australia. METHODS For each epoch, we calculated the birthweight cutoffs defining each birthweight centile at 34, 37 and 40 weeks' gestation. We calculated rates of iatrogenic delivery over time. We then calculated the number of babies whose birthweight would have classified them as ≥3rd centile based on 1983-84 centile definitions but as <3rd centile based on 2016-2017 centile definitions. MAIN OUTCOME MEASURES Birthweight centile, and gestation at delivery. RESULTS From 1983-84 to 2016-2017, the rate of iatrogenic delivery for singleton pregnancies increased at all term gestations: 1.6-6.4% at 37 weeks', 4.5-18.3% at 38 weeks', 7.6-23.9% at 39 weeks' and 18.4-25.1% at 40 weeks' (all P < 0.001). Over the same period, the birthweight cutoffs defining the 3rd, 5th and 10th centiles increased significantly at term, but not preterm, gestations. This led to increasing numbers of term births being classified as small for gestational age (SGA). Of the 2748 babies born in 2016-2017 at 37-39 weeks' gestation with a birthweight <3rd centile in that period, 1478 (53.8%) would have been classified as ≥3rd centile based on 1983-84 centile definitions. CONCLUSION Increasing intervention is shifting the birthweight cutoffs that define birthweight centiles and thereby redefining what constitutes SGA. This undermines the use of population-derived birthweight centiles to audit clinical care. TWEETABLE ABSTRACT Increasing obstetric intervention is shifting birthweight centiles and therefore definitions of normality.
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Affiliation(s)
- R J Selvaratnam
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Vic., Australia
| | - M-A Davey
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Vic., Australia
| | - B W Mol
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Clayton, Vic., Australia
| | - E M Wallace
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Vic., Australia
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19
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Maple-Brown L, Lee IL, Longmore D, Barzi F, Connors C, Boyle JA, Moore E, Whitbread C, Kirkwood M, Graham S, Hampton V, Simmonds A, Van Dokkum P, Kelaart J, Thomas S, Chitturi S, Eades S, Corpus S, Lynch M, Lu ZX, O'Dea K, Zimmet P, Oats J, McIntyre HD, Brown ADH, Shaw JE. Pregnancy And Neonatal Diabetes Outcomes in Remote Australia: the PANDORA study-an observational birth cohort. Int J Epidemiol 2020; 48:307-318. [PMID: 30508095 DOI: 10.1093/ije/dyy245] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In Australia's Northern Territory, 33% of babies are born to Indigenous mothers, who experience high rates of hyperglycemia in pregnancy. We aimed to determine the extent to which pregnancy outcomes for Indigenous Australian women are explained by relative frequencies of diabetes type [type 2 diabetes (T2DM) and gestational diabetes (GDM)]. METHODS This prospective birth cohort study examined participants recruited from a hyperglycemia in pregnancy register. Baseline data collected were antenatal and perinatal clinical information, cord blood and neonatal anthropometry. Of 1135 women (48% Indigenous), 900 had diabetes: 175 T2DM, 86 newly diagnosed diabetes in pregnancy (DIP) and 639 had GDM. A group of 235 women without hyperglycemia in pregnancy was also recruited. RESULTS Diabetes type differed for Indigenous and non-Indigenous women (T2DM, 36 vs 5%; DIP, 15 vs 7%; GDM, 49 vs 88%, p < 0.001). Within each diabetes type, Indigenous women were younger and had higher smoking rates. Among women with GDM/DIP, Indigenous women demonstrated poorer birth outcomes than non-Indigenous women: large for gestational age, 19 vs 11%, p = 0·002; neonatal fat 11.3 vs 10.2%, p < 0.001. In the full cohort, on multivariate regression, T2DM and DIP were independently associated (and Indigenous ethnicity was not) with pregnancy outcomes. CONCLUSIONS Higher rates of T2DM among Indigenous women predominantly contribute to absolute poorer pregnancy outcomes among Indigenous women with hyperglycemia. As with Indigenous and minority populations globally, prevention or delay of type 2 diabetes in younger women is vital to improve pregnancy outcomes and possibly to improve the long-term health of their offspring.
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Affiliation(s)
- Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - I-Lynn Lee
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Danielle Longmore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Christine Connors
- Remote Primary Health Care, Top End Health Services, Northern Territory Department of Health, Darwin, NT, Australia
| | - Jacqueline A Boyle
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Moore
- Public Health Unit, Aboriginal Medical Services Alliance, Darwin, NT, Australia
| | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Marie Kirkwood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Sian Graham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Vanya Hampton
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Alison Simmonds
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Paula Van Dokkum
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Joanna Kelaart
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Sujatha Thomas
- Division of Maternal and Child Health, Royal Darwin Hospital, Darwin, NT, Australia
| | - Shridhar Chitturi
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Sandra Eades
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Sumaria Corpus
- Clinical Services, Danila Dilba Health Service, Darwin, NT, Australia
| | - Michael Lynch
- Pathology Network, Top End Health and Hospital Services, Darwin, NT, Australia
| | - Zhong X Lu
- Biochemistry Department, Melbourne Pathology, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Kerin O'Dea
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Harold D McIntyre
- Faculty of Medicine, Mater Medical Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Alex D H Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Jonathan E Shaw
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
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Cheng E, Longmore DK, Barzi F, Barr ELM, Lee IL, Whitbread C, Boyle JA, Oats J, Connors C, McIntyre HD, Kirkwood M, Dempsey K, Zhang X, Thomas S, Williams D, Zimmet P, Brown ADH, Shaw JE, Maple-Brown LJ. Birth outcomes in women with gestational diabetes managed by lifestyle modification alone: The PANDORA study. Diabetes Res Clin Pract 2019; 157:107876. [PMID: 31586661 DOI: 10.1016/j.diabres.2019.107876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/08/2019] [Accepted: 10/02/2019] [Indexed: 12/16/2022]
Abstract
AIMS To assess outcomes of women in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort with gestational diabetes mellitus (GDM) managed by lifestyle modification compared with women without hyperglycaemia in pregnancy. METHODS Indigenous (n = 97) and Europid (n = 113) women managed by lifestyle modification were compared to women without hyperglycaemia (n = 235). Multivariate linear and logistic regressions assessed whether GDM-lifestyle women had poorer outcomes compared to women without hyperglycaemia. RESULTS Women with GDM-lifestyle had higher body mass index and lower gestational weight gain than women without hyperglycaemia. On univariate analysis, gestational age at delivery was lower and induction rates were higher in women with GDM-lifestyle than without hyperglycaemia. On multivariable regression, GDM-lifestyle was associated with lower gestational age at delivery (by 0.73 weeks), lower birthweight z-score (by 0.26, p = 0.007), lower likelihood of large for gestational age (LGA) [OR (95% CI): 0.55 (0.28, 1.02), p = 0.059], and greater likelihood of labour induction [2.34 (1.49, 3.66), p < 0.001] than women without hyperglycaemia. CONCLUSION Women with GDM managed by lifestyle modification had higher induction rates and their offspring had lower birthweight z-scores, with a trend to lower LGA than those without hyperglycaemia in pregnancy. Further studies are indicated to explore reasons for higher induction rates.
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Affiliation(s)
- E Cheng
- Menzies School of Health Research, NT, Australia; Division of Obstetrics and Gynaecology, Royal Darwin Hospital, NT, Australia; Danila Dilba Health Service, Darwin, NT, Australia.
| | - D K Longmore
- Menzies School of Health Research, NT, Australia.
| | - F Barzi
- Menzies School of Health Research, NT, Australia.
| | - E L M Barr
- Menzies School of Health Research, NT, Australia; Baker Heart and Diabetes Institute, VIC, Australia.
| | - I L Lee
- Menzies School of Health Research, NT, Australia.
| | - C Whitbread
- Menzies School of Health Research, NT, Australia; Division of Medicine, Royal Darwin Hospital, NT, Australia.
| | - J A Boyle
- Menzies School of Health Research, NT, Australia; Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia.
| | - J Oats
- Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - C Connors
- Primary Health Care Branch, Top End Health Service, NT, Australia.
| | - H D McIntyre
- Mater Medical Research Institute, University of Queensland, Australia.
| | - M Kirkwood
- Menzies School of Health Research, NT, Australia.
| | - K Dempsey
- Menzies School of Health Research, NT, Australia.
| | - X Zhang
- Innovation and Research, Department of Health, NT, Australia.
| | - S Thomas
- Division of Obstetrics and Gynaecology, Royal Darwin Hospital, NT, Australia.
| | - D Williams
- Darwin Midwifery Group, NT Health, Australia.
| | - P Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Australia.
| | - A D H Brown
- South Australian Health and Medical Research Institute, Australia; Faculty of Health and Medical Science, University of Adelaide, Australia.
| | - J E Shaw
- Baker Heart and Diabetes Institute, VIC, Australia.
| | - L J Maple-Brown
- Menzies School of Health Research, NT, Australia; Division of Medicine, Royal Darwin Hospital, NT, Australia.
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21
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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: 7] [Impact Index Per Article: 1.4] [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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22
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Savirón-Cornudella R, Esteban LM, Tajada-Duaso M, Castán-Mateo S, Dieste-Pérez P, Cotaina-Gracia L, Lerma-Puertas D, Sanz G, Pérez-López FR. Detection of Adverse Perinatal Outcomes at Term Delivery Using Ultrasound Estimated Percentile Weight at 35 Weeks of Gestation: Comparison of Five Fetal Growth Standards. Fetal Diagn Ther 2019; 47:104-114. [PMID: 31212273 DOI: 10.1159/000500453] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/16/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the predictive ability of the ultrasound estimated percentile weight (EPW) at 35 weeks of pregnancy to predict adverse perinatal outcomes (APOs) at term delivery according to 5 fetal growth standards, including population, population-customized, and international references. METHODS This was a retrospective cohort study of 9,585 singleton pregnancies. Maternal clinical characteristics, fetal ultrasound data obtained at 35 weeks and pregnancy and perinatal outcomes were used to calculate EPWs to predict APOs according to: the customized and noncustomized (NC) Miguel Servet University Hospital (MSUH), the customized Figueras, the NC INTERGROWTH-21st, and the NC World Health Organization (WHO) international standards. APOs were defined as the occurrence of cesarean or instrumental delivery for nonreassuring fetal status, 5-min Apgar score < 7, arterial cord blood pH <7.10, or stillbirth. The predictive ability of EPW for APOs was analyzed using the area under the curve (AUC), and sensitivities were calculated for different false-positive rates (FPRs). RESULTS For a 10% FPR, detection rates for total APOs ranged between 12.7% with the customized MSUH (AUC 0.52; 95% CI 0.50-0.55) and 14.4% with the NC MSUH standard (AUC 0.55; 95% CI 0.53-0.57) for EPW by ultrasound; and from 22.0% with the customized MSUH standard (AUC 0.60; 95% CI 0.58-0.63) to 27.8% with the NC WHO (AUC 0.65; 95% CI 0.63-0.68) for EPW at delivery. CONCLUSIONS The predictive capacity of the EPW for APOS is limited and similar, by both ultrasound and at delivery, for the 5 growth standards, without significant differences between customized and NC standards.
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Affiliation(s)
| | - Luis M Esteban
- Escuela Universitaria Politécnica de La Almunia, University of Zaragoza, Zaragoza, Spain
| | - Mauricio Tajada-Duaso
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain,
| | - Sergio Castán-Mateo
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Peña Dieste-Pérez
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Laura Cotaina-Gracia
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Diego Lerma-Puertas
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Gerardo Sanz
- Department of Statistical Methods and Institute for Biocomputation and Physics of Complex Systems-BIFI, University of Zaragoza, Zaragoza, Spain
| | - Faustino R Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine and Lozano-Blesa University Hospital, Zaragoza, Spain
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23
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Hoftiezer L, Hof MHP, Dijs-Elsinga J, Hogeveen M, Hukkelhoven CWPM, van Lingen RA. From population reference to national standard: new and improved birthweight charts. Am J Obstet Gynecol 2019; 220:383.e1-383.e17. [PMID: 30576661 DOI: 10.1016/j.ajog.2018.12.023] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/11/2018] [Accepted: 12/12/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Antenatal detection of intrauterine growth restriction remains a major obstetrical challenge, with the majority of cases not detected before birth. In these infants with undetected intrauterine growth restriction, the diagnosis must be made after birth. Clinicians use birthweight charts to identify infants as small-for-gestational-age if their birthweights are below a predefined threshold for gestational age. The choice of birthweight chart strongly affects the classification of small-for-gestational-age infants and has an impact on both research findings and clinical practice. Despite extensive literature on pathological risk factors associated with small-for-gestational-age, controversy exists regarding the exclusion of affected infants from a reference population. OBJECTIVE This study aims to identify pathological risk factors for abnormal fetal growth, to quantify their effects, and to use these findings to calculate prescriptive birthweight charts for the Dutch population. MATERIALS AND METHODS We performed a retrospective cross-sectional study, using routinely collected data of 2,712,301 infants born in The Netherlands between 2000 and 2014. Risk factors for abnormal fetal growth were identified and categorized in 7 groups: multiple gestation, hypertensive disorders, diabetes, other pre-existing maternal medical conditions, maternal substance (ab)use, medical conditions related to the pregnancy, and congenital malformations. The effects of these risk factors on mean birthweight were assessed using linear regression. Prescriptive birthweight charts were derived from live-born singleton infants, born to ostensibly healthy mothers after uncomplicated pregnancies and spontaneous onset of labor. The Box-Cox-t distribution was used to model birthweight and to calculate sex-specific percentiles. The new charts were compared to various existing birthweight and fetal-weight charts. RESULTS We excluded 111,621 infants because of missing data on birthweight, gestational age or sex, stillbirth, or a gestational age not between 23 and 42 weeks. Of the 2,599,640 potentially eligible infants, 969,552 (37.3%) had 1 or more risk factors for abnormal fetal growth and were subsequently excluded. Large absolute differences were observed between the mean birthweights of infants with and without these risk factors, with different patterns for term and preterm infants. The final low-risk population consisted of 1,629,776 live-born singleton infants (50.9% male), from which sex-specific percentiles were calculated. Median and 10th percentiles closely approximated fetal-weight charts but consistently exceeded existing birthweight charts. CONCLUSION Excluding risk factors that cause lower birthweights results in prescriptive birthweight charts that are more akin to fetal-weight charts, enabling proper discrimination between normal and abnormal birthweight. This proof of concept can be applied to other populations.
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Affiliation(s)
- Liset Hoftiezer
- Department of Neonatology, Princess Amalia Department of Pediatrics, Isala, Zwolle, The Netherlands; Department of Neonatology, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Michel H P Hof
- Department of Clinical Epidemiology, Bioinformatics & Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Marije Hogeveen
- Department of Neonatology, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Richard A van Lingen
- Department of Neonatology, Princess Amalia Department of Pediatrics, Isala, Zwolle, The Netherlands
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24
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Vieira MC, Relph S, Copas A, Healey A, Coxon K, Alagna A, Briley A, Johnson M, Lawlor DA, Lees C, Marlow N, McCowan L, Page L, Peebles D, Shennan A, Thilaganathan B, Khalil A, Sandall J, Pasupathy D. The DESiGN trial (DEtection of Small for Gestational age Neonate), evaluating the effect of the Growth Assessment Protocol (GAP): study protocol for a randomised controlled trial. Trials 2019; 20:154. [PMID: 30832739 PMCID: PMC6398257 DOI: 10.1186/s13063-019-3242-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 02/06/2019] [Indexed: 11/29/2022] Open
Abstract
Background Stillbirth rates in the United Kingdom (UK) are amongst the highest of all developed nations. The association between small-for-gestational-age (SGA) foetuses and stillbirth is well established, and observational studies suggest that improved antenatal detection of SGA babies may halve the stillbirth rate. The Growth Assessment Protocol (GAP) describes a complex intervention that includes risk assessment for SGA and screening using customised fundal-height growth charts. Increased detection of SGA from the use of GAP has been implicated in the reduction of stillbirth rates by 22%, in observational studies of UK regions where GAP uptake was high. This study will be the first randomised controlled trial examining the clinical efficacy, health economics and implementation of the GAP programme in the antenatal detection of SGA. Methods/design In this randomised controlled trial, clusters comprising a maternity unit (or National Health Service Trust) were randomised to either implementation of the GAP programme, or standard care. The primary outcome is the rate of antenatal ultrasound detection of SGA in infants found to be SGA at birth by both population and customised standards, as this is recognised as being the group with highest risk for perinatal morbidity and mortality. Secondary outcomes include antenatal detection of SGA by population centiles, antenatal detection of SGA by customised centiles, short-term maternal and neonatal outcomes, resource use and economic consequences, and a process evaluation of GAP implementation. Qualitative interviews will be performed to assess facilitators and barriers to implementation of GAP. Discussion This study will be the first to provide data and outcomes from a randomised controlled trial investigating the potential difference between the GAP programme compared to standard care for antenatal ultrasound detection of SGA infants. Accurate information on the performance and service provision requirements of the GAP protocol has the potential to inform national policy decisions on methods to reduce the rate of stillbirth. Trial registration Primary registry and trial identifying number: ISRCTN 67698474. Registered on 2 November 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3242-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matias C Vieira
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Sophie Relph
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Andrew Copas
- Centre for Pragmatic Global Health Trials, Institute for Global Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Andrew Healey
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Kirstie Coxon
- Faculty of Health, Social Care and Education, Kingston and St. George's University, 6th Floor, Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK
| | - Alessandro Alagna
- The Guy's and St Thomas' Charity, 9 King's Head Yard, London, SE1 1NA, UK
| | - Annette Briley
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Mark Johnson
- Department of Surgery and Cancer, Imperial College London, Kensington, London, SW7 2AZ, UK
| | - Deborah A Lawlor
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, BS8 2BL, UK.,Bristol NIHR Biomedical Research Centre, Bristol, BS8 2BL, UK
| | - Christoph Lees
- Department of Surgery and Cancer, Imperial College London, Kensington, London, SW7 2AZ, UK
| | - Neil Marlow
- UCL Institute for Women's Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Lesley McCowan
- Faculty of Medical and Health Sciences, University of Auckland, Victoria Street West, Auckland, 1142, New Zealand
| | - Louise Page
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Twickenham Road, Isleworth, TW7 6AF, UK
| | - Donald Peebles
- UCL Institute for Women's Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Baskaran Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.,Molecular and Clinical Sciences Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.,Molecular and Clinical Sciences Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
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25
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Savirón-Cornudella R, Esteban LM, Lerma D, Cotaina L, Borque Á, Sanz G, Castán S. Comparison of fetal weight distribution improved by paternal height by Spanish standard versus Intergrowth 21st standard. J Perinat Med 2018; 46:750-759. [PMID: 28498795 DOI: 10.1515/jpm-2016-0298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/30/2017] [Indexed: 11/15/2022]
Abstract
Abstract
Objective:
Our main objective was to study the influence on birth and ultrasound fetal weight of traditional factors in combination with non-traditionally explored predictors such as paternal height to provide a new customized in utero growth model. We also have compared it in our population with other customized and non-customized models.
Methods:
We collected 5243 cases of singleton pregnancies. An integrated study of the different variables was performed in a multivariate model to predict the fetus birthweight and customized growth curves were created following the Gardosi procedure.
Results:
Gestational age (P<0.001), parity (P<0.001), maternal age (P<0.001), maternal body mass index (P<0.001), maternal height (P<0.001), parental height (P<0.001), pregnancy-associated plasma protein A (PAPP-A) (P<0.001), free-beta human chorionic gonadotropin (FBHCG) (P<0.013), single umbilical artery (SUA) (P<0.009), region of origin (P<0.001), fetal sex (P<0.001), smoking (P<0.001) and pre-gestational diabetes (P<0.001) showed statistical significance. We created two growth customized models (simple and advance) that have shown good performance in predicting fetal weight at delivery and estimated by ultrasounds. The percentage of small for gestational age (SGA) cases (P10) predicted by the two models at birth were 9.9% and 9%, and for large gestational ages (LGA) (P90) we obtained values of 90.1% and 90.3%. Also, using the fetal weights measured by ultrasounds, we obtained P10 adjusted predictions, 9.2% and 9.4%, for the simpler and advance models, respectively, which were more adjusted than the 0.4, 4.6 and 10.6 obtained using the other compared models. For an easy use of models an app and a nomogram is provided.
Conclusion:
Using new predictor variables we implemented new growth in utero model, with predictions more adjusted to our population than Spanish customized or Intergrowth 21st models with better performance for birth and ultrasound fetal weights. We propose using a prediction model that includes parental height.
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Affiliation(s)
- Ricardo Savirón-Cornudella
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Calle Isabel La Católica 3. 50009 Zaragoza, Spain
| | - Luis Mariano Esteban
- Escuela Universitaria Politécnica de La Almunia, Universidad de Zaragoza, Calle Mayor, 0, 50100 La Almunia de Doña Godina, Zaragoza, Spain
| | - Diego Lerma
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Calle Isabel La Católica 3. 50009 Zaragoza, Spain
| | - Laura Cotaina
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Calle Isabel La Católica 3. 50009 Zaragoza, Spain
| | - Ángel Borque
- Department of Urology, Hospital Universitario Miguel Servet, Calle Isabel La Católica 3. 50009 Zaragoza, Spain
| | - Gerardo Sanz
- Departamento de Métodos Estadísticos, Universidad de Zaragoza, Pedro Cerbuna, 12 (Edificio de Matemáticas). 50009 Zaragoza, Spain
| | - Sergio Castán
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Calle Isabel La Católica 3. 50009 Zaragoza, Spain
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26
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Small for gestational age: Case definition & guidelines for data collection, analysis, and presentation of maternal immunisation safety data. Vaccine 2018; 35:6518-6528. [PMID: 29150057 PMCID: PMC5710996 DOI: 10.1016/j.vaccine.2017.01.040] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/13/2017] [Indexed: 12/13/2022]
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27
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Odibo AO, Nwabuobi C, Odibo L, Leavitt K, Obican S, Tuuli MG. Customized fetal growth standard compared with the INTERGROWTH-21st century standard at predicting small-for-gestational-age neonates. Acta Obstet Gynecol Scand 2018; 97:1381-1387. [PMID: 29878301 DOI: 10.1111/aogs.13394] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/01/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The INTERGROWTH-21st project (IG-21) was recently performed aiming to provide a universal benchmark for comparing fetal growth across different ethnicities. Our aim was to compare the IG-21 with a customized standard for predicting pregnancies at risk for neonatal small-for-gestational age (SGA) and adverse outcomes. MATERIAL AND METHODS This was a prospective cohort study including singleton pregnancies presenting for fetal growth assessment between 26 and 36 weeks of gestation. Fetal growth restriction was defined as estimated fetal weight <10th centile for gestational age using IG-21 and a customized standard. Neonatal SGA was defined as birthweight <10th centile for gestational age by the Alexander chart. Primary outcome was the prediction of neonatal SGA. Secondary outcomes included a composite of adverse neonatal outcomes. The discriminatory ability of each growth standard was compared using area under receiver operating characteristic curves (AUC). RESULTS Of 1054 pregnancies meeting the inclusion criteria, the incidence of neonatal SGA was 139 (13.2%), and a composite adverse neonatal outcome occurred in 300 (28.4%). The sensitivity of the customized standard (38.8%) was higher than that of IG-21 (24.5%) for predicting neonatal SGA, with AUC (95% CI) of 0.67 (0.63-0.71) for customized vs 0.62 (0.58-0.65) for IG-21; P = .003. Both standards were comparable in predicting the composite adverse neonatal outcomes: AUC (95% CI) 0.52 (0.50-0.55) for customized vs 0.51 (0.50-0.53) for IG-21; P = 0.25. CONCLUSIONS Both growth standards had modest performance in detecting neonatal SGA and were poor at predicting short-term adverse neonatal outcome.
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Affiliation(s)
- Anthony O Odibo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Chinedu Nwabuobi
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Linda Odibo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Karla Leavitt
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Sarah Obican
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Methodius G Tuuli
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
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Fetal biometry to assess the size and growth of the fetus. Best Pract Res Clin Obstet Gynaecol 2018; 49:3-15. [DOI: 10.1016/j.bpobgyn.2018.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 02/14/2018] [Indexed: 01/13/2023]
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Korzeniewski SJ, Allred EN, Joseph RM, Heeren T, Kuban KC, O’Shea TM, Leviton A. Neurodevelopment at Age 10 Years of Children Born <28 Weeks With Fetal Growth Restriction. Pediatrics 2017; 140:peds.2017-0697. [PMID: 29030525 PMCID: PMC5654396 DOI: 10.1542/peds.2017-0697] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We sought to evaluate the relationships between fetal growth restriction (FGR) (both severe and less severe) and assessments of cognitive, academic, and adaptive behavior brain function at age 10 years. METHODS At age 10 years, the Extremely Low Gestational Age Newborns Cohort Study assessed the cognitive function, academic achievement, social-communicative function, psychiatric symptoms, and overall quality of life of 889 children born before 28 weeks' gestation. A pediatric epileptologist also interviewed parents as part of a seizure evaluation. The 52 children whose birth weight z scores were <-2 were classified as having severe FGR, and the 113 whose birth weight z scores were between -2 and -1 were considered to have less severe FGR. RESULTS The more severe the growth restriction in utero, the lower the level of function on multiple cognitive and academic achievement assessments performed at age 10 years. Growth-restricted children were also more likely than their extremely preterm peers to have social awareness impairments, autistic mannerisms, autism spectrum diagnoses, difficulty with semantics and speech coherence, and diminished social and psychosocial functioning. They also more frequently had phobias, obsessions, and compulsions (according to teacher, but not parent, report). CONCLUSIONS Among children born extremely preterm, those with severe FGR appear to be at increased risk of multiple cognitive and behavioral dysfunctions at age 10 years, raising the possibility that whatever adversely affected their intrauterine growth also adversely affected multiple domains of cognitive and neurobehavioral development.
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Affiliation(s)
- Steven J. Korzeniewski
- Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, Michigan;,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Elizabeth N. Allred
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Neurology, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Tim Heeren
- Department of Biostatistics, School of Public Health
| | - Karl C.K. Kuban
- Boston University, Boston, Massachusetts;,Departments of Pediatrics, Boston Medical Center, Boston, Massachusetts; and
| | - T. Michael O’Shea
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - Alan Leviton
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Neurology, Harvard Medical School, Harvard University, Boston, Massachusetts
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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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Iliodromiti S, Mackay DF, Smith GCS, Pell JP, Sattar N, Lawlor DA, Nelson SM. Customised and Noncustomised Birth Weight Centiles and Prediction of Stillbirth and Infant Mortality and Morbidity: A Cohort Study of 979,912 Term Singleton Pregnancies in Scotland. PLoS Med 2017; 14:e1002228. [PMID: 28141865 PMCID: PMC5283655 DOI: 10.1371/journal.pmed.1002228] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 12/20/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is limited evidence to support the use of customised centile charts to identify those at risk of stillbirth and infant death at term. We sought to determine birth weight thresholds at which mortality and morbidity increased and the predictive ability of noncustomised (accounting for gestational age and sex) and partially customised centiles (additionally accounting for maternal height and parity) to identify fetuses at risk. METHODS This is a population-based linkage study of 979,912 term singleton pregnancies in Scotland, United Kingdom, between 1992 and 2010. The main exposures were noncustomised and partially customised birth weight centiles. The primary outcomes were infant death, stillbirth, overall mortality (infant and stillbirth), Apgar score <7 at 5 min, and admission to the neonatal unit. Optimal thresholds that predicted outcomes for both non- and partially customised birth weight centiles were calculated. Prediction of mortality between non- and partially customised birth weight centiles was compared using area under the receiver operator characteristic curve (AUROC) and net reclassification index (NRI). FINDINGS Birth weight ≤25th centile was associated with higher risk for all mortality and morbidity outcomes. For stillbirth, low Apgar score, and neonatal unit admission, risk also increased from the 85th centile. Similar patterns and magnitude of associations were observed for both non- and partially customised birth weight centiles. Partially customised birth weight centiles did not improve the discrimination of mortality (AUROC 0.61 [95%CI 0.60, 0.62]) compared with noncustomised birth weight centiles (AUROC 0.62 [95%CI 0.60, 0.63]) and slightly underperformed in reclassifying pregnancies to different risk categories for both fatal and non-fatal adverse outcomes (NRI -0.027 [95% CI -0.039, -0.016], p < 0.001). We were unable to fully customise centile charts because we lacked data on maternal weight and ethnicity. Additional analyses in an independent UK cohort (n = 10,515) suggested that lack of data on ethnicity in this population (in which national statistics show 98% are white British) and maternal weight would have misclassified ~15% of the large-for-gestation fetuses. CONCLUSIONS At term, birth weight remains strongly associated with the risk of stillbirth and infant death and neonatal morbidity. Partial customisation does not improve prediction performance. Consideration of early term delivery or closer surveillance for those with a predicted birth weight ≤25th or ≥85th centile may reduce adverse outcomes. Replication of the analysis with fully customised centiles accounting for ethnicity is warranted.
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Affiliation(s)
- Stamatina Iliodromiti
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
- * E-mail:
| | - Daniel F. Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Gordon C. S. Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, Rosie Hospital, Cambridge, United Kingdom
- NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Debbie A. Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
| | - Scott M. Nelson
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Khalil A, Thilaganathan B. Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term. Best Pract Res Clin Obstet Gynaecol 2017; 38:38-47. [DOI: 10.1016/j.bpobgyn.2016.09.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 01/31/2023]
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Salas AA, Carlo WA, Ambalavanan N, Nolen TL, Stoll BJ, Das A, Higgins RD. Gestational age and birthweight for risk assessment of neurodevelopmental impairment or death in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed 2016; 101:F494-F501. [PMID: 26895876 PMCID: PMC4991950 DOI: 10.1136/archdischild-2015-309670] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/07/2016] [Accepted: 01/24/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND The risk of poor outcomes in preterm infants is primarily determined by birthweight (BW) and gestational age (GA). It is not known whether BW is a better outcome predictor than GA. OBJECTIVE To test whether BW is better than GA (measured in days, rather than completed weeks) for prediction of neurodevelopmental impairment (NDI) and death. DESIGN/METHODS Extremely preterm infants born at the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centres between 1998 and 2009 were studied. For the unadjusted analysis, the associations of GA (in days based on best obstetrical estimate) and BW (in grams) with NDI or death were compared using area under the curve (AUC). Adjusted analyses were performed using birth year, sex, race, antenatal steroids, singleton birth, pre-eclampsia, Apgar score at 5 min and small for GA as covariates. RESULTS 10 652 preterm infants (89%) had outcome data at 18-22 months' corrected age. The mean BW was 678 g (SD: 155) and the mean GA was 173 days (SD: 10) or 245/7 weeks (SD: 13/7). The AUC for NDI or death was 80% with BW and 79% with GA (p=0.82). Unadjusted and adjusted analyses did not differ. NDI or death rates decreased with increasing GA through 26 weeks (estimated risk reduction with each additional day of gestation: 2.2%). CONCLUSION Both BW in grams and GA in days are good predictors of NDI and death in a preterm population selected on the basis of reliable GA. TRIAL REGISTRATION NUMBER NCT00009633.
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Affiliation(s)
- Ariel A. Salas
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Waldemar A Carlo
- University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Tracy L Nolen
- RTI International, Research Triangle Park, NC, United States
| | | | - Abhik Das
- RTI International, Research Triangle Park, NC, United States
| | - Rosemary D. Higgins
- GDB and FU Subcommittee, NICHD Neonatal Research Network, Bethesda, MD, United States
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Baird SM, Davies-Tuck M, Coombs P, Knight M, Wallace EM. Detection of the growth-restricted fetus: which centile charts? SONOGRAPHY 2016. [DOI: 10.1002/sono.12065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Samantha M. Baird
- The Ritchie Centre; Hudson Institute of Medical Research; Clayton Victoria Australia
- Department of Obstetrics and Gynaecology; Monash University; Clayton Victoria Australia
| | - Miranda Davies-Tuck
- The Ritchie Centre; Hudson Institute of Medical Research; Clayton Victoria Australia
- Department of Obstetrics and Gynaecology; Monash University; Clayton Victoria Australia
| | - Peter Coombs
- Department of Medical Imaging and Radiation Sciences, School of Clinical Sciences; Monash University; Clayton Victoria Australia
- Department of Diagnostic Imaging; Monash Health; Clayton Victoria Australia
| | - Michelle Knight
- Monash Women's Services; Monash Health; Clayton Victoria Australia
| | - Euan M. Wallace
- The Ritchie Centre; Hudson Institute of Medical Research; Clayton Victoria Australia
- Department of Obstetrics and Gynaecology; Monash University; Clayton Victoria Australia
- Monash Women's Services; Monash Health; Clayton Victoria Australia
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Hoftiezer L, Hukkelhoven CWPM, Hogeveen M, Straatman HMPM, van Lingen RA. Defining small-for-gestational-age: prescriptive versus descriptive birthweight standards. Eur J Pediatr 2016; 175:1047-57. [PMID: 27255904 DOI: 10.1007/s00431-016-2740-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/01/2016] [Accepted: 05/25/2016] [Indexed: 01/08/2023]
Abstract
UNLABELLED Descriptive population-based birthweight standards possess low sensitivity in detecting infants with growth impairment. A prescriptive birthweight standard based on a 'healthy' subpopulation without risk factors for intrauterine growth restriction might be superior. We created two birthweight standards based on live born, singleton infants with gestational age 24-42 weeks and born in The Netherlands between 2000 and 2007. Inclusion criteria for the prescriptive birthweight standard were restricted to infants without congenital malformations, born to healthy mothers after uncomplicated pregnancies. We defined small-for-gestational-age (SGA) as birthweight <10th percentile and assessed the ability of both standards to predict adverse neonatal outcomes. The prescriptive birthweight standard identified significantly more infants as SGA, up to 38.0 % at 29 weeks gestation. SGA infants classified according to both standards as well as those classified according to the prescriptive birthweight standard only, were at increased risk of both major and minor adverse neonatal outcomes. The prescriptive birthweight standard was both more sensitive and less specific, with a maximum increase in sensitivity predicting bronchopulmonary dysplasia (+42.6 %) and a maximum decrease in specificity predicting intraventricular haemorrhage (-26.9 %) in infants aged 28-31 weeks. CONCLUSION Prescriptive birthweight standards could improve identification of infants born SGA and at risk of adverse neonatal outcomes. WHAT IS KNOWN • Descriptive birthweight standards possess low sensitivity in detecting growth restricted infants at risk of adverse neonatal outcomes. • Prescriptive standards could improve identification of very preterm small-for-gestational-age (SGA) infants at risk of intraventricular haemorrhage. What is New: • Prescriptive standards identify more preterm and term SGA infants at risk of major adverse neonatal outcomes. • Late preterm and term SGA infants classified according to the prescriptive standard are at increased risk of minor adverse neonatal outcomes with potentially harmful implications.
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Affiliation(s)
- Liset Hoftiezer
- Princess Amalia Department of Paediatrics, Department of Neonatology, P.O. Box 10400, 8000 GK, Isala, Zwolle, The Netherlands.
| | | | - Marije Hogeveen
- Amalia Children's Hospital, Department of Neonatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Richard A van Lingen
- Princess Amalia Department of Paediatrics, Department of Neonatology, P.O. Box 10400, 8000 GK, Isala, Zwolle, The Netherlands
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Belihu FB, Davey MA, Small R. Perinatal health outcomes of East African immigrant populations in Victoria, Australia: a population based study. BMC Pregnancy Childbirth 2016; 16:86. [PMID: 27113930 PMCID: PMC4845379 DOI: 10.1186/s12884-016-0886-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/21/2016] [Indexed: 11/25/2022] Open
Abstract
Background Sub-Saharan African women are often treated as a single group in epidemiological studies of immigrant birth outcomes, potentially masking variations across countries. Methods Cross-sectional population-based study of 432,567 singleton births in Victoria, Australia comparing mothers born in one of four East African countries (453 Eritreans, 1094 Ethiopians, 1,861 Somali and 1,404 Sudanese) relative to 427,755 Australian-born women was conducted using the Victorian Perinatal Data Collection. Pearson’s chi-square test and logistic regression analyses were performed to investigate disparities and estimate risks of perinatal mortality and other adverse perinatal outcomes after adjustment for confounders selected a priori. Results Compared with mothers born in Australia, East African immigrants as a group had elevated odds of perinatal mortality (ORadj1.83, 95 % CI 1.47, 2.28), small for gestational age births (SGA) (ORadj1.59 95 % CI 1.46, 1.74), very low birthweight (ORadj1.33, 95 % CI 1.11, 1.58) and very preterm birth (ORadj1.55, 95 % CI 1.27, 1.90). However, they had lower odds of preterm birth (ORadj0.86 95 % CI 0.76, 0.98) and macrosomia (ORadj0.65 95 % CI 0.51, 0.83). Individual country of birth analyses indicated significant variations, with Eritrean women having higher odds of very low birthweight (ORadj1.80, 95 % CI 1.09, 2.98), very preterm birth (ORadj 1.96, 95 % CI 1.08, 3.58), small for gestational age births (ORadj 1.52, 95 % CI 1.14, 2.03) and perinatal mortality (ORadj 2.69, 95 % CI 1.47, 4.91). Sudanese women had higher odds of low birthweight (ORadj 1.36, 95 % CI 1.10, 1.68), very low birthweight (ORadj 1.53, 95 % CI 1.13, 2.07), very preterm birth (ORadj 1.78, 95 % CI 1.26, 2.53), small for gestational age births (ORadj 2.13, 95 % CI 1.84, 2.47) and perinatal mortality (ORadj 2.10, 95 % CI 1.44, 3.07)]. Ethiopian women differed from Australian-born women only in relation to higher odds of very preterm birth, (ORadj1.70 95 % CI 1.16, 2.50), and only Somali-women had significantly lower odds of preterm birth (ORadj0.70 95 % CI 0.56, 0.88). Conclusions Overall, East African countries of birth were associated with increased perinatal death and some adverse perinatal outcomes; suggesting the need for strategies to enhance surveillance and health care delivery for these women. Analysis by individual country of birth groups has shown women from Eritrea and Sudan are particularly at increased risk of adverse outcomes, demonstrating the importance of antenatal identification of maternal country of birth. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0886-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fetene B Belihu
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia.
| | - Mary-Ann Davey
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia.,Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia
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Ghi T, Cariello L, Rizzo L, Ferrazzi E, Periti E, Prefumo F, Stampalija T, Viora E, Verrotti C, Rizzo G. Customized Fetal Growth Charts for Parents' Characteristics, Race, and Parity by Quantile Regression Analysis: A Cross-sectional Multicenter Italian Study. JOURNAL OF ULTRASOUND IN MEDICINE 2016; 35:83-92. [PMID: 26643757 DOI: 10.7863/ultra.15.03003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/27/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The purpose of this study was to construct fetal biometric charts between 16 and 40 weeks' gestation that were customized for parental characteristics, race, and parity, using quantile regression analysis. METHODS In a multicenter cross-sectional study, 8070 sonographic examinations from low-risk pregnancies between 16 and 40 weeks' gestation were analyzed. The fetal measurements obtained were biparietal diameter, head circumference, abdominal circumference, and femur diaphysis length. Quantile regression was used to examine the impact of parental height and weight, parity, and race across biometric percentiles for the fetal measurements considered. RESULTS Paternal and maternal height were significant covariates for all of the measurements considered (P < .05). Maternal weight significantly influenced head circumference, abdominal circumference, and femur diaphysis length. Parity was significantly associated with biparietal diameter and head circumference. Central African race was associated with head circumference and femur diaphysis length, whereas North African race was only associated with femur diaphysis length. CONCLUSIONS In this study we constructed customized biometric growth charts using quantile regression in a large cohort of low-risk pregnancies. These charts offer the advantage of defining individualized normal ranges of fetal biometric parameters at each specific percentile corrected for parental height and weight, parity, and race. This study supports the importance of including these variables in routine sonographic screening for fetal growth abnormalities.
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Affiliation(s)
- Tullio Ghi
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy (T.G., C.V.); Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy (L.C.); Operations Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts USA (L.R.); Department of Obstetrics and Gynecology, University of Milan, Buzzi Children's Hospital, Milan, Italy (E.F.); Department of Obstetrics and Gynecology, Presidio Ospedaliero Firenze, Centro Piero Palagi, Florence, Italy (E.P.); Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy (F.P.); Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy (T.S.); Department of Obstetrics and Gynecology, Sant'Anna Hospital, Torino, Italy (E.V.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
| | - Luisa Cariello
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy (T.G., C.V.); Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy (L.C.); Operations Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts USA (L.R.); Department of Obstetrics and Gynecology, University of Milan, Buzzi Children's Hospital, Milan, Italy (E.F.); Department of Obstetrics and Gynecology, Presidio Ospedaliero Firenze, Centro Piero Palagi, Florence, Italy (E.P.); Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy (F.P.); Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy (T.S.); Department of Obstetrics and Gynecology, Sant'Anna Hospital, Torino, Italy (E.V.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
| | - Ludovica Rizzo
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy (T.G., C.V.); Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy (L.C.); Operations Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts USA (L.R.); Department of Obstetrics and Gynecology, University of Milan, Buzzi Children's Hospital, Milan, Italy (E.F.); Department of Obstetrics and Gynecology, Presidio Ospedaliero Firenze, Centro Piero Palagi, Florence, Italy (E.P.); Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy (F.P.); Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy (T.S.); Department of Obstetrics and Gynecology, Sant'Anna Hospital, Torino, Italy (E.V.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
| | - Enrico Ferrazzi
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy (T.G., C.V.); Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy (L.C.); Operations Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts USA (L.R.); Department of Obstetrics and Gynecology, University of Milan, Buzzi Children's Hospital, Milan, Italy (E.F.); Department of Obstetrics and Gynecology, Presidio Ospedaliero Firenze, Centro Piero Palagi, Florence, Italy (E.P.); Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy (F.P.); Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy (T.S.); Department of Obstetrics and Gynecology, Sant'Anna Hospital, Torino, Italy (E.V.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
| | - Enrico Periti
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy (T.G., C.V.); Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy (L.C.); Operations Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts USA (L.R.); Department of Obstetrics and Gynecology, University of Milan, Buzzi Children's Hospital, Milan, Italy (E.F.); Department of Obstetrics and Gynecology, Presidio Ospedaliero Firenze, Centro Piero Palagi, Florence, Italy (E.P.); Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy (F.P.); Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy (T.S.); Department of Obstetrics and Gynecology, Sant'Anna Hospital, Torino, Italy (E.V.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
| | - Federico Prefumo
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy (T.G., C.V.); Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy (L.C.); Operations Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts USA (L.R.); Department of Obstetrics and Gynecology, University of Milan, Buzzi Children's Hospital, Milan, Italy (E.F.); Department of Obstetrics and Gynecology, Presidio Ospedaliero Firenze, Centro Piero Palagi, Florence, Italy (E.P.); Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy (F.P.); Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy (T.S.); Department of Obstetrics and Gynecology, Sant'Anna Hospital, Torino, Italy (E.V.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
| | - Tamara Stampalija
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy (T.G., C.V.); Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy (L.C.); Operations Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts USA (L.R.); Department of Obstetrics and Gynecology, University of Milan, Buzzi Children's Hospital, Milan, Italy (E.F.); Department of Obstetrics and Gynecology, Presidio Ospedaliero Firenze, Centro Piero Palagi, Florence, Italy (E.P.); Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy (F.P.); Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy (T.S.); Department of Obstetrics and Gynecology, Sant'Anna Hospital, Torino, Italy (E.V.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
| | - Elsa Viora
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy (T.G., C.V.); Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy (L.C.); Operations Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts USA (L.R.); Department of Obstetrics and Gynecology, University of Milan, Buzzi Children's Hospital, Milan, Italy (E.F.); Department of Obstetrics and Gynecology, Presidio Ospedaliero Firenze, Centro Piero Palagi, Florence, Italy (E.P.); Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy (F.P.); Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy (T.S.); Department of Obstetrics and Gynecology, Sant'Anna Hospital, Torino, Italy (E.V.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
| | - Carla Verrotti
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy (T.G., C.V.); Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy (L.C.); Operations Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts USA (L.R.); Department of Obstetrics and Gynecology, University of Milan, Buzzi Children's Hospital, Milan, Italy (E.F.); Department of Obstetrics and Gynecology, Presidio Ospedaliero Firenze, Centro Piero Palagi, Florence, Italy (E.P.); Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy (F.P.); Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy (T.S.); Department of Obstetrics and Gynecology, Sant'Anna Hospital, Torino, Italy (E.V.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy (T.G., C.V.); Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy (L.C.); Operations Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts USA (L.R.); Department of Obstetrics and Gynecology, University of Milan, Buzzi Children's Hospital, Milan, Italy (E.F.); Department of Obstetrics and Gynecology, Presidio Ospedaliero Firenze, Centro Piero Palagi, Florence, Italy (E.P.); Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy (F.P.); Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy (T.S.); Department of Obstetrics and Gynecology, Sant'Anna Hospital, Torino, Italy (E.V.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.).
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Li Z, Umstad MP, Hilder L, Xu F, Sullivan EA. Australian national birthweight percentiles by sex and gestational age for twins, 2001-2010. BMC Pediatr 2015; 15:148. [PMID: 26450410 PMCID: PMC4599725 DOI: 10.1186/s12887-015-0464-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/25/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Birthweight remains one of the strongest predictors of perinatal mortality and disability. Birthweight percentiles form a reference that allows the detection of neonates at higher risk of neonatal and postneonatal morbidity. The aim of the study is to present updated national birthweight percentiles by gestational age for male and female twins born in Australia. METHODS Population data were extracted from the Australian National Perinatal Data Collection for twins born in Australia between 2001 and 2010. A total of 43,833 women gave birth to 87,666 twins in Australia which were included in the study analysis. Implausible birthweights were excluded using Tukey's methodology based on the interquartile range. Univariate analysis was used to examine the birthweight percentiles for liveborn twins born between 20 and 42 weeks gestation. RESULTS Birthweight percentiles by gestational age were calculated for 85,925 live births (43,153 males and 42,706 females). Of these infants, 53.6% were born preterm (birth before 37 completed weeks of gestation) while 50.2% were low birthweight (<2500 g) and 8.7% were very low birthweight (<1500 g). The mean birthweight decreased from 2462 g in 2001 to 2440 g in 2010 for male twins, compared with 2485 g in 1991-94. For female twins, the mean birthweight decreased from 2375 g in 2001 to 2338 g in 2010, compared with 2382 g in 1991-94. CONCLUSIONS The birthweight percentiles provide clinicians and researchers with up-to-date population norms of birthweight percentiles for twins in Australia.
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Affiliation(s)
- Zhuoyang Li
- Faculty of Health, University of Technology Sydney, Sydney, Australia.
- National Perinatal Epidemiology and Statistics Units, University of New South Wales, Sydney, Australia.
| | - Mark P Umstad
- The Royal Women's Hospital, Melbourne, Australia.
- The University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Australia.
| | - Lisa Hilder
- National Perinatal Epidemiology and Statistics Units, University of New South Wales, Sydney, Australia.
| | - Fenglian Xu
- Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - Elizabeth A Sullivan
- Faculty of Health, University of Technology Sydney, Sydney, Australia.
- National Perinatal Epidemiology and Statistics Units, University of New South Wales, Sydney, Australia.
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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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White SW, Marsh JA, Lye SJ, Briollais L, Newnham JP, Pennell CE. Improving customized fetal biometry by longitudinal modelling. J Matern Fetal Neonatal Med 2015; 29:1888-94. [PMID: 26169714 DOI: 10.3109/14767058.2015.1070139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To develop customized biometric charts to better define abnormal fetal growth. METHODS A total of 1056 singleton fetuses from the Raine Study underwent serial ultrasound biometry (abdominal circumference [AC], head circumference, and femur length) at 18, 24, 28, 34, and 38 weeks' gestation. Customized biometry trajectories were developed adjusting for epidemiological influences upon fetal biometry using covariates available at 18 weeks gestation. Prediction accuracy (areas under the receiver operating characteristic curve [AUC] and 95% confidence interval [95%CI]) was evaluated by repeated random sub-sampling cross-validation methodology. RESULTS The model for derived estimated fetal weight (EFW) performed well for EFW less than 10th predicted percentile (AUC = 0.695, 95%CI, 0.692-0.699) and EFW greater than 90th predicted percentile (AUC = 0.705, 95%CI, 0.702-0.708). Fetal AC was also well predicted for growth restriction (AUC = 0.789, 95%CI, 0.784-0.794) and macrosomia (AUC = 0.796, 95%CI, 0.793-0.799). Population-derived, sex-specific charts misclassified 7.9% of small fetuses and 10.7% of large fetuses as normal. Conversely, 9.2% of those classified as abnormally grown by population-derived charts were considered normal by customized charts, potentially leading to complications of unnecessary intervention. CONCLUSIONS Customized fetal biometric charts may offer improved ability for clinicians to detect deviations from optimal fetal growth and influence pregnancy management.
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Affiliation(s)
- Scott W White
- a School of Women's and Infants' Health, The University of Western Australia , Perth , Western Australia , Australia .,b Women and Infants Research Foundation, King Edward Memorial Hospital , Perth , Western Australia , Australia .,c Maternal Fetal Medicine Service, King Edward Memorial Hospital , Perth , Western Australia , Australia
| | - Julie A Marsh
- d School of Mathematics and Statistics, The University of Western Australia , Perth , Western Australia , Australia , and
| | - Stephen J Lye
- e Samuel Lunenfeld Research Institute, Mt Sinai Medical Centre, The University of Toronto , Toronto , Ontario , Canada
| | - Laurent Briollais
- e Samuel Lunenfeld Research Institute, Mt Sinai Medical Centre, The University of Toronto , Toronto , Ontario , Canada
| | - John P Newnham
- a School of Women's and Infants' Health, The University of Western Australia , Perth , Western Australia , Australia .,b Women and Infants Research Foundation, King Edward Memorial Hospital , Perth , Western Australia , Australia .,c Maternal Fetal Medicine Service, King Edward Memorial Hospital , Perth , Western Australia , Australia
| | - Craig E Pennell
- a School of Women's and Infants' Health, The University of Western Australia , Perth , Western Australia , Australia .,b Women and Infants Research Foundation, King Edward Memorial Hospital , Perth , Western Australia , Australia .,c Maternal Fetal Medicine Service, King Edward Memorial Hospital , Perth , Western Australia , Australia
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41
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Affiliation(s)
- Jan E. Dickinson
- Australian and New Zealand Journal of Obstetrics and Gynaecology; School of Women's and Infants' Health; The University of Western Australia; Perth Western Australia Australia
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Poulain C, Duhamel A, Garabedian C, Cazaubiel M, Rejou MC, Vambergue A, Deruelle P. Outcome of twin pregnancies associated with glucose intolerance. DIABETES & METABOLISM 2015; 41:387-92. [PMID: 25636580 DOI: 10.1016/j.diabet.2014.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/07/2014] [Accepted: 12/08/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVES There is little information about the impact of hyperglycaemia in twin pregnancies. The objective of our study was to evaluate the maternal, foetal and neonatal complications in patients with twin pregnancy and glucose intolerance defined by gestational diabetes mellitus and gestational mild hyperglycaemia. STUDY DESIGN We performed a single-centre retrospective study. Screening for gestational diabetes was achieved by a two-step method. Patients were managed according to the French guidelines. After matching for age and body mass index, outcomes were compared in 177 patients with glucose intolerance and 509 controls. Macrosomia was defined as birth weight above the 90th percentile of gestational age adjusted for parity, foetal sex and maternal biometrics. RESULTS Prevalence of glucose intolerance was 17.5% in our population. Complications of pregnancy and mode of delivery were similar between the two groups. Caesarean section was associated with age >35 years, vascular complications of pregnancy and non-cephalic presentation of the first twin. Rate of macrosomia was not different between the two groups. The only risk factor for macrosomia was a history of macrosomia in a previous pregnancy (odds ratio = 5.9, 95% confidence interval = 1.8-19.2). CONCLUSION Twin pregnancies complicated by glucose intolerance were not associated with an increased risk of macrosomia or Caesarean section. Further studies should assess the value of screening gestational diabetes mellitus in twin pregnancies.
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Affiliation(s)
- C Poulain
- GEM-JDF Project, Pôle femme, mère, nouveau-né, Maternité Jeanne-de-Flandre, CHRU de Lille, Lille, France
| | - A Duhamel
- Department of biostatistics, EA2694, Faculté de médecine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, Lille, France
| | - C Garabedian
- GEM-JDF Project, Pôle femme, mère, nouveau-né, Maternité Jeanne-de-Flandre, CHRU de Lille, Lille, France; UPRES EA 4489, Environnement périnatal et croissance, Faculté de médecine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, Lille, France
| | - M Cazaubiel
- Pôle médico-chirurgical, Hôpital Huriez, CHRU de Lille, Lille, France
| | - M C Rejou
- Pôle médico-chirurgical, Hôpital Huriez, CHRU de Lille, Lille, France
| | - A Vambergue
- Pôle médico-chirurgical, Hôpital Huriez, CHRU de Lille, Lille, France; UPRES EA 4489, Environnement périnatal et croissance, Faculté de médecine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, Lille, France
| | - P Deruelle
- GEM-JDF Project, Pôle femme, mère, nouveau-né, Maternité Jeanne-de-Flandre, CHRU de Lille, Lille, France; UPRES EA 4489, Environnement périnatal et croissance, Faculté de médecine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, Lille, France.
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MacDonald TM, McCarthy EA, Walker SP. Shining light in dark corners: diagnosis and management of late-onset fetal growth restriction. Aust N Z J Obstet Gynaecol 2015; 55:3-10. [PMID: 25557743 DOI: 10.1111/ajo.12264] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 08/25/2014] [Indexed: 12/01/2022]
Abstract
Fetal growth restriction (FGR) is the single biggest risk factor for stillbirth. In the absence of any effective treatment for fetal growth restriction, the mainstay of management is close surveillance and timely delivery. While such statements are almost self-evident, the daily clinical challenge of late-onset fetal growth restriction remains; the competing priorities of minimising stillbirth risk, while avoiding excessive obstetric intervention and the neonatal sequelae of iatrogenic preterm birth. This dilemma is made harder because the tools for late-onset FGR diagnosis and surveillance compare poorly to those used in early-onset FGR; screening tests in early pregnancy have limited predictive value; most cases escape clinical detection, a phenomenon set to worsen given the obesity epidemic; there is a failure of consensus on the definition of small for gestational age, and ancillary tools, such as umbilical artery Doppler--of value in identification of preterm FGR--are less useful in the late-preterm period and at term. Most importantly, the problem is common; 96% of all births occur after 32 weeks. This means a poor noise/signal ratio of any test or management algorithm will inevitably have large clinical consequences. Into such a dark corner, we cast some light; a summary on diagnostic criteria, new developments to improve the diagnosis of late-onset FGR and a suggested approach to management.
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Affiliation(s)
- Teresa M MacDonald
- The Northern Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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Gaillard R, Jaddoe VWV. Assessment of fetal growth by customized growth charts. ANNALS OF NUTRITION AND METABOLISM 2014; 65:149-55. [PMID: 25413653 DOI: 10.1159/000361055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Customized fetal growth charts take account of the individual variation in the fetal growth potential based on non-pathological maternal and fetal characteristics. Application of these customized weight charts might improve the distinction between pathological growth-restricted fetuses and fetuses that are small but have reached their growth potential. Current models for customized growth standards have been based on birth weight and fetal growth data. Variables used for customization are gestational age, maternal age, parity, ethnicity, height, weight and fetal sex. Thus far, it remains controversial whether these maternal and fetal characteristics used for customization are strong enough predictors for fetal growth on an individual level and are truly physiological characteristics. The currently available customized growth charts might be of benefit for use in epidemiological studies and clinical practice. Further studies are needed to validate these customized growth models and to examine whether and to what extend they improve identification of children that are at risk for morbidity in the perinatal period and later in life.
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Affiliation(s)
- Romy Gaillard
- The Generation R Study Group and Departments of Epidemiology and Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
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45
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Regnault N, Gillman MW. Importance of characterizing growth trajectories. ANNALS OF NUTRITION & METABOLISM 2014; 65:110-3. [PMID: 25413648 PMCID: PMC4904831 DOI: 10.1159/000365893] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In the era of the obesity epidemic in children, characterizing childhood growth trajectories (weight, length/height, or body mass index/weight for length) is becoming essential for surveillance. Clinicians routinely use growth curves to identify abnormal growth trajectories. Clinical epidemiologists are interested in both the determinants of growth and the consequences of certain patterns of growth on later health and diseases. Characterizing growth trajectories is also helpful to predict future growth based on past growth and might be useful in the future to compare the impact of various interventions.
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Affiliation(s)
- Nolwenn Regnault
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Mass., USA
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Wentz AE, Messer LC, Nguyen T, Boone-Heinonen J. Small and large size for gestational age and neighborhood deprivation measured within increasing proximity to homes. Health Place 2014; 30:98-106. [PMID: 25240489 DOI: 10.1016/j.healthplace.2014.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 08/04/2014] [Accepted: 08/21/2014] [Indexed: 11/28/2022]
Abstract
Neighborhood deprivation is consistently associated with greater risk of low birthweight. However, large birth size is increasingly relevant but overlooked in neighborhood health research, and proximity within which neighborhood deprivation may affect birth outcomes is unknown. We estimated race/ethnic-specific effects of neighborhood deprivation index (NDI) within 1, 3, 5, and 8km buffers around Oregon Pregnancy Risk Assessment Monitoring System (n=3716; 2004-2007) respondents׳ homes on small and large for gestational age (SGA, LGA). NDI was positively associated with LGA and SGA in most race/ethnic groups. The results varied little across the four buffer sizes.
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Affiliation(s)
- Anna E Wentz
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA; Population Studies Center, University of Michigan Institute for Social Research, 426 Thompson Street, Ann Arbor, MI, 48104, USA.
| | - Lynne C Messer
- Portland State University, Community Health - Urban & Public Affairs (SCH), PO Box 751, Portland, OR 97207, USA.
| | - Thuan Nguyen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA.
| | - Janne Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA.
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One size does not fit all: differences in newborn weight among mothers of Philippine and other East Asian origin. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 34:1026-1037. [PMID: 23231840 DOI: 10.1016/s1701-2163(16)35432-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the likelihood that infants born to Filipina, other East Asian, and Canadian-born women may be misclassified as small for gestational age when using conventional Canadian birth weight curves rather than those specific to their world region. METHODS We conducted a population-based study of 548 418 singleton live births in Ontario between 2002 and 2007. Smoothed birth weight percentile curves were generated for males and females born to women from Canada, the Philippines, and the rest of East Asia/Pacific. We determined the likelihood of misclassifying an infant as small for gestational age (SGA < 10th percentile weight) or large for gestational age (LGA ≥ 90th percentile weight) on a Canadian-born birth weight curve vs. a curve specific to the other two world regions. RESULTS For gestation-specific 10th and 50th percentiles, term infants born to women from the Philippines often had significantly lower birth weights than infants of Canadian-born mothers. Controlling for maternal age and parity, approximately 88 per 1000 male newborns (95% CI 82 to 95) and 72 per 1000 female newborns (95% CI 54 to 60) of mothers from the Philippines were at risk of being misclassified as SGA. LGA would be missed in approximately 54 per 1000 male newborns (95% CI 49 to 59) and 49 per 1000 female newborns (95% CI 44 to 54) of Filipina mothers. Misclassification of both SGA and LGA was more pronounced among infants of Filipina mothers than of mothers from other East Asian origin. CONCLUSIONS Infants of mothers born in the Philippines weigh significantly less than those of Canadian-born women or mothers emigrating from other East Asian countries. Those who use birth weight curves should consider these differences.
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Dai L, Deng C, Li Y, Zhu J, Mu Y, Deng Y, Mao M, Wang Y, Li Q, Ma S, Ma X, Zhang Y. Birth weight reference percentiles for Chinese. PLoS One 2014; 9:e104779. [PMID: 25127131 PMCID: PMC4134219 DOI: 10.1371/journal.pone.0104779] [Citation(s) in RCA: 215] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/16/2014] [Indexed: 12/12/2022] Open
Abstract
Objective To develop a reference of population-based gestational age-specific birth weight percentiles for contemporary Chinese. Methods Birth weight data was collected by the China National Population-based Birth Defects Surveillance System. A total of 1,105,214 live singleton births aged ≥28 weeks of gestation without birth defects during 2006–2010 were included. The lambda-mu-sigma method was utilized to generate percentiles and curves. Results Gestational age-specific birth weight percentiles for male and female infants were constructed separately. Significant differences were observed between the current reference and other references developed for Chinese or non-Chinese infants. Conclusion There have been moderate increases in birth weight percentiles for Chinese infants of both sexes and most gestational ages since 1980s, suggesting the importance of utilizing an updated national reference for both clinical and research purposes.
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Affiliation(s)
- Li Dai
- National Center for Birth Defects Monitoring, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Obstetrics & Gynecology and Pediatric Diseases and Birth Defects of the Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China
- * E-mail: (LD); (YZ)
| | - Changfei Deng
- National Center for Birth Defects Monitoring, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Yanhua Li
- Obstetric and Gynecologic Department, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Jun Zhu
- National Center for Birth Defects Monitoring, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Obstetrics & Gynecology and Pediatric Diseases and Birth Defects of the Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Yi Mu
- National Center for Birth Defects Monitoring, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Ying Deng
- National Center for Birth Defects Monitoring, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Obstetrics & Gynecology and Pediatric Diseases and Birth Defects of the Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Meng Mao
- Key Laboratory of Obstetrics & Gynecology and Pediatric Diseases and Birth Defects of the Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Yanping Wang
- National Center for Birth Defects Monitoring, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Qi Li
- National Center for Birth Defects Monitoring, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Shuangge Ma
- Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Xiaomei Ma
- Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Yawei Zhang
- Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
- * E-mail: (LD); (YZ)
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Sørbye IK, Daltveit AK, Sundby J, Vangen S. Preterm subtypes by immigrants' length of residence in Norway: a population-based study. BMC Pregnancy Childbirth 2014; 14:239. [PMID: 25048200 PMCID: PMC4223612 DOI: 10.1186/1471-2393-14-239] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/18/2014] [Indexed: 11/25/2022] Open
Abstract
Background The reduction of the preterm delivery (PTD) rate is a maternal and child health target. Elevated rates have been found among several immigrant groups, but few studies have distinguished between PTD according to the mode of birth start. In addition, migrants’ birth outcomes have further been shown to be affected by the time in residence; however, the association to PTD subtypes has not previously been assessed. In this study we examined if the risk of spontaneous and non-spontaneous, or iatrogenic, PTD among immigrants in Norway varied according to the length of residence and the country of birth, and compared with the risks among the majority population. Methods We linked population-based birth and immigration data for 40 709 singletons born to immigrant women from Iraq, Pakistan, the Philippines, Somalia, Sri Lanka and Vietnam and 868 832 singletons born to non-immigrant women from 1990–2009. Associations between the length of residence and subtypes of PTD were estimated as relative risks (RRs) with 95% confidence intervals (CIs) from multivariable models. Results In total, 48 191 preterm births occurred. Both spontaneous and non-spontaneous PTD rates were higher among immigrants (4.8% and 2.0%) than among non-immigrants (3.6% and 1.6%). Only non-spontaneous PTD was associated with longer lengths of residence (p trend <0.001). Recent immigrants (<5 years of residence) and non-immigrants had a similar risk of non-spontaneous PTD, whereas immigrants with lengths of residence of 5–9 years, 10–14 years and ≥15 years had adjusted RRs of 1.18 [95% CI 1.03,1.35], 1.43 [95% CI 1.20,1.71] and 1.66 [95% CI 1.41,1.96]. The association was reduced after further adjustments for maternal and infant morbidity. Conversely, the risk of spontaneous PTD among immigrants was not mitigated by length of residence, but varied with country of birth according to the duration of pregnancy in term births. Conclusions Non-spontaneous PTD increased with the length of residence whereas spontaneous PTD remained elevated regardless of the length of residence. Policies to improve birth outcomes in ethnically mixed populations should address the modifiable causes of PTD rather than aiming to reduce absolute PTD rates.
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Affiliation(s)
- Ingvil K Sørbye
- Norwegian Resource Centre for Women's Health, Women and Children's Division, Oslo University Hospital, P,O, Box 4950 Nydalen, Oslo 0424, Norway.
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Talge NM, Mudd LM, Sikorskii A, Basso O. United States birth weight reference corrected for implausible gestational age estimates. Pediatrics 2014; 133:844-53. [PMID: 24777216 DOI: 10.1542/peds.2013-3285] [Citation(s) in RCA: 221] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To provide an updated US birth weight for gestational age reference corrected for likely errors in last menstrual period (LMP)-based gestational age dating, as well as means and SDs, to enable calculation of continuous and categorical measures of birth weight for gestational age. METHODS From the 2009-2010 US live birth files, we abstracted singleton births between 22 and 44 weeks of gestation with at least 1 nonmissing estimate of gestational age (ie, LMP or obstetric/clinical) and birth weight. Using an algorithm based on birth weight and the concordance between these gestational age estimates, implausible LMP-based gestational age estimates were either excluded or corrected by using the obstetric/clinical estimate. Gestational age- and sex-specific birth weight means, SDs, and smoothed percentiles (3rd, 5th, 10th, 90th, 95th, 97th) were calculated, and the 10th and 90th percentiles were compared with published population-based references. RESULTS A total of 7 818 201 (99% of eligible) births were included. The LMP-based estimate of gestational age comprised 85% of the dataset, and the obstetric/clinical estimate comprised the remaining 15%. Cut points derived from the current reference identified ∼10% of births as ≤10th and ≥90th percentiles at all gestational weeks, whereas cut points derived from previous US-based references captured variable proportions of infants at these thresholds within the preterm and postterm gestational age ranges. CONCLUSIONS This updated US-based birth weight for gestational age reference corrects for likely errors in gestational age dating and allows for the calculation of categorical and continuous measures of birth size.
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Affiliation(s)
| | | | - Alla Sikorskii
- Statistics and Probability, Michigan State University, East Lansing, Michigan; and
| | - Olga Basso
- Departments of Obstetrics and Gynecology, and Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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