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Jacobson MH, Wang Y, Long SE, Liu M, Ghassabian A, Kahn LG, Afanasyeva Y, Brubaker SG, Mehta-Lee SS, Trasande L. The Effect of Maternal US Nativity on Racial/Ethnic Differences in Fetal Growth. Am J Epidemiol 2022; 191:1568-1583. [PMID: 35434731 PMCID: PMC9618163 DOI: 10.1093/aje/kwac072] [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: 03/01/2022] [Revised: 03/01/2022] [Accepted: 04/06/2022] [Indexed: 01/29/2023] Open
Abstract
While racial/ethnic differences in fetal growth have been documented, few studies have examined whether they vary by exogenous factors, which could elucidate underlying causes. The purpose of this study was to characterize longitudinal fetal growth patterns by maternal sociodemographic, behavioral, and clinical factors and examine whether associations with maternal race/ethnicity varied by these other predictors. Between 2016 and 2019, pregnant women receiving prenatal care at NYU Langone Health (New York, New York) were invited to participate in a birth cohort study. Women completed questionnaires, and clinical data were abstracted from ultrasound examinations. Maternal characteristics were assessed in relation to fetal biometric measures throughout pregnancy using linear mixed models. Maternal race/ethnicity was consistently associated with fetal biometry: Black, Hispanic, and Asian women had fetuses with smaller head circumference, abdominal circumference, and biparietal diameter than White women. The associations between race/ethnicity and fetal growth varied by nativity for Asian women, such that the disparity between Asian and White women was much greater for US-born women than for foreign-born women. However, associations for Black and Hispanic women did not vary by nativity. While race/ethnicity-specific fetal growth standards have been proposed, additional work is needed to elucidate what could be driving these differences, including factors that occur in parallel and differentially affect fetal growth.
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Affiliation(s)
- Melanie H Jacobson
- Correspondence to Dr. Melanie H. Jacobson, Department of Pediatrics, Grossman School of Medicine, New York University, 227 East 30th Street, 8th Floor, New York, NY 10016 (e-mail: )
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Zou JJ, Wei Q, Shi YY, Wang K, Zhang YH, Shi HJ. Longitudinal Associations Between Maternal Glucose Levels and Ultrasonographic Fetal Biometrics in a Shanghai Cohort. JAMA Netw Open 2022; 5:e226407. [PMID: 35389498 PMCID: PMC8990351 DOI: 10.1001/jamanetworkopen.2022.6407] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Evidence on the timing of fetal growth alterations associated with gestational diabetes or on the association of the maternal glycemic trajectory with fetal growth during pregnancy remains lacking. OBJECTIVE To examine the associations between maternal glucose levels and offspring intrauterine growth. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from 4574 eligible pregnant women and their offspring in the Shanghai Maternal-Child Pairs Cohort collected from April 10, 2016, to April 30, 2018. Group-based trajectory modeling was used to classify fasting plasma glucose levels during pregnancy into 3 glycemic trajectories (trajectory 1, consistently normal glucose levels in all 3 trimesters; trajectory 2, hyperglycemia only in late pregnancy; and trajectory 3, hyperglycemia in all 3 trimesters [ie, consistently high glucose levels]). Statistical analysis was performed from April 25, 2020, to October 1, 2021. EXPOSURES Gestational diabetes, which was defined using the results of an oral glucose tolerance test. MAIN OUTCOMES AND MEASURES Longitudinal fetal biometrics during gestational weeks 11 to 40 and birth outcomes were obtained from medical records. Pregnancy was partitioned into 3 periods (<24, 24-34, and >34 weeks' gestational age). The differences in offspring growth (log-transformed) and maternal glucose levels were compared using generalized linear mixed models. RESULTS A total of 4121 pregnant women had oral glucose tolerance test results (mean [SD] age, 28.8 [4.1] years), 3746 of whom had glycemic trajectory data (mean [SD] age, 28.6 [4.1] years); 983 women (23.8%) had gestational diabetes. Throughout the pregnancy period and compared with the women without gestational diabetes or with women in the trajectory 1 group, the fetal biometrics for the women with gestational diabetes or for those in the trajectory 3 group were significantly higher (except for biparietal diameter), with an estimated increase in fetal weight in the group with gestational diabetes (β = 1.82; 95% CI, 1.03-2.61) and in the trajectory 3 group (β = 1.50; 95% CI, 0.54-2.47; P = .002). Fetal biometric alterations among women with gestational diabetes appeared before 24 weeks' gestational age, with neonatal birth weight significantly higher than in the group without gestational diabetes at 40.4 g (95% CI, 9.8-71.1 g) along with an increased risk of large size for gestational age (odds ratio, 1.36; 95% CI, 1.05-1.75) and macrosomia (odds ratio, 1.47; 95% CI, 1.12-1.94). However, pregnant women in the trajectory 2 group manifested significantly reduced fetal biometrics, and abdominal circumference was significantly augmented after 34 weeks' gestational age (increase, β = 1.92; 95% CI, 0.87-2.99). CONCLUSIONS AND RELEVANCE In this cohort study, pregnant women who received a diagnosis of gestational diabetes in midpregnancy or had hyperglycemia during all 3 trimesters showed an association with altered fetal growth patterns, including increased estimated fetal weight that appeared before 24 weeks' gestational age, increased birth weight, and the risk for large size for gestational age and macrosomia.
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Affiliation(s)
- Jiao-jiao Zou
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Qian Wei
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Yu-yang Shi
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Ke Wang
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Yun-hui Zhang
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Hui-jing Shi
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
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Mustafa HJ, Tessier KM, Reagan LA, Luo X, Contag SA. Fetal growth standards for Somali population. J Matern Fetal Neonatal Med 2019; 34:2440-2453. [PMID: 31544565 DOI: 10.1080/14767058.2019.1667327] [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: 10/25/2022]
Abstract
BACKGROUND Accurate assessment of fetal size is essential in providing optimal prenatal care. National Institute of Child Health and Human Development (NICHD) study from 2015 demonstrated that estimated fetal weight (EFW) differed significantly by race/ethnicity after 20 weeks. There is a large Somali population residing in Minnesota, many of whom are cared for at our maternal fetal medicine practice at the University of Minnesota. Anecdotally, we noticed an increased proportion of small-for-gestational age diagnoses within this population. We sought to use our ultrasound data to create a reference standard specific for this population and compare to currently applied references. PURPOSE We aimed to model fetal growth standards within a healthy Somali population between 16 and 40 weeks gestation, and address possible differences in the growth patterns compared with standards for non-Hispanic White, non-Hispanic Black, Hispanic, and Asian singleton fetuses published by the NICHD in the Fetal Growth Study. MATERIALS AND METHODS This is a retrospective cohort study using ultrasound data from 527 low risk pregnancies of Somali ethnicity at single tertiary care center between 2011 and 2017. A total of 1107 scans were identified for these pregnancies and maternal and obstetrical data were reviewed. Women 18-40 years of age with low-risk pregnancies and established dating consistent with first trimester ultrasound scan were included. Exclusion criteria were any maternal, fetal or obstetrical conditions known to affect fetal growth. RESULTS Estimated fetal weight among Somali pregnancies differed significantly at some time points from the NICHD four ethnic groups, but generally the EFW graph curves crossed over at most time points between the study groups. At week 18, EFW was significantly larger than all other four ethnic groups (all p<.001), it was also significantly larger from the Hispanic, Black, and Asian ethnic groups at some time points between 18 and 27 weeks gestation (p < .05). Additionally, EFW among Somali pregnancies was significantly smaller than the Black and Asian ethnicity at 32 and 35-36 weeks and smaller than the White ethnicity at 30 and 38-39 weeks (p < .05). Abdominal circumference (AC) for the Somali population was significantly smaller than the other ethnic groups, especially than the White ethnicity at various time points across 16-40 weeks (p < .05). Femur and humerus length were significantly longer when compared to all other ethnic groups at most time points from 16 to 40 weeks of gestation (p < .05). Biparietal diameter (BPD) was significantly smaller than all other ethnic groups specifically at time of fetal survey (18 weeks) and at time of fetal growth assessment (32 weeks) (p < .05). CONCLUSIONS Significant differences in fetal growth standards were found between the Somali ethnicity and other ethnic groups (White, Black, Asian, and Hispanic) at various time points from 16 to 40 weeks of gestation. Racial/ethnic-specific standards improve the precision for evaluating fetal growth and may decrease the proportion of fetuses of Somali ethnicity labeled as small-for-gestational age.
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Affiliation(s)
- Hiba J Mustafa
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA
| | - Katelyn M Tessier
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA
| | - Lauren A Reagan
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA
| | - Xianghua Luo
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA
| | - Stephen A Contag
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA
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Nahirney M, Chaput KH, Metcalfe A. Assessing the role of maternal race on the prediction of NICU admission by three growth charts: a cross-sectional study. J Matern Fetal Neonatal Med 2019; 34:1233-1240. [PMID: 31189402 DOI: 10.1080/14767058.2019.1631791] [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: 10/26/2022]
Abstract
BACKGROUND The National Institutes of Health (NIH) race-specific and Intergrowth 21st race-independent fetal growth standards have recently been developed to assess fetal growth although the Alexander reference has been commonly used for over two decades. Societies are becoming increasingly stratified by race, and thus fetal growth effects are increasingly socially-derived. Relatedly, there is discussion surrounding the utility of classifying fetal growth on the basis of ideal growth versus typical growth. Therefore, we aimed to evaluate the classification discrepancies for small for gestational age (SGA) or large for gestational age (LGA) infants between growth charts, stratified by maternal race; and to determine which chart most accurately identifies vulnerable infants requiring NICU (Neonatal Intensive Care Unit) admission. METHODS This cross-sectional study examined singleton liveborn infants born between 33 and 42 weeks of gestation with a self-identified White, Black, Hispanic, or Asian mother. Data were obtained from the 2014 National Centre of Health Statistics' Vital Statistics Natality files. SGA infants were considered those <10th percentile and LGA were those >90th percentile, for each growth chart. SGA and LGA classification by maternal race was evaluated using stratified analysis and logistic regression. Odds ratios and goodness of fit characteristics were assessed to determine which chart best predicted NICU admission. RESULTS In our sample of 3,782,660 singleton infants, significantly different proportions of infants were classified SGA/LGA using the Alexander (SGA: 4.6%, LGA:19.4%), Intergrowth 21st (SGA: 4.0%, LGA:19.6%), and NIH (SGA: 9.8%, LGA: 8.5%) charts. Race-specific classification of SGA differed by race and chart; there was an 8.4% difference in white infants considered SGA by Intergrowth (3.3; 95% CI, 3.2-3.3) compared to NIH (11.7%; 95% CI, 11.6-11.7). The NIH and Intergrowth 21st charts were typically in agreement for both SGA and LGA, differing substantially from the Alexander reference; however, there were significant differences between Intergrowth and NIH for proportions of SGA (NIH: 10.2%, CI 95%, 10.1-10.2; Intergrowth: 4.0%, CI 95%, 3.9-4.0) and LGA (NIH: 6.3%, CI 95%, 6.3-6.4; Intergrowth: 19.6%, CI 95%, 19.5-19.6) infants. Overall, 11.1% of Black infants were considered SGA by NIH and 6.8% by Intergrowth-more often than other races. Intergrowth classified the fewest infants as SGA and Alexander classified the most as SGA for all races. While NIH was better at discriminating LGA (OR: 2.72) and SGA-associated (OR: 1.71) NICU admissions compared to other charts, no standard was a significantly better predictor of NICU admission. CONCLUSION Since the NIH standard identified the fewest LGA infants and the Intergrowth 21st standard identified the fewest SGA infants, these charts may have been better identifiers of infants on either extreme of growth. The agreement between NIH and Intergrowth 21st charts suggest their interchangeable use for healthy populations, but the NIH may be more applicable given its racial stratification. However, the differences in proportions of SGA/LGA infants among the three charts according to maternal race introduce significant clinical ambiguity when identifying vulnerable infants. Additionally, no chart was able to accurately identify vulnerable infants and the dataset did not permit differentiation between growth-restricted and constitutionally small infants. Further work is necessary before selecting a true gold standard for use in routine clinical practice.
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Affiliation(s)
- Marissa Nahirney
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | | | - Amy Metcalfe
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Medicine, University of Calgary, Calgary, Canada
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Grewal J, Grantz KL, Zhang C, Sciscione A, Wing DA, Grobman WA, Newman RB, Wapner R, D'Alton ME, Skupski D, Nageotte MP, Ranzini AC, Owen J, Chien EK, Craigo S, Albert PS, Kim S, Hediger ML, Buck Louis GM. Cohort Profile: NICHD Fetal Growth Studies-Singletons and Twins. Int J Epidemiol 2019; 47:25-25l. [PMID: 29025016 DOI: 10.1093/ije/dyx161] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jagteshwar Grewal
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Katherine L Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE
| | - Deborah A Wing
- Division of Maternal-Fetal Medicine, Department of Obstetrics-Gynecology, School of Medicine, University of California, Irvine, CA
- Fountain Valley Regional Hospital and Medical Center, Fountain Valley, CA
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Roger B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
| | - Daniel Skupski
- Department of Obstetrics and Gynecology, New York Hospital Queens, Queens, NY
| | - Michael P Nageotte
- Department of Obstetrics and Gynecology, Miller Children's Hospital/Long Beach Memorial Medical Center, Long Beach, CA
| | - Angela C Ranzini
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, St Peter's University Hospital, New Brunswick, NJ
| | - John Owen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of Alabama, Birmingham, AL
| | - Edward K Chien
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Sabrina Craigo
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - 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
| | - Sungduk Kim
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Mary L Hediger
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Germaine M Buck Louis
- 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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Brand JS, West J, Tuffnell D, Bird PK, Wright J, Tilling K, Lawlor DA. Gestational diabetes and ultrasound-assessed fetal growth in South Asian and White European women: findings from a prospective pregnancy cohort. BMC Med 2018; 16:203. [PMID: 30396349 PMCID: PMC6219043 DOI: 10.1186/s12916-018-1191-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 10/10/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Maternal gestational diabetes (GDM) is an established risk factor for large size at birth, but its influence on intrauterine fetal growth in different ethnic populations is less well understood. Here, we examine the joint associations of GDM and ethnicity with longitudinal fetal growth in South Asian and White European origin women. METHODS This study included 10,705 singletons (4747 White European and 5958 South Asian) from a prospective cohort of women attending an antenatal clinic in Bradford, in the North of England. All women completed a 75-g oral glucose tolerance test at 26-28 weeks' gestation. Ultrasound measurements of fetal head circumference (HC), femur length (FL) abdominal circumference (AC), and estimated fetal weight (EFW), and corresponding anthropometric measurements at birth were used to derive fetal growth trajectories. Associations of GDM and ethnicity with these trajectories were assessed using multilevel fractional polynomial models. RESULTS Eight hundred thirty-two pregnancies (7.8%) were affected by GDM: 10.4% of South Asians and 4.4% of White Europeans. GDM was associated with a smaller fetal size in early pregnancy [differences (95% CI) in mean HC at 12 weeks and mean AC and EFW at 16 weeks comparing fetuses exposed to GDM to fetuses unexposed (reference) = - 1.8 mm (- 2.6; - 1.0), - 1.7 mm (- 2.5; - 0.9), and - 6 g (- 10; - 2)] and a greater fetal size from 24 weeks' gestation through to term [differences (95% CI) in mean HC, AC, and EFW comparing fetuses exposed to GDM to those unexposed = 0.9 mm (0.3; 1.4), 0.9 mm (0.2; 1.7), and 7 g (0; 13) at 24 weeks]. Associations of GDM with fetal growth were of similar magnitude in both ethnic groups. Growth trajectories, however, differed by ethnicity with South Asians being smaller than White Europeans irrespective of GDM status. Consequently, South Asian fetuses exposed to GDM were smaller across gestation than fetuses of White Europeans without GDM. CONCLUSIONS In both ethnic groups, GDM is associated with early fetal size deviations prior to GDM diagnosis, highlighting the need for novel strategies to diagnose pregnancy hyperglycemia earlier than current methods. Our findings also suggest that ethnic-specific fetal growth criteria are important in identifying hyperglycemia-associated pathological effects.
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Affiliation(s)
- Judith S Brand
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, Bristol, UK
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Jane West
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Derek Tuffnell
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Philippa K Bird
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
- Population Health Science, Bristol Medical School, Bristol, UK.
- NIHR Bristol Biomedical Research Centre, Bristol, UK.
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van de Kamp K, Pajkrt E, Zwinderman A, van der Post J, Snijders R. Validation of Reference Charts for Mid-Trimester Fetal Biometry. Fetal Diagn Ther 2018. [DOI: 10.1159/000486094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Shen Y, Zhao W, Lin J, Liu F. Accuracy of sonographic fetal weight estimation prior to delivery in a Chinese han population. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:465-471. [PMID: 28332212 DOI: 10.1002/jcu.22463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/07/2017] [Accepted: 01/22/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compare the sonographic-estimated fetal weights (EFW) calculated with the Hadlock formula and with the Woo formula in a group of Chinese pregnant women. METHODS We prospectively recruited term pregnancies for sonographic biometric examination. EFWs were calculated according to two formulas and compared with the corresponding birth weight (BW). We also assessed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of EFW for the diagnosis of small-for-gestational age (SGA) and large-for-gestational age (LGA) neonates. RESULTS A total of 374 subjects who delivered within 7 days after the sonographic examinations was recruited. Using the Hadlock formula, the median absolute difference between EFW and BW was 182 g (15-308 g) and the median percentage difference was 5.3% (0.5-9.1%), whereas it was 230 g (62-367) and 7.1% (2.1-10.4%) for the Woo formula (p < 0.001). Several factors, namely the fetal presentation, gender, and high amniotic quantity, showed no evident impact on this predictive difference. Among the 175 women who delivered within 2 days after ultrasound, the sensitivity and specificity of Hadlock EFW were 100% and 97.1% for the detection of SGA and 48.1% and 97.3% for the detection of LGA, respectively. The PPV and NPV were 44.4% and 100.0% for the detection of SGA and 76.5% and 91.1% for the detection of LGA, respectively. CONCLUSIONS EFWs calculated using the Hadlock formula for our research subjects were as accurate as those reported for other populations. The predictive performance showed a high NPV for the diagnosis of SGA and a relatively acceptable PPV for the diagnosis of LGA. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:465-471, 2017.
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Affiliation(s)
- Yao Shen
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China
| | - WeiXiu Zhao
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China
| | - JianHua Lin
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China
| | - FangSun Liu
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China
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Buck Louis GM, Grewal J, Albert PS, Sciscione A, Wing DA, Grobman WA, Newman RB, Wapner R, D'Alton ME, Skupski D, Nageotte MP, Ranzini AC, Owen J, Chien EK, Craigo S, Hediger ML, Kim S, Zhang C, Grantz KL. Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies. Am J Obstet Gynecol 2015; 213:449.e1-449.e41. [PMID: 26410205 DOI: 10.1016/j.ajog.2015.08.032] [Citation(s) in RCA: 317] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/20/2015] [Accepted: 08/10/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fetal growth is associated with long-term health yet no appropriate standards exist for the early identification of undergrown or overgrown fetuses. We sought to develop contemporary fetal growth standards for 4 self-identified US racial/ethnic groups. STUDY DESIGN We recruited for prospective follow-up 2334 healthy women with low-risk, singleton pregnancies from 12 community and perinatal centers from July 2009 through January 2013. The cohort comprised: 614 (26%) non-Hispanic whites, 611 (26%) non-Hispanic blacks, 649 (28%) Hispanics, and 460 (20%) Asians. Women were screened at 8w0d to 13w6d for maternal health status associated with presumably normal fetal growth (aged 18-40 years; body mass index 19.0-29.9 kg/m(2); healthy lifestyles and living conditions; low-risk medical and obstetrical history); 92% of recruited women completed the protocol. Women were randomized among 4 ultrasonography schedules for longitudinal fetal measurement using the Voluson E8 (GE Healthcare, Milwaukee, WI). In-person interviews and anthropometric assessments were conducted at each visit; medical records were abstracted. The fetuses of 1737 (74%) women continued to be low risk (uncomplicated pregnancy, absent anomalies) at birth, and their measurements were included in the standards. Racial/ethnic-specific fetal growth curves were estimated using linear mixed models with cubic splines. Estimated fetal weight (EFW) and biometric parameter percentiles (5th, 50th, 95th) were determined for each gestational week and comparisons made by race/ethnicity, with and without adjustment for maternal and sociodemographic factors. RESULTS EFW differed significantly by race/ethnicity >20 weeks. Specifically at 39 weeks, the 5th, 50th, and 95th percentiles were 2790, 3505, and 4402 g for white; 2633, 3336, and 4226 g for Hispanic; 2621, 3270, and 4078 g for Asian; and 2622, 3260, and 4053 g for black women (adjusted global P < .001). For individual parameters, racial/ethnic differences by order of detection were: humerus and femur lengths (10 weeks), abdominal circumference (16 weeks), head circumference (21 weeks), and biparietal diameter (27 weeks). The study-derived standard based solely on the white group erroneously classifies as much as 15% of non-white fetuses as growth restricted (EFW <5th percentile). CONCLUSION Significant differences in fetal growth were found among the 4 groups. Racial/ethnic-specific standards improve the precision in evaluating fetal growth.
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Affiliation(s)
- Germaine M Buck Louis
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
| | - Jagteshwar Grewal
- 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
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE
| | - Deborah A Wing
- Division of Maternal-Fetal Medicine, Department of Obstetrics-Gynecology, University of California, Irvine, School of Medicine, Irvine, and Fountain Valley Regional Hospital and Medical Center, Fountain Valley, CA
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Roger B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
| | - Daniel Skupski
- Department of Obstetrics and Gynecology, New York Hospital Queens, Queens, NY
| | - Michael P Nageotte
- Department of Obstetrics and Gynecology, Miller Children's Hospital/Long Beach Memorial Medical Center, Long Beach, CA
| | - Angela C Ranzini
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, St Peter's University Hospital, New Brunswick, NJ
| | - John Owen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology University of Alabama, Birmingham, School of Medicine, Birmingham, AL
| | - Edward K Chien
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Sabrina Craigo
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - Mary L Hediger
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Sungduk Kim
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Katherine L Grantz
- 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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Abstract
OBJECTIVES Impaired or excessive fetal growth is associated with adverse short- and long-term health outcomes that differ between ethnic groups. We explored ethnic differences in fetal size and growth from mid pregnancy until birth. METHODS Data are from the multi-ethnic STORK-Groruddalen study, a population-based, prospective cohort of 823 pregnant women and their offspring in Oslo, Norway. Measures were z-scores of estimated fetal weight (EFW), head circumference (HC), abdominal circumference (AC) and femur length (FL), in gestational week 24, 32 and 37, measured by ultrasound, and similar measures at birth. Differences in fetal size and growth were assessed using separate Linear Mixed Models including all four time points, with ethnic Europeans as reference. RESULTS In week 24 South Asian fetuses had smaller AC, but larger FL than Europeans, and slightly lower EFW (-0.17 SD (-0.33, -0.01), p=0.04). Middle East/North African fetuses also had larger FL, but similar AC, and hence slightly higher EFW (0.18 (0.003, 0.36), p=0.05). Both groups had slower growth of AC, FL and EFW from this time until birth, and had -0.61 SD (-0.73, -0.49) and -0.28 SD (-0.41, -0.15) lower birth weight respectively. Ethnic East Asians, on the other hand, were smaller throughout pregnancy and had -0.58 SD (-0.82, -0.34) lower birth weight. Significant ethnic differences remained after adjusting for maternal factors. CONCLUSION We observed ethnic differences in fetal size and body proportions already in gestational week 24, and in fetal growth from this time until birth, which were only partly explained by key maternal factors.
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11
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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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