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MATERNAL HEIGHT AND PRE-PREGNANCY WEIGHT STATUS ARE ASSOCIATED WITH FETAL GROWTH PATTERNS AND NEWBORN SIZE. J Biosoc Sci 2016; 49:392-407. [DOI: 10.1017/s0021932016000493] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SummaryThe impact of maternal height, pre-pregnancy weight status and gestational weight gain on fetal growth patterns and newborn size was analysed using a dataset of 4261 singleton term births taking place at the Viennese Danube Hospital between 2005 and 2013. Fetal growth patterns were reconstructed from three ultrasound examinations carried out at the 11th/12th, 20th/21th and 32th/33th weeks of gestation. Crown–rump length, biparietal diameter, fronto-occipital diameter, head circumference, abdominal transverse diameter, abdominal anterior–posterior diameter, abdominal circumference and femur length were determined. Birth weight, birth length and head circumference were measured immediately after birth. The vast majority of newborns were of normal weight, i.e. between 2500 and 4000 g. Maternal height showed a just-significant but weak positive association (r=0.03: p=0.039) with crown–rump length at the first trimester and with the majority of fetal parameters at the second trimester (r>0.06; p<0.001) and third trimester (r>0.09; p<0.001). Pre-pregnancy weight status was significantly positively associated with nearly all fetal dimensions at the third trimester (r>0.08; p<0.001). Maternal height (r>0.17; p<0.001) and pre-pregnancy weight status (r>0.13; p<0.001), but also gestational weight gain (r>0.13; p<0.001), were significantly positively associated with newborn size. Some of these associations were quite weak and the statistical significance was mainly due to the large sample size. The association patterns between maternal height and pre-pregnancy weight status with fetal growth patterns (p<0.001), as well as newborn size (p<0.001), were independent of maternal age, nicotine consumption and fetal sex. In general, taller and heavier women gave birth to larger infants. This association between maternal size and fetal growth patterns was detectable from the first trimester onwards.
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Napolitano R, Donadono V, Ohuma EO, Knight CL, Wanyonyi SZ, Kemp B, Norris T, Papageorghiou AT. Scientific basis for standardization of fetal head measurements by ultrasound: a reproducibility study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:80-5. [PMID: 27158767 PMCID: PMC5113683 DOI: 10.1002/uog.15956] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/27/2016] [Accepted: 04/29/2016] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To compare the standard methods for ultrasound measurement of fetal head circumference (HC) and biparietal diameter (BPD) (outer-to-outer (BPDoo) vs outer-to-inner (BPDoi) caliper placement), and compare acquisition of these measurements in transthalamic (TT) vs transventricular (TV) planes. METHODS This study utilized ultrasound images acquired from women participating in the Oxford arm of the INTERGROWTH-21(st) Project. In the first phase of the study, BPDoo and BPDoi were measured on stored images. In the second phase, real-time measurements of BPD, occipitofrontal diameter (OFD) and HC in TT and TV planes were obtained by pairs of sonographers. Reproducibility of measurements made by the same (intraobserver) and by different (interobserver) sonographers, as well as the reproducibility of caliper placement and measurements obtained in different planes, was assessed using Bland-Altman plots. RESULTS In Phase I, we analyzed ultrasound images of 108 singleton fetuses. The mean intraobserver and interobserver differences were < 2% (1.34 mm) and the 95% limits of agreement were < 5% (3 mm) for both BPDoo and BPDoi. Neither method for measuring BPD showed consistently better reproducibility. In Phase II, we analyzed ultrasound images of 100 different singleton fetuses. The mean intraobserver and interobserver differences were < 1% (2.26 mm) and the 95% limits of agreement were < 8% (14.45 mm) for all fetal head measurements obtained in TV and TT planes. Neither plane for measuring fetal head showed consistently better reproducibility. Measurement of HC using the ellipse facility was as reproducible as HC calculated from BPD and OFD. OFD by itself was the least reproducible of all fetal head measurements. CONCLUSIONS Measurements of BPDoi and BPDoo are equally reproducible; however, we believe BPDoo should be used in clinical practice as it allows fetal HC to be measured and compared with neonatal HC. For all head measurements, TV and TT planes provide equally reproducible values at any gestational age, and HC values are similar in both planes. Fetal head measurement in the TT plane is preferable as international standards in this plane are available; however, measurements in the TV plane can be plotted on the same standards. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R. Napolitano
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
| | - V. Donadono
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
| | - E. O. Ohuma
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
- Oxford Maternal & Perinatal Health Institute, Green Templeton CollegeUniversity of OxfordOxfordUK
- Centre for Statistics in Medicine, Botnar Research CentreUniversity of OxfordOxfordUK
| | - C. L. Knight
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
| | - S. Z. Wanyonyi
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
| | - B. Kemp
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
| | - T. Norris
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
| | - A. T. Papageorghiou
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
- Oxford Maternal & Perinatal Health Institute, Green Templeton CollegeUniversity of OxfordOxfordUK
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Karl S, Li Wai Suen CSN, Unger HW, Ome-Kaius M, Mola G, White L, Wangnapi RA, Rogerson SJ, Mueller I. Preterm or not--an evaluation of estimates of gestational age in a cohort of women from Rural Papua New Guinea. PLoS One 2015; 10:e0124286. [PMID: 25945927 PMCID: PMC4422681 DOI: 10.1371/journal.pone.0124286] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Knowledge of accurate gestational age is required for comprehensive pregnancy care and is an essential component of research evaluating causes of preterm birth. In industrialised countries gestational age is determined with the help of fetal biometry in early pregnancy. Lack of ultrasound and late presentation to antenatal clinic limits this practice in low-resource settings. Instead, clinical estimators of gestational age are used, but their accuracy remains a matter of debate. METHODS In a cohort of 688 singleton pregnancies from rural Papua New Guinea, delivery gestational age was calculated from Ballard score, last menstrual period, symphysis-pubis fundal height at first visit and quickening as well as mid- and late pregnancy fetal biometry. Published models using sequential fundal height measurements and corrected last menstrual period to estimate gestational age were also tested. Novel linear models that combined clinical measurements for gestational age estimation were developed. Predictions were compared with the reference early pregnancy ultrasound (<25 gestational weeks) using correlation, regression and Bland-Altman analyses and ranked for their capability to predict preterm birth using the harmonic mean of recall and precision (F-measure). RESULTS Average bias between reference ultrasound and clinical methods ranged from 0-11 days (95% confidence levels: 14-42 days). Preterm birth was best predicted by mid-pregnancy ultrasound (F-measure: 0.72), and neuromuscular Ballard score provided the least reliable preterm birth prediction (F-measure: 0.17). The best clinical methods to predict gestational age and preterm birth were last menstrual period and fundal height (F-measures 0.35). A linear model combining both measures improved prediction of preterm birth (F-measure: 0.58). CONCLUSIONS Estimation of gestational age without ultrasound is prone to significant error. In the absence of ultrasound facilities, last menstrual period and fundal height are among the more reliable clinical measures. This study underlines the importance of strengthening ultrasound facilities and developing novel ways to estimate gestational age.
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Affiliation(s)
- Stephan Karl
- Walter and Eliza Hall Institute of Medical Research (WEHI), Melbourne, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Australia
| | - Connie S. N. Li Wai Suen
- Walter and Eliza Hall Institute of Medical Research (WEHI), Melbourne, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Australia
| | - Holger W. Unger
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia
- Papua New Guinea Institute of Medical Research (PNG IMR), Goroka, Papua New Guinea
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research (PNG IMR), Goroka, Papua New Guinea
| | - Glen Mola
- Department of Obstetrics and Gynaecology, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Lisa White
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Regina A. Wangnapi
- Papua New Guinea Institute of Medical Research (PNG IMR), Goroka, Papua New Guinea
| | - Stephen J. Rogerson
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research (WEHI), Melbourne, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Australia
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- * E-mail:
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Unger HW, Karl S, Wangnapi RA, Siba P, Mola G, Walker J, Mueller I, Ome M, Rogerson SJ. Fetal size in a rural melanesian population with minimal risk factors for growth restriction: an observational ultrasound study from Papua New Guinea. Am J Trop Med Hyg 2014; 92:178-86. [PMID: 25385863 DOI: 10.4269/ajtmh.14-0423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We conducted a prospective longitudinal study of fetal size in rural Papua New Guinea (PNG) involving 439 ultrasound-dated singleton pregnancies with no obvious risk factors for growth restriction. Sonographically estimated fetal weights (EFWs; N = 788) and birth weights (N = 376) were included in a second-order polynomial regression model (optimal fit) to generate fetal weight centiles. Means for specific fetal biometric measurements were also estimated. Fetal weight centiles from a healthy PNG cohort were consistently lower than those derived from Caucasian and Congolese populations, which overestimated the proportion of fetuses measuring small for gestational age (SGA; < 10th centile). Tanzanian and global reference centiles (Caucasian weight reference adapted to our PNG cohort) were more similar to those observed in our cohort, but the global reference underestimated SGA. Individual biometric measurements did not differ significantly from other cohorts. In rural PNG, a locally derived nomogram may be most appropriate for detection of SGA fetuses.
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Affiliation(s)
- Holger W Unger
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Walter and Eliza Hall Institute (WEHI), Parkville, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Obstetrics and Gynaecology, University of Papua New Guinea, Port Moresby, Papua New Guinea; Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Stephan Karl
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Walter and Eliza Hall Institute (WEHI), Parkville, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Obstetrics and Gynaecology, University of Papua New Guinea, Port Moresby, Papua New Guinea; Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Regina A Wangnapi
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Walter and Eliza Hall Institute (WEHI), Parkville, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Obstetrics and Gynaecology, University of Papua New Guinea, Port Moresby, Papua New Guinea; Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Peter Siba
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Walter and Eliza Hall Institute (WEHI), Parkville, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Obstetrics and Gynaecology, University of Papua New Guinea, Port Moresby, Papua New Guinea; Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Glen Mola
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Walter and Eliza Hall Institute (WEHI), Parkville, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Obstetrics and Gynaecology, University of Papua New Guinea, Port Moresby, Papua New Guinea; Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Jane Walker
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Walter and Eliza Hall Institute (WEHI), Parkville, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Obstetrics and Gynaecology, University of Papua New Guinea, Port Moresby, Papua New Guinea; Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Ivo Mueller
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Walter and Eliza Hall Institute (WEHI), Parkville, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Obstetrics and Gynaecology, University of Papua New Guinea, Port Moresby, Papua New Guinea; Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Maria Ome
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Walter and Eliza Hall Institute (WEHI), Parkville, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Obstetrics and Gynaecology, University of Papua New Guinea, Port Moresby, Papua New Guinea; Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Stephen J Rogerson
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Walter and Eliza Hall Institute (WEHI), Parkville, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Obstetrics and Gynaecology, University of Papua New Guinea, Port Moresby, Papua New Guinea; Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
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Briceño F, Restrepo H, Paredes R, Cifuentes R. Charts for fetal age assessment based on fetal sonographic biometry in a population from Cali, Colombia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:2135-2143. [PMID: 24277896 DOI: 10.7863/ultra.32.12.2135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To create reference charts for fetal age assessment based on fetal sonographic biometry in a population of pregnant women living in the third largest city in Colombia and compare them with charts included in ultrasound machines. METHODS The study data were obtained from women with a single pregnancy and confirmed gestational age between 12 and 40 completed weeks. All women were recruited specifically for the study, and every fetus was measured only once for biparietal diameter, head circumference, abdominal circumference, and femur length. Polynomial regression models for gestational age as a function of each fetal measurement were fitted to estimate the mean and standard deviation. Percentile curves of gestational age were constructed for each fetal measurement using these regression models. RESULTS Biparietal diameter, head circumference, abdominal circumference, and femur length were measured in 792 fetuses. Tables and charts of gestational age were derived for each fetal parameter. A cubic polynomial model was the best-fitted regression model to describe the relationships between gestational age and each fetal measurement. The standard deviation was estimated by simple linear regression as a function of each fetal measurement. Comparison of our gestational age mean z scores with those calculated by reference equations showed statistically significant differences (P < .01). CONCLUSIONS We present a set of reference charts, tables, and formulas for fetal age assessment based on fetal sonographic biometry. The results support the recommendation that these charts and tables could be more appropriate for assessing fetal age in Colombian populations than those currently included in the software of ultrasound machines.
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Affiliation(s)
- Freddy Briceño
- Children's Heart Center Nevada, 3006 S Maryland Pkwy, Suite 690, Las Vegas, NV 89109 USA.
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Schmiegelow C, Scheike T, Oesterholt M, Minja D, Pehrson C, Magistrado P, Lemnge M, Rasch V, Lusingu J, Theander TG, Nielsen BB. Development of a fetal weight chart using serial trans-abdominal ultrasound in an East African population: a longitudinal observational study. PLoS One 2012; 7:e44773. [PMID: 23028617 PMCID: PMC3448622 DOI: 10.1371/journal.pone.0044773] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 08/07/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To produce a fetal weight chart representative of a Tanzanian population, and compare it to weight charts from Sub-Saharan Africa and the developed world. Methods A longitudinal observational study in Northeastern Tanzania. Pregnant women were followed throughout pregnancy with serial trans-abdominal ultrasound. All pregnancies with pathology were excluded and a chart representing the optimal growth potential was developed using fetal weights and birth weights. The weight chart was compared to a chart from Congo, a chart representing a white population, and a chart representing a white population but adapted to the study population. The prevalence of SGA was assessed using all four charts. Results A total of 2193 weight measurements from 583 fetuses/newborns were included in the fetal weight chart. Our chart had lower percentiles than all the other charts. Most importantly, in the end of pregnancy, the 10th percentiles deviated substantially causing an overestimation of the true prevalence of SGA newborns if our chart had not been used. Conclusions We developed a weight chart representative for a Tanzanian population and provide evidence for the necessity of developing regional specific weight charts for correct identification of SGA. Our weight chart is an important tool that can be used for clinical risk assessments of newborns and for evaluating the effect of intrauterine exposures on fetal and newborn weight.
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Affiliation(s)
- Christentze Schmiegelow
- Centre for Medical Parasitology, Institute of International Health, Immunology, and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark.
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