International estimated fetal weight standards of the INTERGROWTH-21st Project
Julien Stirnemann,José Villar,Laurent Salomon,Eric O Ohuma,Eric O Ohuma,P Ruyan,Douglas G. Altman,François Nosten,R Craik,Shama Munim,L Cheikh Ismail,F C Barros,F C Barros,A Lambert,Shane A. Norris,M Carvalho,Y A Jaffer,J.A. Noble,Enrico Bertino,M G Gravett,Manorama Purwar,Cesar G. Victora,Ricardo Uauy,Ricardo Uauy,Zulfiqar A Bhutta,Stephen Kennedy,Aris T. Papageorghiou +26 more
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TLDR
The aim was to provide international EFW standards to complement the INTERGROWTH‐21st Fetal Growth Standards that are available for use worldwide.Abstract:
Objective
Estimated fetal weight (EFW) and fetal biometry are complementary measures used to screen for fetal growth disturbances. Our aim was to provide international EFW standards to complement the INTERGROWTH-21st Fetal Growth Standards that are available for use worldwide.
Methods
Women with an accurate gestational-age assessment, who were enrolled in the prospective, international, multicenter, population-based Fetal Growth Longitudinal Study (FGLS) and INTERBIO-21st Fetal Study (FS), two components of the INTERGROWTH-21st Project, had ultrasound scans every 5 weeks from 9–14 weeks' until 40 weeks' gestation. At each visit, measurements of fetal head circumference (HC), biparietal diameter, occipitofrontal diameter, abdominal circumference (AC) and femur length (FL) were obtained blindly by dedicated research sonographers using standardized methods and identical ultrasound machines. Birth weight was measured within 12 h of delivery by dedicated research anthropometrists using standardized methods and identical electronic scales. Live babies without any congenital abnormality, who were born within 14 days of the last ultrasound scan, were selected for inclusion. As most births occurred at around 40 weeks' gestation, we constructed a bootstrap model selection and estimation procedure based on resampling of the complete dataset under an approximately uniform distribution of birth weight, thus enriching the sample size at extremes of fetal sizes, to achieve consistent estimates across the full range of fetal weight. We constructed reference centiles using second-degree fractional polynomial models.
Results
Of the overall population, 2404 babies were born within 14 days of the last ultrasound scan. Mean time between the last scan and birth was 7.7 (range, 0–14) days and was uniformly distributed. Birth weight was best estimated as a function of AC and HC (without FL) as log(EFW) = 5.084820 − 54.06633 × (AC/100)3 − 95.80076 × (AC/100)3 × log(AC/100) + 3.136370 × (HC/100), where EFW is in g and AC and HC are in cm. All other measures, gestational age, symphysis–fundus height, amniotic fluid indices and interactions between biometric measures and gestational age, were not retained in the selection process because they did not improve the prediction of EFW. Applying the formula to FGLS biometric data (n = 4231) enabled gestational age-specific EFW tables to be constructed. At term, the EFW centiles matched those of the INTERGROWTH-21st Newborn Size Standards but, at < 37 weeks' gestation, the EFW centiles were, as expected, higher than those of babies born preterm. Comparing EFW cross-sectional values with the INTERGROWTH-21st Preterm Postnatal Growth Standards confirmed that preterm postnatal growth is a different biological process from intrauterine growth.
Conclusions
We provide an assessment of EFW, as an adjunct to routine ultrasound biometry, from 22 to 40 weeks' gestation. However, we strongly encourage clinicians to evaluate fetal growth using separate biometric measures such as HC and AC, as well as EFW, to avoid the minimalist approach of focusing on a single value. © 2016 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.read more
Citations
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ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth
Laurent Salomon,Zarko Alfirevic,F. da Silva Costa,F. da Silva Costa,Russell L. Deter,F. Figueras,Tullio Ghi,Phyllis Glanc,Asma Khalil,Asma Khalil,Wesley Lee,R. Napolitano,Aris T. Papageorghiou,Aris T. Papageorghiou,Alexandros Sotiriadis,Julien Stirnemann,Ants Toi,George S. H. Yeo +17 more
TL;DR: Screening for, and adequate management of, fetal growth abnormalities are essential components of antenatal care, and fetal ultrasound plays a key role in assessment ofThese Guidelines aim to describe appropriate assessment of fetal biometry and diagnosis of fetal growth disorders.
Journal ArticleDOI
Fetal Medicine Foundation fetal and neonatal population weight charts
TL;DR: It is proposed that the reference population for BW charts, as in the case of EFW charts, should comprise all babies at a given gestational age, including those still in utero.
Journal ArticleDOI
Customized growth charts: rationale, validation and clinical benefits.
TL;DR: 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.
Journal ArticleDOI
The INTERGROWTH-21st fetal growth standards: toward the global integration of pregnancy and pediatric care
Aris T. Papageorghiou,Stephen Kennedy,Laurent Salomon,Douglas G. Altman,Eric O Ohuma,William Stones,M G Gravett,Fernando C. Barros,Cesar G. Victora,Manorama Purwar,Y A Jaffer,J A Noble,Enrico Bertino,Ruyan Pang,Leila Cheikh Ismail,A Lambert,Zulfiqar A Bhutta,José Villar +17 more
TL;DR: The INTERGROWTH‐21st fetal growth standards show how fetuses should grow–rather than the more limited objective of past references, which describe how they have grown at specific times and locations, and it is suggested that misclassification of these infants by using local charts could affect the delivery of optimal health care.
Journal ArticleDOI
Monitoring the Postnatal Growth of Preterm Infants: A Paradigm Change
José Villar,Francesca Giuliani,Fernando C. Barros,Fernando C. Barros,Paola Roggero,Irma Alejandra Coronado Zarco,Maria Albertina Santiago Rego,Roseline Ochieng,Maria Lorella Giannì,Suman Rao,A Lambert,Irina Ryumina,Carl Britto,Deepak Chawla,Leila Cheikh Ismail,Syed Rehan Ali,Jane E. Hirst,Jagjit S Teji,Karim Abawi,Jacqueline Asibey,Josephine Agyeman-Duah,Kenny McCormick,Enrico Bertino,Aris T. Papageorghiou,Josep Figueras-Aloy,Zulfiqar A Bhutta,Stephen Kennedy +26 more
TL;DR: It is suggested that the correct comparator for assessing the growth of preterm infants, especially those who are moderately or late preterm, is a cohort of pre term newborns (not fetuses or term infants) with an uncomplicated intrauterine life and low neonatal and infant morbidity.
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