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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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Saw SN, Lim MC, Liew CN, Ahmad Kamar A, Sulaiman S, Saaid R, Loo CK. The accuracy of international and national fetal growth charts in detecting small-for-gestational-age infants using the Lambda-Mu-Sigma method. Front Surg 2023; 10:1123948. [PMID: 37114151 PMCID: PMC10126230 DOI: 10.3389/fsurg.2023.1123948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/28/2023] [Indexed: 04/29/2023] Open
Abstract
Objective To construct a national fetal growth chart using retrospective data and compared its diagnostic accuracy in predicting SGA at birth with existing international growth charts. Method This is a retrospective study where datasets from May 2011 to Apr 2020 were extracted to construct the fetal growth chart using the Lambda-Mu-Sigma method. SGA is defined as birth weight <10th centile. The local growth chart's diagnostic accuracy in detecting SGA at birth was evaluated using datasets from May 2020 to Apr 2021 and was compared with the WHO, Hadlock, and INTERGROWTH-21st charts. Balanced accuracy, sensitivity, and specificity were reported. Results A total of 68,897 scans were collected and five biometric growth charts were constructed. Our national growth chart achieved an accuracy of 69% and a sensitivity of 42% in identifying SGA at birth. The WHO chart showed similar diagnostic performance as our national growth chart, followed by the Hadlock (67% accuracy and 38% sensitivity) and INTERGROWTH-21st (57% accuracy and 19% sensitivity). The specificities for all charts were 95-96%. All growth charts showed higher accuracy in the third trimester, with an improvement of 8-16%, as compared to that in the second trimester. Conclusion Using the Hadlock and INTERGROWTH-21st chart in the Malaysian population may results in misdiagnose of SGA. Our population local chart has slightly higher accuracy in predicting preterm SGA in the second trimester which can enable earlier intervention for babies who are detected as SGA. All growth charts' diagnostic accuracies were poor in the second trimester, suggesting the need of improvising alternative techniques for early detection of SGA to improve fetus outcomes.
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Affiliation(s)
- Shier Nee Saw
- Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mei Cee Lim
- Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chuan Nyen Liew
- Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Azanna Ahmad Kamar
- Department of Paediatrics, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sofiah Sulaiman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rahmah Saaid
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chu Kiong Loo
- Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, Universiti Malaya, Kuala Lumpur, Malaysia
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Verspyck E, Gascoin G, Senat MV, Ego A, Simon L, Guellec I, Monier I, Zeitlin J, Subtil D, Vayssiere C. [Ante- and postnatal growth charts in France - guidelines for clinical practice from the Collège national des gynécologues et obstétriciens français (CNGOF) and from the Société française de néonatologie (SFN)]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:570-584. [PMID: 35781088 DOI: 10.1016/j.gofs.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To recommend the most appropriate biometric charts for the detection of antenatal growth abnormalities and postnatal growth surveillance. METHODS Elaboration of specific questions and selection of experts by the organizing committee to answer these questions; analysis of the literature by experts and drafting conclusions by assigning a recommendation (strong or weak) and a quality of evidence (high, moderate, low, very low) and for each question; all these recommendations have been subject to multidisciplinary external review (obstetrician gynecologists, pediatricians). The objective for the reviewers was to verify the completeness of the literature review, to verify the levels of evidence established and the consistency and applicability of the resulting recommendations. The overall review of the literature, quality of evidence and recommendations were revised to take into consideration comments from external reviewers. RESULTS Antenatally, it is recommended to use all WHO fetal growth charts for EFW and common ultrasound biometric measurements (strong recommendation; low quality of evidence). Indeed, in comparison with other prescriptive curves and descriptive curves, the WHO prescriptive charts show better performance for the screening of SGA (Small for Gestational Age) and LGA (Large for Gestational Age) with adequate proportions of fetuses screened at extreme percentiles in the French population. It also has the advantages of having EFW charts by sex and biometric parameters obtained from the same perspective cohort of women screened by qualified sonographers who measured the biometric parameters according to international standards. Postnatally, it is recommended to use the updated Fenton charts for the assessment of birth measurements and for growth monitoring in preterm infants (strong recommendation; moderate quality of evidence) and for the assessment of birth measurements in term newborn (expert opinion). CONCLUSION It is recommended to use WHO fetal growth charts for antenatal growth monitoring and Fenton charts for the newborn.
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Affiliation(s)
- E Verspyck
- Service de gynécologie-obstétrique, CHU de Rouen, université de Rouen, Rouen, France.
| | - G Gascoin
- Service de néonatologie, CHU de Toulouse, université de Toulouse, hôpital des enfants, Toulouse, France
| | - M-V Senat
- Service de gynécologie-obstétrique, CHU du Kremlin-Bicêtre, université du Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - A Ego
- Pôle santé publique, CHU de Grenoble-Alpes, Grenoble, France
| | - L Simon
- Service de néonatologie, CHU de Nantes, université de Nantes, Nantes, France
| | - I Guellec
- Service de néonatologie, CHU de Nice, université de Nice, Nice, France
| | - I Monier
- Inserm UMR1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), CRESS, Sorbonne Paris-Cité, Paris, France; Service de gynécologie-obstétrique, université Paris Saclay, hôpital Antoine-Béclère, AP-HP, Clamart, France
| | - J Zeitlin
- Inserm UMR1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), CRESS, Sorbonne Paris-Cité, Paris, France
| | - D Subtil
- Service de gynécologie-obstétrique, CHU de Lille, université de Lille, Lille, France
| | - C Vayssiere
- Service de gynécologie-obstétrique, CHU de Toulouse, hôpital Paule-de-Viguier, Toulouse, France; Team SPHERE (Study of Perinatal, pediatric and adolescent Health: Epidemiological Research and Evaluation), CERPOP, UMR 1295, Toulouse III University, Toulouse, France
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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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Customized versus Population Growth Standards for Morbidity and Mortality Risk Stratification Using Ultrasonographic Fetal Growth Assessment at 22 to 29 Weeks' Gestation. Am J Perinatol 2021; 38:e46-e56. [PMID: 32198743 PMCID: PMC7537732 DOI: 10.1055/s-0040-1705114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of study is to compare the performance of ultrasonographic customized and population fetal growth standards for prediction adverse perinatal outcomes. STUDY DESIGN This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be, in which l data were collected at visits throughout pregnancy and after delivery. Percentiles were assigned to estimated fetal weights (EFWs) measured at 22 to 29 weeks using the Hadlock population standard and a customized standard (www.gestation.net). Areas under the curve were compared for the prediction of composite and severe composite perinatal morbidity using EFW percentile. RESULTS Among 8,701 eligible study participants, the population standard diagnosed more fetuses with fetal growth restriction (FGR) than the customized standard (5.5 vs. 3.5%, p < 0.001). Neither standard performed better than chance to predict composite perinatal morbidity. Although the customized performed better than the population standard to predict severe perinatal morbidity (areas under the curve: 0.56 vs. 0.54, p = 0.003), both were poor. Fetuses considered FGR by the population standard but normal by the customized standard had morbidity rates similar to fetuses considered normally grown by both standards.The population standard diagnosed FGR among black women and Hispanic women at nearly double the rate it did among white women (p < 0.001 for both comparisons), even though morbidity was not different across racial/ethnic groups. The customized standard diagnosed FGR at similar rates across groups. Using the population standard, 77% of FGR cases were diagnosed among female fetuses even though morbidity among females was lower (p < 0.001). The customized model diagnosed FGR at similar rates in male and female fetuses. CONCLUSION At 22 to 29 weeks' gestation, EFW percentile alone poorly predicts perinatal morbidity whether using customized or population fetal growth standards. The population standard diagnoses FGR at increased rates in subgroups not at increased risk of morbidity and at lower rates in subgroups at increased risk of morbidity, whereas the customized standard does not.
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Choi SKY, Gordon A, Hilder L, Henry A, Hyett JA, Brew BK, Joseph F, Jorm L, Chambers GM. Performance of six birth-weight and estimated-fetal-weight standards for predicting adverse perinatal outcome: a 10-year nationwide population-based study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:264-277. [PMID: 32672406 DOI: 10.1002/uog.22151] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/17/2020] [Accepted: 07/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate three birth-weight (BW) standards (Australian population-based, Fenton and INTERGROWTH-21st ) and three estimated-fetal-weight (EFW) standards (Hadlock, INTERGROWTH-21st and WHO) for classifying small-for-gestational age (SGA) and large-for-gestational age (LGA) and predicting adverse perinatal outcomes in preterm and term babies. METHODS This was a nationwide population-based study conducted on a total of 2.4 million singleton births that occurred from 24 + 0 to 40 + 6 weeks' gestation between 2004 and 2013 in Australia. The performance of the growth charts was evaluated according to SGA and LGA classification, and relative risk (RR) and diagnostic accuracy based on the areas under the receiver-operating-characteristics curves (AUCs) for stillbirth, neonatal death, perinatal death, composite morbidity and a composite of perinatal death and morbidity outcomes. The analysis was stratified according to gestational age at delivery (< 37 + 0 vs ≥ 37 + 0 weeks). RESULTS Following exclusions, 2 392 782 singleton births were analyzed. There were significant differences in the SGA and LGA classification and risk of adverse outcomes between the six BW and EFW standards evaluated. For the term group, compared with the other standards, the INTERGROWTH-21st BW and EFW standards classified half the number of SGA (< 10th centile) babies (3-4% vs 7-11%) and twice the number of LGA (> 90th centile) babies (24-25% vs 8-15%), resulting in a smaller cohort of term SGA at higher risk of adverse outcome and a larger LGA cohort at lower risk of adverse outcome. For term SGA (< 3rd centile) babies, the RR of perinatal death using the two INTERGROWTH-21st standards was up to 1.5-fold higher than those of the other standards (including the WHO-EFW and Hadlock-EFW), while the INTERGROWTH-21st -EFW standard indicated a 12-26% reduced risk of perinatal death for LGA cases across centile thresholds. Conversely, for the preterm group, the WHO-EFW and Hadlock-EFW standards identified a higher SGA classification rate than did the other standards (18-19% vs 10-11%) and a 20-65% increased risk of perinatal death in term LGA babies. All BW and EFW charts had similarly poor performance in predicting adverse outcomes, including the composite outcome (AUC range, 0.49-0.62) for both preterm (AUC range, 0.58-0.62) and term (AUC range, 0.49-0.50) cases and across centiles. Furthermore, specific centile thresholds for identifying adverse outcomes varied markedly by chart between BW and EFW standards. CONCLUSIONS This study addresses the recurrent problem of identifying fetuses at risk of morbidity and perinatal mortality associated with growth disorders and provides new insights into the applicability of international growth standards. Our findings of marked variation in classification and the similarly poor performance of prescriptive international standards and the other commonly used standards raise questions about whether the prescriptive international standards that were constructed for universal adoption are indeed applicable to a multiethnic population such as that of Australia. Thus, caution is needed when adopting universal standards for clinical and epidemiological use. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S K Y Choi
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - A Gordon
- Newborn Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - L Hilder
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - A Henry
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Women's and Children's Health, St George Hospital, Sydney, New South Wales, Australia
| | - J A Hyett
- Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - B K Brew
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - F Joseph
- Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - L Jorm
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - G M Chambers
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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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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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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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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10
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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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11
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Iliodromiti S, Smith GCS, Lawlor DA, Pell JP, Nelson SM. UK stillbirth trends in over 11 million births provide no evidence to support effectiveness of Growth Assessment Protocol program. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:599-604. [PMID: 32266750 DOI: 10.1002/uog.21999] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Use of the Growth Assessment Protocol (GAP) has increased internationally under the assumption that it reduces the stillbirth rate. The evidence for this is limited and based largely on an ecological time-trend study. Discordance in the uptake of the GAP program between Scotland and England/Wales enabled us to assess the assertion that implementation of GAP leads to a reduced stillbirth rate. METHODS We analyzed data from the National Records for Scotland and the Office for National Statistics on the number of singleton maternities and stillbirths in Scotland and in England and Wales, respectively, from 1 January 2000 to 31 December 2015. National uptake of the GAP program over time in each of the regions was recorded. Stillbirth rate per 1000 maternities was calculated, according to year of delivery, and compared between Scotland and England/Wales. RESULTS During the study period, there were 870 632 singleton maternities in Scotland, of which 4243 were stillbirths, and there were 10 469 120 singleton maternities in England and Wales, of which 51 562 were stillbirths. There was a marked difference in uptake of the GAP program between the two regions, with substantially fewer maternity units in Scotland implementing the program. Stillbirth rates were static up to 2010, with a decline thereafter in both regions, to 3.75 (95% CI, 3.25-4.30) per 1000 maternities in Scotland and 4.30 (95% CI, 4.15-4.46) per 1000 maternities in England and Wales in 2015. From 2010 onwards, the decline in Scotland was faster, equating to 48 (95% CI, 47.9-48.1) fewer stillbirths per 100 000 maternities in Scotland than in England and Wales from 2010 to 2015 compared with 2000 to 2009. CONCLUSIONS We observed a decline in stillbirth rate in England and Wales, which coincided with implementation of the GAP program. However, a concurrent decline in stillbirth rate was observed in Scotland in the absence of increased implementation of GAP. The secular rates of change in stillbirth rate in England and Wales cannot be used to infer efficacy of the GAP program. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Iliodromiti
- Centre for Women's Health, Institute of Population Health, Queen Mary University London, London, UK
- School of Medicine, University of Glasgow, Glasgow, UK
| | - G C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK
| | - D A Lawlor
- Bristol NIHR Biomedical Research Centre, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - S M Nelson
- School of Medicine, University of Glasgow, Glasgow, UK
- Bristol NIHR Biomedical Research Centre, Bristol, UK
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12
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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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Kabiri D, Romero R, Gudicha DW, Hernandez-Andrade E, Pacora P, Benshalom-Tirosh N, Tirosh D, Yeo L, Erez O, Hassan SS, Tarca AL. Prediction of adverse perinatal outcome by fetal biometry: comparison of customized and population-based standards. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:177-188. [PMID: 31006913 PMCID: PMC6810752 DOI: 10.1002/uog.20299] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/09/2019] [Accepted: 04/12/2019] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To compare the predictive performance of estimated fetal weight (EFW) percentiles, according to eight growth standards, to detect fetuses at risk for adverse perinatal outcome. METHODS This was a retrospective cohort study of 3437 African-American women. Population-based (Hadlock, INTERGROWTH-21st , World Health Organization (WHO), Fetal Medicine Foundation (FMF)), ethnicity-specific (Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)), customized (Gestation-Related Optimal Weight (GROW)) and African-American customized (Perinatology Research Branch (PRB)/NICHD) growth standards were used to calculate EFW percentiles from the last available scan prior to delivery. Prediction performance indices and relative risk (RR) were calculated for EFW < 10th and > 90th percentiles, according to each standard, for individual and composite adverse perinatal outcomes. Sensitivity at a fixed (10%) false-positive rate (FPR) and partial (FPR < 10%) and full areas under the receiver-operating-characteristics curves (AUC) were compared between the standards. RESULTS Ten percent (341/3437) of neonates were classified as small-for-gestational age (SGA) at birth, and of these 16.4% (56/341) had at least one adverse perinatal outcome. SGA neonates had a 1.5-fold increased risk of any adverse perinatal outcome (P < 0.05). The screen-positive rate of EFW < 10th percentile varied from 6.8% (NICHD) to 24.4% (FMF). EFW < 10th percentile, according to all standards, was associated with an increased risk for each of the adverse perinatal outcomes considered (P < 0.05 for all). The highest RRs associated with EFW < 10th percentile for each adverse outcome were 5.1 (95% CI, 2.1-12.3) for perinatal mortality (WHO); 5.0 (95% CI, 3.2-7.8) for perinatal hypoglycemia (NICHD); 3.4 (95% CI, 2.4-4.7) for mechanical ventilation (NICHD); 2.9 (95% CI, 1.8-4.6) for 5-min Apgar score < 7 (GROW); 2.7 (95% CI, 2.0-3.6) for neonatal intensive care unit (NICU) admission (NICHD); and 2.5 (95% CI, 1.9-3.1) for composite adverse perinatal outcome (NICHD). Although the RR CIs overlapped among all standards for each individual outcome, the RR of composite adverse perinatal outcome in pregnancies with EFW < 10th percentile was higher according to the NICHD (2.46; 95% CI, 1.9-3.1) than the FMF (1.47; 95% CI, 1.2-1.8) standard. The sensitivity for composite adverse perinatal outcome varied substantially between standards, ranging from 15% for NICHD to 32% for FMF, due mostly to differences in FPR; this variation subsided when the FPR was set to the same value (10%). Analysis of AUC revealed significantly better performance for the prediction of perinatal mortality by the PRB/NICHD standard (AUC = 0.70) compared with the Hadlock (AUC = 0.66) and FMF (AUC = 0.64) standards. Evaluation of partial AUC (FPR < 10%) demonstrated that the INTERGROWTH-21st standard performed better than the Hadlock standard for the prediction of NICU admission and mechanical ventilation (P < 0.05 for both). Although fetuses with EFW > 90th percentile were also at risk for any adverse perinatal outcome according to the INTERGROWTH-21st (RR = 1.4; 95% CI, 1.0-1.9) and Hadlock (RR = 1.7; 95% CI, 1.1-2.6) standards, many times fewer cases (2-5-fold lower sensitivity) were detected by using EFW > 90th percentile, rather than EFW < 10th percentile, in screening by these standards. CONCLUSIONS Fetuses with EFW < 10th percentile or EFW > 90th percentile were at increased risk of adverse perinatal outcomes according to all or some of the eight growth standards, respectively. The RR of a composite adverse perinatal outcome in pregnancies with EFW < 10th percentile was higher for the most-stringent (NICHD) compared with the least-stringent (FMF) standard. The results of the complementary analysis of AUC suggest slightly improved detection of adverse perinatal outcome by more recent population-based (INTERGROWTH-21st ) and customized (PRB/NICHD) standards compared with the Hadlock and FMF standards. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Doron Kabiri
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI
- Corresponding authors: Roberto Romero, MD, D.Med.Sci., Perinatology Research Branch, NICHD/NIH/DHHS, Hutzel Women’s Hospital, 3990 John R Street, 4 Brush, Detroit, Michigan 48201; telephone: (313) 993-2700; fax: (313) 577-6294; . Adi L. Tarca, PhD, Perinatology Research Branch, NICHD/NIH/DHHS, Hutzel Women’s Hospital, 3990 John R Street, 4 Brush, Detroit, Michigan 48201; telephone: (313) 577-5305; fax: (313) 577-6294;
| | - Dereje W. Gudicha
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
| | - Edgar Hernandez-Andrade
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Neta Benshalom-Tirosh
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Dan Tirosh
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
- Maternity Department “D”, Division of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Sonia S. Hassan
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI
| | - Adi L. Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS)
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
- Department of Computer Science, Wayne State University College of Engineering, Detroit, MI
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Vieira MC, Relph S, Persson M, Seed PT, Pasupathy D. Determination of birth-weight centile thresholds associated with adverse perinatal outcomes using population, customised, and Intergrowth charts: A Swedish population-based cohort study. PLoS Med 2019; 16:e1002902. [PMID: 31539391 PMCID: PMC6754137 DOI: 10.1371/journal.pmed.1002902] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 08/19/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although many studies have compared birth-weight charts to determine which better identify infants at risk of adverse perinatal outcomes, less attention has been given to the threshold used to define small or large for gestational age (SGA or LGA) infants. Our aim was to explore different thresholds associated with increased risk of adverse perinatal outcomes using population, customised, and Intergrowth centile charts. METHODS AND FINDINGS This is a population-based cohort study (Swedish Medical Birth Registry), which included term singleton births between 2006 and 2015 from women with available data on first-trimester screening. Population, customised, and Intergrowth charts were studied. Outcomes included cesarean section, postpartum haemorrhage, severe perineal tear, Apgar score at 5 minutes, neonatal morbidity, and perinatal mortality. Odds for each outcome were assessed in intervals of 5 centiles of birth weight (reference being 40th-60th centiles) using logistic regression. Intervals of 5% of the population were also explored. Sensitivity for fixed false-positive rates (FPRs) was reported for neonatal outcomes. Data from 212,101 births were analysed. Mean age was 33 ± 5 years, 48% of women were nulliparous, and 80% were born in Sweden. Prevalence of SGA (<10th centile) was 10.1%, 10.0%, and 3.1%, and prevalence of LGA (>90th centile) was 10.0%, 8.2%, and 25.1%, assessed using population, customised, and Intergrowth charts, respectively. In small infants, the risk of perinatal mortality was consistently increased below the 15th, 10th, and 35th birth-weight centiles for the respective charts (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.05-2.39, p = 0.03 for 10th-15th population centile; OR 2.54, 95% CI 1.74-3.71, p < 0.001 for 5th-10th customised centile; OR 1.81, 95% CI 1.07-3.04, p = 0.03 for 30th-35th Intergrowth centile). The strength of association with adverse perinatal outcomes was different between infants below the 5th birth-weight centile for each chart (OR 4.47, 95% CI 3.30-6.04, p < 0.001 for the population chart; OR 5.78, 95% CI 4.22-7.91, p < 0.001 for the customised chart; OR 10.74, 95% CI 7.32-15.77, p < 0.001 for the Intergrowth chart) but similar in the smallest 5% of the population (OR 4.34, 95% CI 3.22-5.86, p < 0.001 for the population chart; OR 5.23, 95% CI 3.85-7.11, p < 0.001 for the customised chart; OR 4.69, 95% CI 3.47-6.34, p < 0.001 for the Intergrowth chart). For a fixed FPR of 10%, different thresholds for each chart achieved similar sensitivity for perinatal mortality in small infants (29% for all charts). Similar behaviour of different thresholds and similar risk/sensitivity for fixed FPR were observed in relation to other outcomes and for LGA infants. Limitations of this study include the relative homogeneity of the Swedish population, which limits generalisability to other populations; customised centiles may perform differently in populations with increased heterogeneity of ethnic background. CONCLUSIONS The risk of adverse outcomes was consistent across proportions of the population but did not reflect fixed thresholds, such as the 10th or 90th centiles, across different growth charts. Chart-specific thresholds for the population should be considered in clinical practice.
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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, London, United Kingdom
- Department of Obstetrics and Gynaecology, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sophie Relph
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Martina Persson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Paul T. Seed
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Dharmintra Pasupathy
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- * E-mail:
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15
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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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Kramer MS. Foetal growth standards: Description, prescription, or prediction? Paediatr Perinat Epidemiol 2019; 33:57-58. [PMID: 30548498 DOI: 10.1111/ppe.12528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/31/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Michael S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupation Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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Barn P, Gombojav E, Ochir C, Boldbaatar B, Beejin B, Naidan G, Galsuren J, Legtseg B, Byambaa T, Hutcheon JA, Janes C, Janssen PA, Lanphear BP, McCandless LC, Takaro TK, Venners SA, Webster GM, Allen RW. The effect of portable HEPA filter air cleaner use during pregnancy on fetal growth: The UGAAR randomized controlled trial. ENVIRONMENT INTERNATIONAL 2018; 121:981-989. [PMID: 30213473 DOI: 10.1016/j.envint.2018.08.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/19/2018] [Accepted: 08/15/2018] [Indexed: 05/22/2023]
Abstract
BACKGROUND Fine particulate matter (PM2.5) exposure may impair fetal growth. AIMS/OBJECTIVES Our aim was to assess the effect of portable high efficiency particulate air (HEPA) filter air cleaner use during pregnancy on fetal growth. METHODS The Ulaanbaatar Gestation and Air Pollution Research (UGAAR) study is a single-blind randomized controlled trial conducted in Ulaanbaatar, Mongolia. Non-smoking pregnant women recruited at ≤18 weeks gestation were randomized to an intervention (1-2 air cleaners in homes from early pregnancy until childbirth) or control (no air cleaners) group. Participants were not blinded to their intervention status. Demographic, health, and birth outcome data were obtained via questionnaires and clinic records. We used unadjusted linear and logistic regression and time-to-event analysis to evaluate the intervention. Our primary outcome was birth weight. Secondary outcomes were gestational age-adjusted birth weight, birth length, head circumference, gestational age at birth, and small for gestational age. The study is registered at ClinicalTrials.gov (NCT01741051). RESULTS We recruited 540 participants (272 control and 268 intervention) from January 9, 2014 to May 1, 2015. There were 465 live births and 28 losses to follow up. We previously reported a 29% (95% CI: 21, 37%) reduction in indoor PM2.5 concentrations with portable HEPA filter air cleaner use. The median (25th, 75th percentile) birth weights for control and intervention participants were 3450 g (3150, 3800 g) and 3550 g (3200, 3800 g), respectively (p = 0.34). The intervention was not associated with birth weight (18 g; 95% CI: -84, 120 g), but in a pre-specified subgroup analysis of 429 term births the intervention was associated with an 85 g (95% CI: 3, 167 g) increase in mean birth weight. CONCLUSIONS HEPA filter air cleaner use in a high pollution setting was associated with greater birth weight only among babies born at term.
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Affiliation(s)
- Prabjit Barn
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada.
| | - Enkhjargal Gombojav
- School of Public Health, Mongolian National University of Medical Sciences, Zorig Street, Ulaanbaatar 14210, Mongolia
| | - Chimedsuren Ochir
- School of Public Health, Mongolian National University of Medical Sciences, Zorig Street, Ulaanbaatar 14210, Mongolia
| | - Buyantushig Boldbaatar
- School of Public Health, Mongolian National University of Medical Sciences, Zorig Street, Ulaanbaatar 14210, Mongolia
| | - Bolor Beejin
- Ministry of Health of Mongolia, Olympic Street-2, Government building VIII, Sukhbaatar District, Ulaanbaatar, Mongolia
| | - Gerel Naidan
- School of Public Health, Mongolian National University of Medical Sciences, Zorig Street, Ulaanbaatar 14210, Mongolia
| | - Jargalsaikhan Galsuren
- School of Public Health, Mongolian National University of Medical Sciences, Zorig Street, Ulaanbaatar 14210, Mongolia
| | - Bayarkhuu Legtseg
- Sukhbaatar District Health Center, 11 Horoo, Tsagdaagiin Gudamj, Sukhbaatar District, Ulaanbaatar, Mongolia
| | - Tsogtbaatar Byambaa
- Ministry of Health of Mongolia, Olympic Street-2, Government building VIII, Sukhbaatar District, Ulaanbaatar, Mongolia
| | - Jennifer A Hutcheon
- Faculty of Medicine, Department of Obstetrics & Gynaecology, University of British Columbia, 4500 Oak Street, Vancouver V6H 2N1, Canada
| | - Craig Janes
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West,Waterloo N2L 3G1, Canada
| | - Patricia A Janssen
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver V6T 1Z3, Canada
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada
| | - Lawrence C McCandless
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada
| | - Scott A Venners
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada
| | - Glenys M Webster
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada
| | - Ryan W Allen
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada
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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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Shapiro GD, Sheppard AJ, Bushnik T, Kramer MS, Mashford-Pringle A, Kaufman JS, Yang S. Adverse birth outcomes and infant mortality according to registered First Nations status and First Nations community residence across Canada. Canadian Journal of Public Health 2018; 109:692-699. [PMID: 30242635 DOI: 10.17269/s41997-018-0134-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 09/06/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Studies of perinatal health outcomes in Canadian First Nations populations have largely focused on limited geographical areas and have been unable to examine outcomes by registered status and community residence. In this study, we compare rates of adverse birth outcomes among First Nations individuals living within vs. outside of First Nations communities and those with vs. without registered status. METHODS Data included 13,506 singleton pregnancies from the 2006 Canadian Birth-Census Cohort. Outcomes examined included preterm birth (PTB), small- and large-for-gestational-age birth (SGA, LGA), stillbirth, overall infant mortality, and neonatal and postneonatal mortality. Risk ratios (RRs) were estimated with adjustment for maternal age, education, parity, and paternal education. RESULTS Mothers living in First Nations communities and those with status had elevated adjusted risks of LGA (RR for First Nations community residence = 1.22, 95% CI = 1.09-1.35; RR for status = 1.50, 95% CI = 1.16-1.93). Rates of SGA were significantly lower among mothers with status (adjusted RR = 0.62, 95% CI = 0.44-0.86). Rates of PTB did not vary substantially by residence or by status. Adjusted differences in fatal outcomes could not be estimated, owing to small cell sizes. However, mothers living in First Nations communities had higher crude rates of infant mortality (10.9 vs. 7.7 per 1000), particularly for neonatal mortality (6.1 vs. 2.9). CONCLUSION Future investigations should explore risk factors, including food security and access to health care services, that may explain disparities in SGA and LGA by status and residence within First Nations populations.
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Affiliation(s)
- Gabriel D Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Ave West, Montreal, Quebec, H3A 1A2, Canada.
| | - Amanda J Sheppard
- Aboriginal Cancer Care Unit, Cancer Care Ontario, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Michael S Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Ave West, Montreal, Quebec, H3A 1A2, Canada.,Department of Pediatrics, McGill University, Montreal, Canada
| | | | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Ave West, Montreal, Quebec, H3A 1A2, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Ave West, Montreal, Quebec, H3A 1A2, Canada
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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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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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Gardosi J, Francis A, Turner S, Williams M. Customized growth charts: rationale, validation and clinical benefits. Am J Obstet Gynecol 2018; 218:S609-S618. [PMID: 29422203 DOI: 10.1016/j.ajog.2017.12.011] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 11/28/2022]
Abstract
Appropriate standards for the assessment of fetal growth and birthweight are central to good clinical care, and have become even more important with increasing evidence that growth-related adverse outcomes are potentially avoidable. Standards need to be evidence based and validated against pregnancy outcome and able to demonstrate utility and effectiveness. A review of proposals by the Intergrowth consortium to adopt their single international standard finds little support for the claim that the cases that it identifies as small are due to malnutrition or stunting, and substantial evidence that there is normal physiologic variation between different countries and ethnic groups. It is possible that the one-size-fits-all standard ends up fitting no one and could be harmful if implemented. An alternative is the concept of country-specific charts that can improve the association between abnormal growth and adverse outcome. However, such standards ignore individual physiologic variation that affects fetal growth, which exists in any heterogeneous population and exceeds intercountry differences. It is therefore more logical to adjust for the characteristics of each mother, taking her ethnic origin and her height, weight, and parity into account, and to set a growth and birthweight standard for each pregnancy against which actual growth can be assessed. A customized standard better reflects adverse pregnancy outcome at both ends of the fetal size spectrum and has increased clinicians' confidence in growth assessment, while providing reassurance when abnormal size merely represents physiologic variation. Rollout in the United Kingdom has proceeded as part of the comprehensive Growth Assessment Protocol (GAP), and has resulted in a steady increase in antenatal detection of babies who are at risk because of fetal growth restriction. This in turn has been accompanied by a year-on-year drop in stillbirth rates to their lowest ever levels in England. A global version of customized growth charts with over 100 ethnic origin categories is being launched in 2018, and will provide an individualized, yet universally applicable, standard for fetal growth.
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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: 90] [Impact Index Per Article: 12.9] [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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Quinn JA, Munoz FM, Gonik B, Frau L, Cutland C, Mallett-Moore T, Kissou A, Wittke F, Das M, Nunes T, Pye S, Watson W, Ramos AMA, Cordero JF, Huang WT, Kochhar S, Buttery J. Preterm birth: Case definition & guidelines for data collection, analysis, and presentation of immunisation safety data. Vaccine 2016; 34:6047-6056. [PMID: 27743648 PMCID: PMC5139808 DOI: 10.1016/j.vaccine.2016.03.045] [Citation(s) in RCA: 232] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 12/27/2022]
Abstract
Preterm birth is commonly defined as any birth before 37 weeks completed weeks of gestation. An estimated 15 million infants are born preterm globally, disproportionately affecting low and middle income countries (LMIC). It contributes directly to estimated one million neonatal deaths annually and is a significant contributor to childhood morbidity. However, in many clinical settings, the information available to calculate completed weeks of gestation varies widely. Accurate dating of the last menstrual period (LMP), as well as access to clinical and ultrasonographic evaluation are important components of gestational age assessment antenatally. This case definition assign levels of confidence to categorisation of births as preterm, utilising assessment modalities which may be available across different settings. These are designed to enable systematic safety evaluation of vaccine clinical trials and post-implementation programmes of immunisations in pregnancy.
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Affiliation(s)
- Julie-Anne Quinn
- SAEFVIC, Murdoch Childrens Research Institute, Victoria, Australia; Infection and Immunity, Monash Children's Hospital, Department of Paediatrics, The Ritchie Centre, Hudson Institute, Monash University, Australia
| | - Flor M Munoz
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Bernard Gonik
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | | | - Clare Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Department of Science and Technology National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Aimee Kissou
- Department of Pediatrics, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | | | | | | | - Savia Pye
- Communicable Disease Prevention and Control, Nova Scotia, Canada
| | | | | | - Jose F Cordero
- University of Puerto Rico Graduate School of Public Health, Medical Sciences Campus, San Juan 00935, Puerto Rico
| | | | | | - Jim Buttery
- SAEFVIC, Murdoch Childrens Research Institute, Victoria, Australia; Infection and Immunity, Monash Children's Hospital, Department of Paediatrics, The Ritchie Centre, Hudson Institute, Monash University, Australia.
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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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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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Deter RL, Lee W, Sangi-Haghpeykar H, Tarca AL, Li J, Yeo L, Romero R. Personalized third-trimester fetal growth evaluation: comparisons of individualized growth assessment, percentile line and conditional probability methods. J Matern Fetal Neonatal Med 2015; 29:177-85. [PMID: 25491881 DOI: 10.3109/14767058.2014.995083] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare third-trimester size trajectory prediction errors (average transformed percent deviations) for three individualized fetal growth assessment methods. METHODS This study utilized longitudinal measurements of nine directly measured size parameters in 118 fetuses with normal neonatal growth outcomes. Expected value (EV) function coefficients and variance components were obtained using two-level random coefficient modeling. Growth models (IGA) or EV coefficients and variance components (PLM and CPM) were used to calculate predicted values at ∼400 third-trimester time points. Percent deviations (%Dev) calculated at these time points using all three methods were expressed as percentages of IGA MA-specific reference ranges [transformed percent deviations (T%Dev)]. Third-trimester T%Dev values were averaged (aT%Dev) for each parameter. Mean ± standard deviation's for sets of aT%Dev values derived from each method (IGA, PLM and CPM) were calculated and compared. RESULTS Mean aT%Dev values for nine parameters were: (i) IGA: -4.3 to 5.2% (9/9 not different from zero); (ii) PLM: -32.7 to 25.6% (4/9 not different from zero) and (iii) CPM: -20.4 to 17.4% (5/9 not different from zero). Seven of nine systematic deviations from zero were statistically significant when IGA values were compared to either PLM or CPM values. Variabilities were smaller for IGA when compared to those for PLM or CPM, with (i) 5/9 being statistically significant (IGA versus PLM), (ii) 2/9 being statistically significant (IGA versus CPM) and (iii) 5/9 being statistically significant (PLM versus CPM). CONCLUSIONS Significant differences in the agreement between predicted third-trimester size parameters and their measured values were found for the three methods tested. With most parameters, IGA gave smaller mean aT%Dev values and smaller variabilities. The CPM method was better than the PLM approach for most but not all parameters. These results suggest that third-trimester size trajectories are best characterized by IGA in fetuses with normal growth outcomes.
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Affiliation(s)
- Russell L Deter
- a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , TX , USA
| | - Wesley Lee
- a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , TX , USA .,b Department of Obstetrics and Gynecology , Oakland University William Beaumont School of Medicine , Rochester , MI , USA .,c Perinatology Research Branch, NICHD/NIH/DHHS , Detroit , MI , USA
| | - Haleh Sangi-Haghpeykar
- a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , TX , USA
| | - Adi L Tarca
- c Perinatology Research Branch, NICHD/NIH/DHHS , Detroit , MI , USA
| | - Jia Li
- d Department of Electrical and Computer Engineering , Oakland University , Rochester , MI , USA
| | - Lami Yeo
- c Perinatology Research Branch, NICHD/NIH/DHHS , Detroit , MI , USA .,e Department of Obstetrics and Gynecology , Wayne State University/Hutzel Hospital , Detroit , MI , USA
| | - Roberto Romero
- c Perinatology Research Branch, NICHD/NIH/DHHS , Detroit , MI , USA .,f Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA , and.,g Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA
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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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Maternal anthropometric measurements as predictors of low birth weight in developing and developed countries. Arch Gynecol Obstet 2015; 292:829-42. [DOI: 10.1007/s00404-015-3721-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/07/2015] [Indexed: 11/26/2022]
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Norris T, Johnson W, Farrar D, Tuffnell D, Wright J, Cameron N. Small-for-gestational age and large-for-gestational age thresholds to predict infants at risk of adverse delivery and neonatal outcomes: are current charts adequate? An observational study from the Born in Bradford cohort. BMJ Open 2015; 5:e006743. [PMID: 25783424 PMCID: PMC4368928 DOI: 10.1136/bmjopen-2014-006743] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Construct an ethnic-specific chart and compare the prediction of adverse outcomes using this chart with the clinically recommended UK-WHO and customised birth weight charts using cut-offs for small-for-gestational age (SGA: birth weight <10th centile) and large-for-gestational age (LGA: birth weight >90th centile). DESIGN Prospective cohort study. SETTING Born in Bradford (BiB) study, UK. PARTICIPANTS 3980 White British and 4448 Pakistani infants with complete data for gestational age, birth weight, ethnicity, maternal height, weight and parity. MAIN OUTCOME MEASURES Prevalence of SGA and LGA, using the three charts and indicators of diagnostic utility (sensitivity, specificity and area under the receiver operating characteristic (AUROC)) of these chart-specific cut-offs to predict delivery and neonatal outcomes and a composite outcome. RESULTS In White British and Pakistani infants, the prevalence of SGA and LGA differed depending on the chart used. Increased risk of SGA was observed when using the UK-WHO and customised charts as opposed to the ethnic-specific chart, while the opposite was apparent when classifying LGA infants. However, the predictive utility of all three charts to identify adverse clinical outcomes was poor, with only the prediction of shoulder dystocia achieving an AUROC>0.62 on all three charts. CONCLUSIONS Despite being recommended in national clinical guidelines, the UK-WHO and customised birth weight charts perform poorly at identifying infants at risk of adverse neonatal outcomes. Being small or large may increase the risk of an adverse outcome; however, size alone is not sensitive or specific enough with current detection to be useful. However, a significant amount of missing data for some of the outcomes may have limited the power needed to determine true associations.
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Affiliation(s)
- T Norris
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - W Johnson
- MRC Unit for Lifelong Health & Ageing, University College London, London, UK
| | - D Farrar
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - D Tuffnell
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, UK
| | - J Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - N Cameron
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Size at birth by gestational age and hospital mortality in very preterm infants: results of the area-based ACTION project. Early Hum Dev 2015; 91:77-85. [PMID: 25555236 DOI: 10.1016/j.earlhumdev.2014.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Size at birth is an important predictor of neonatal outcomes, but there are inconsistencies on the definitions and optimal cut-offs. AIMS The aim of this study is to compute birth size percentiles for Italian very preterm singleton infants and assess relationship with hospital mortality. STUDY DESIGN Prospective area-based cohort study. SUBJECTS All singleton Italian infants with gestational age 22-31 weeks admitted to neonatal care in 6 Italian regions (Friuli Venezia-Giulia, Lombardia, Marche, Tuscany, Lazio and Calabria) (n. 1605). OUTCOME MEASURE Hospital mortality. METHODS Anthropometric reference charts were derived, separately for males and females, using the lambda (λ) mu (μ) and sigma (σ) method (LMS). Logistic regression analysis was used to estimate mortality rates by gestational age and birth weight centile class, adjusting for sex, congenital anomalies and region. RESULTS At any gestational age, mortality decreased as birth weight centile increased, with lowest values observed between the 50th and the 89th centiles interval. Using the 75th-89th centile class as reference, adjusted mortality odds ratios were 7.94 (95% CI 4.18-15.08) below 10th centile; 3.04 (95% CI 1.63-5.65) between the 10th and 24th; 1.96 (95% CI 1.07-3.62) between the 25th and the 49th; 1.25 (95% CI 0.68-2.30) between the 50(h) and the 74th; and 2.07 (95% CI 1.01-4.25) at the 90th and above. CONCLUSIONS Compared to the reference, we found significantly increasing adjusted risk of death up to the 49th centile, challenging the usual 10th centile criterion as risk indicator. Continuous measures such as the birthweight z-score may be more appropriate to explore the relationship between growth retardation and adverse perinatal outcomes.
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Urquia ML, Berger H, Ray JG. Risk of adverse outcomes among infants of immigrant women according to birth-weight curves tailored to maternal world region of origin. CMAJ 2014; 187:E32-E40. [PMID: 25384653 DOI: 10.1503/cmaj.140748] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Infants of immigrant women in Western nations generally have lower birth weights than infants of native-born women. Whether this difference is physiologic or pathological is unclear. We determined whether the use of birth-weight curves tailored to maternal world region of origin would discriminate adverse neonatal and obstetric outcomes more accurately than a single birth-weight curve based on infants of Canadian-born women. METHODS We performed a retrospective cohort study of in-hospital singleton live births (328,387 to immigrant women, 761,260 to nonimmigrant women) in Ontario between 2002 and 2012 using population health services data linked to the national immigration database. We classified infants as small for gestational age (<10th percentile) or large for gestational age (≥90th percentile) using both Canadian and world region-specific birth-weight curves and compared associations with adverse neonatal and obstetric outcomes. RESULTS Compared with world region-specific birth-weight curves, the Canadian curve classified 20 431 (6.2%) additional newborns of immigrant women as small for gestational age, of whom 15,467 (75.7%) were of East or South Asian descent. The odds of neonatal death were lower among small-for-gestational-age infants of immigrant women than among those of nonimmigrant women based on the Canadian birth-weight curve (adjusted odds ratio [OR] 0.83, 95% confidence interval [CI] 0.72-0.95), but higher when small for gestational age was defined by the world region-specific curves (adjusted OR 1.24, 95% CI 1.08-1.42). Conversely, the odds of some adverse outcomes were lower among large-for-gestational-age infants of immigrant women than among those of nonimmigrant women based on world region-specific birth-weight curves, but were similar based on the Canadian curve. INTERPRETATION World region-specific birth-weight curves seemed to be more appropriate than a single Canadian population-based curve for assessing the risk of adverse neonatal and obstetric outcomes among small- and large-for-gestational-age infants born to immigrant women, especially those from the East and South Asian regions.
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Affiliation(s)
- Marcelo L Urquia
- Centre for Research on Inner City Health (Urquia), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Medicine (Berger, Ray), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Urquia, Ray), Dalla Lana School of Public Health (Urquia), Faculty of Medicine (Berger, Ray), University of Toronto, Toronto, Ont.
| | - Howard Berger
- Centre for Research on Inner City Health (Urquia), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Medicine (Berger, Ray), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Urquia, Ray), Dalla Lana School of Public Health (Urquia), Faculty of Medicine (Berger, Ray), University of Toronto, Toronto, Ont
| | - Joel G Ray
- Centre for Research on Inner City Health (Urquia), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Medicine (Berger, Ray), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Urquia, Ray), Dalla Lana School of Public Health (Urquia), Faculty of Medicine (Berger, Ray), University of Toronto, Toronto, Ont
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Hanley GE, Janssen PA. Ethnicity-specific growth distributions for prediction of newborn morbidity. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 34:826-829. [PMID: 22971450 DOI: 10.1016/s1701-2163(16)35380-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Birth weight distributions differ according to the ethnic origin of the mother. We aimed to determine whether using ethnicity-specific growth distributions would identify newborns at risk for adverse infant outcomes associated with small for gestational age (SGA) birth better than population-based distributions. METHODS We examined 2647 singletons born to healthy non-smoking mothers at British Columbia Women's Hospital at 37 to 41 completed weeks' gestation. We compared the ability of ethnicity-specific growth distributions and population-based distributions to predict which infants were at increased risk of adverse outcomes associated with SGA, as well as extended length of stay in hospital, using crude and adjusted odds ratios. RESULTS The ethnicity-specific growth distributions were associated with an increased risk of adverse infant outcomes while the population-based distributions were not (adjusted odds ratio [aOR] 1.49 [95% CI 0.82 to 2.70] vs. aOR 0.88 [95% CI 0.48 to 1.64]). While both distributions predicted extended length of stay in hospital, this likely reflects clinicians' use of the population-based distribution to identify SGA infants. CONCLUSIONS The use of ethnicity-specific growth distributions will likely improve our ability to differentiate between babies who are pathologically small and those who are constitutionally small, and prevent misclassification of constitutionally small but healthy newborns born to mothers of Chinese or South Asian descent as SGA.
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Affiliation(s)
- Gillian E Hanley
- School of Population and Public Health, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC
| | - Patricia A Janssen
- School of Population and Public Health, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC
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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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Deter RL, Lee W, Sangi-Haghpeykar H, Tarca AL, Yeo L, Romero R. A modified prenatal growth assessment score for the evaluation of fetal growth in the third trimester using single and composite biometric parameters. J Matern Fetal Neonatal Med 2014; 28:745-54. [PMID: 24993892 DOI: 10.3109/14767058.2014.934218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To define modified Prenatal Growth Assessment Scores (mPGAS) for single and composite biometric parameters and determine their reference ranges in normal fetuses. METHODS Nine anatomical parameters (ap) were measured and the weight estimated (EWTa, EWTb) in a longitudinal study of 119 fetuses with normal neonatal growth outcomes. Expected third trimester size trajectories, obtained from second trimester Rossavik size models, were used in calculating Percent Deviations (% Dev's) and their age-specific reference ranges in each fetus. The components of individual % Dev's values outside their reference ranges, designated +iapPGAS, -iapPGAS, were averaged to give +apPGAS and -apPGAS values for the 3rd trimester. The +iapPGAS and -iapPGAS values for different combinations of ap (c1a (HC, AC, FDL, ThC, EWTa), c1b (HC, AC, FDL, ThC, EWTb), c2 (ThC, ArmC, AVol, TVol), c3 (HC, AC, FDL, EWTa)) were then averaged to give +icPGAS and -icPGAS values at different time points or at the end of the third trimester (+cPGAS, -cPGAS). Values for iapPGAS, ic1bPGAS, and ic2PGAS were compared to their respective apPGAS or cPGAS reference ranges. RESULTS All mPGAS values had one 95% range boundary at 0.0%. Upper boundaries of 1D +apPGAS values ranged from 0.0% (HC) to +0.49% (ThC) and were +0.06%, +2.3% and +1.8% for EWT, AVol and TVol, respectively. Comparable values for -apPGAS were 0.0% (BPD, FDL, HDL), to -0.58% (ArmC), -0.13% (EWT), -0.8% (AVol), and 0.0% (TVol). The +cPGAS, 95% reference range upper boundaries varied from +0.36% (c1b) to +0.89% (c2). Comparable values for -cPGAS lower boundaries were -0.17% (c1b) to -0.43% (c2). CONCLUSIONS The original PGAS concept has now been extended to individual biometric parameters and their combinations. With the standards provided, mPGAS values can now be tested to see if detection of different types of third trimester growth problems is improved.
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Affiliation(s)
- Russell L Deter
- Department of Obstetrics and Gynecology, Baylor College of Medicine , Houston, TX , USA
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Gardosi J. Customized Charts and Their Role in Identifying Pregnancies at Risk Because of Fetal Growth Restriction. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:408-415. [DOI: 10.1016/s1701-2163(15)30587-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Physical activity, sedentary time and gain in overall and central body fat: 7-year follow-up of the ProActive trial cohort. Int J Obes (Lond) 2014; 39:142-8. [PMID: 24732143 PMCID: PMC4113455 DOI: 10.1038/ijo.2014.66] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/12/2014] [Accepted: 04/02/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to examine the independent associations of time spent in moderate-to-vigorous physical activity (MVPA) and sedentary (SED-time), with total and abdominal body fat (BF), and the bidirectionality of these associations in adults at high risk of type 2 diabetes. DESIGN AND SUBJECTS We measured MVPA (min per day) and SED-time (h per day) by accelerometry, and indices of total (body weight, fat mass (FM), BF% and FM index) and abdominal BF (waist circumference (WC)) using standard procedures in 231 adults (41.3 ± 6.4 years) with parental history of type 2 diabetes (ProActive UK) at baseline, 1-year and 7-year follow-up. Mixed effects models were used to quantify the independent associations (expressed as standardised β-coefficients (95% confidence interval (CI))) of MVPA and SED-time with fat indices, using data from all three time points. All models were adjusted for age, sex, intervention arm, monitor wear time, follow-up time, smoking status, socioeconomic status and MVPA/SED-time. RESULTS MVPA was inversely and independently associated with all indices of total BF (for example, 1 s.d. higher MVPA was associated with a reduction in FM, β = -0.09 (95% CI: -0.14, -0.04) s.d.) and abdominal BF (for example, WC: β = -0.07 (-0.12, -0.02)). Similarly, higher fat indices were independently associated with a reduction in MVPA (for example, WC: β = -0.25 (-0.36, -0.15); FM: β = -0.27 (-0.36, -0.18)). SED-time was positively and independently associated with most fat indices (for example, WC: β = 0.03 (-0.04, 0.09); FM: β = 0.10 (0.03, 0.17)). Higher values of all fat indices independently predicted longer SED-time (for example, WC: β = 0.10 (0.02, 0.18), FM: β = 0.15 (0.07, 0.22)). CONCLUSIONS The associations of MVPA and SED-time with total and abdominal BF are bidirectional and independent among individuals at high risk for type 2 diabetes. The association between BF and MVPA is stronger than the reciprocal association, highlighting the importance of considering BF as a determinant of decreasing activity and a potential consequence. Promoting more MVPA and less SED-time may reduce total and abdominal BF.
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Bukowski R, Hansen NI, Willinger M, Reddy UM, Parker CB, Pinar H, Silver RM, Dudley DJ, Stoll BJ, Saade GR, Koch MA, Rowland Hogue CJ, Varner MW, Conway DL, Coustan D, Goldenberg RL. Fetal growth and risk of stillbirth: a population-based case-control study. PLoS Med 2014; 11:e1001633. [PMID: 24755550 PMCID: PMC3995658 DOI: 10.1371/journal.pmed.1001633] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/11/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Stillbirth is strongly related to impaired fetal growth. However, the relationship between fetal growth and stillbirth is difficult to determine because of uncertainty in the timing of death and confounding characteristics affecting normal fetal growth. METHODS AND FINDINGS We conducted a population-based case-control study of all stillbirths and a representative sample of live births in 59 hospitals in five geographic areas in the US. Fetal growth abnormalities were categorized as small for gestational age (SGA) (<10th percentile) or large for gestational age (LGA) (>90th percentile) at death (stillbirth) or delivery (live birth) using population, ultrasound, and individualized norms. Gestational age at death was determined using an algorithm that considered the time-of-death interval, postmortem examination, and reliability of the gestational age estimate. Data were weighted to account for the sampling design and differential participation rates in various subgroups. Among 527 singleton stillbirths and 1,821 singleton live births studied, stillbirth was associated with SGA based on population, ultrasound, and individualized norms (odds ratio [OR] [95% CI]: 3.0 [2.2 to 4.0]; 4.7 [3.7 to 5.9]; 4.6 [3.6 to 5.9], respectively). LGA was also associated with increased risk of stillbirth using ultrasound and individualized norms (OR [95% CI]: 3.5 [2.4 to 5.0]; 2.3 [1.7 to 3.1], respectively), but not population norms (OR [95% CI]: 0.6 [0.4 to 1.0]). The associations were stronger with more severe SGA and LGA (<5th and >95th percentile). Analyses adjusted for stillbirth risk factors, subset analyses excluding potential confounders, and analyses in preterm and term pregnancies showed similar patterns of association. In this study 70% of cases and 63% of controls agreed to participate. Analysis weights accounted for differences between consenting and non-consenting women. Some of the characteristics used for individualized fetal growth estimates were missing and were replaced with reference values. However, a sensitivity analysis using individualized norms based on the subset of stillbirths and live births with non-missing variables showed similar findings. CONCLUSIONS Stillbirth is associated with both growth restriction and excessive fetal growth. These findings suggest that, contrary to current practices and recommendations, stillbirth prevention strategies should focus on both severe SGA and severe LGA pregnancies. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Radek Bukowski
- University of Texas Medical Branch at Galveston, United States of America
- * E-mail:
| | - Nellie I. Hansen
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Marian Willinger
- The Pregnancy and Perinatology Branch, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Uma M. Reddy
- The Pregnancy and Perinatology Branch, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Corette B. Parker
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Halit Pinar
- Brown University School of Medicine, Providence, Rhode Island, United States of America
| | - Robert M. Silver
- University of Utah School of Medicine and Intermountain Health Care, Salt Lake City, Utah, United States of America
| | - Donald J. Dudley
- University of Texas Health Science Center at San Antonio, United States of America
| | - Barbara J. Stoll
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, United States of America
| | - George R. Saade
- University of Texas Medical Branch at Galveston, United States of America
| | - Matthew A. Koch
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Carol J. Rowland Hogue
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Michael W. Varner
- University of Utah School of Medicine and Intermountain Health Care, Salt Lake City, Utah, United States of America
| | - Deborah L. Conway
- University of Texas Health Science Center at San Antonio, United States of America
| | - Donald Coustan
- Brown University School of Medicine, Providence, Rhode Island, United States of America
| | - Robert L. Goldenberg
- Columbia University Medical Center, New York, New York, United States of America
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Morales-Roselló J, Khalil A, Morlando M, Papageorghiou A, Bhide A, Thilaganathan B. Changes in fetal Doppler indices as a marker of failure to reach growth potential at term. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:303-310. [PMID: 24488879 DOI: 10.1002/uog.13319] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 01/22/2014] [Accepted: 01/27/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate whether changes in the middle cerebral artery (MCA), umbilical artery (UA) and cerebroplacental ratio (CPR) Doppler indices at term might be used to identify those appropriate-for-gestational-age (AGA) fetuses that are failing to reach their growth potential (FRGP). METHODS This was a retrospective cohort study of data obtained in a single tertiary referral center over a 10-year period from 2002 to 2012. The UA pulsatility index (PI), MCA-PI and CPR were recorded between 37+0 and 41+6 weeks within 14 days before delivery. The Doppler parameters were converted into multiples of the median (MoM), adjusting for gestational age, and their correlation with birth-weight (BW) centiles was evaluated by means of regression analysis. Doppler indices were also grouped according to BW quartiles and compared using Kruskal-Wallis and Dunn's post-hoc tests. RESULTS The study included 11576 term fetuses, with 8645 (74.7%) classified as AGA. Within the AGA group, fetuses with lower BW had significantly higher UA-PI, lower MCA-PI and lower CPR MoM values. Large-for-gestational-age (LGA) fetuses were considered as the group least likely to be growth-restricted. The CPR MoM < 5(th) centile (0.6765 MoM) in these fetuses was used as a threshold for diagnosing FRGP. Using this definition, in the AGA pregnancies the percentage of fetuses with FRGP was 1% in the 75-90(th) BW centile group, 1.7% in the 50-75(th) centile group, 2.9% in the 25-50(th) centile group and 6.7% in the 10-25(th) centile group. CONCLUSION AGA pregnancies may present with fetal cerebral and placental blood flow redistribution indicative of fetal hypoxemia. Fetal Doppler assessment may be of value in detecting AGA pregnancies that are subject to placental insufficiency, fetal hypoxemia and FRGP. Future studies are needed to evaluate the appropriate threshold for the diagnosis of FRGP and the diagnostic performance of this new approach for the management of growth disorders.
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Affiliation(s)
- J Morales-Roselló
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, London, UK; Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Do Customized Birth Weight Charts Add Anything but Complexity to the Assessment of Fetal Growth? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:107-109. [DOI: 10.1016/s1701-2163(15)30652-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Rasmussen S. Re: Customized growth curves for identification of large-for-gestational age neonates in pre-eclamptic women. J. Espinoza, W. Lee, S. R. Martin and M. A. Belfort. Ultrasound Obstet Gynecol 2014; 43: 165-169. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:137. [PMID: 24497419 DOI: 10.1002/uog.13299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- S Rasmussen
- Department of Clinical Science, Kvinneklinikken, Haukeland University Hospital, N-5021, Bergen, Norway.
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Hutcheon J. L’évaluation de la croissance n’est-elle que compliquée par l’utilisation de tableaux de poids adaptés? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014. [DOI: 10.1016/s1701-2163(15)30653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Melamed N, Ray JG, Shah PS, Berger H, Kingdom JC. Should We Use Customized Fetal Growth Percentiles in Urban Canada? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:164-170. [DOI: 10.1016/s1701-2163(15)30663-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sjaarda LA, Albert PS, Mumford SL, Hinkle SN, Mendola P, Laughon SK. Customized large-for-gestational-age birthweight at term and the association with adverse perinatal outcomes. Am J Obstet Gynecol 2014; 210:63.e1-63.e11. [PMID: 24035985 PMCID: PMC3872267 DOI: 10.1016/j.ajog.2013.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/08/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Using a cohort of 110,447 singleton, term pregnancies, we aimed to validate the previously proposed customized standard of large-for-gestational-age (LGA) birthweight, derive an additional customized LGA model excluding maternal weight, and evaluate the association between differing definitions of customized LGA and perinatal morbidities. STUDY DESIGN Three customized LGA classifications, in addition to a population-based 90th percentile, were made according to the principals described by Gardosi: (1) customized LGA using Gardosi's previously published coefficients (LGA-Gardosi), (2) customized LGA using coefficients derived by a similar method but from our larger cohort, and (3) derived without customization for maternal weight. Associations between the LGA classifications and various perinatal morbidity outcomes were evaluated. RESULTS Coefficients derived here for physiologic and pathologic effects on birthweight were similar to those previously reported by Gardosi. Customized LGA (any method) generally identified more births to younger, nonwhite, nulliparous mothers with female neonates of lower birthweight compared with population-based LGA. Rates of maternal and neonatal morbidity were greatest in births classified by both population-based LGA and customized LGA (any method). However, the model that excluded customization for maternal weight, revealed a greater proportion of women previously unidentified by population-based LGA who were more frequently black (40% vs 25%) and obese (30% vs 5.1%), along with greater rates of shoulder dystocia, neonatal intensive care unit admission and neonatal respiratory complications, than with LGA-Gardosi. CONCLUSION The use of customized methods of defining LGA was not decisively superior compared with population-based LGA, but custom LGA may be improved by modification of the parameters included in customization.
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Affiliation(s)
- Lindsey A Sjaarda
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Paul S Albert
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Sunni L Mumford
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Stefanie N Hinkle
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Pauline Mendola
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - S Katherine Laughon
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
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Ego A. Définitions : petit poids pour l’âge gestationnel et retard de croissance intra-utérin. ACTA ACUST UNITED AC 2013; 42:872-94. [DOI: 10.1016/j.jgyn.2013.09.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhang J, Sun K. Invited commentary: the incremental value of customization in defining abnormal fetal growth status. Am J Epidemiol 2013; 178:1309-12. [PMID: 23966561 DOI: 10.1093/aje/kwt174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Reference tools based on birth weight percentiles at a given gestational week have long been used to define fetuses or infants that are small or large for their gestational ages. However, important deficiencies of the birth weight reference are being increasingly recognized. Overwhelming evidence indicates that an ultrasonography-based fetal weight reference should be used to classify fetal and newborn sizes during pregnancy and at birth, respectively. Questions have been raised as to whether further adjustments for race/ethnicity, parity, sex, and maternal height and weight are helpful to improve the accuracy of the classification. In this issue of the Journal, Carberry et al. (Am J Epidemiol. 2013;178(8):1301-1308) show that adjustment for race/ethnicity is useful, but that additional fine tuning for other factors (i.e., full customization) in the classification may not further improve the ability to predict infant morbidity, mortality, and other fetal growth indicators. Thus, the theoretical advantage of full customization may have limited incremental value for pediatric outcomes, particularly in term births. Literature on the prediction of short-term maternal outcomes and very long-term outcomes (adult diseases) is too scarce to draw any conclusions. Given that each additional variable being incorporated in the classification scheme increases complexity and costs in practice, the clinical utility of full customization in obstetric practice requires further testing.
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