Comparison of fetal weight distribution improved by paternal height by Spanish standard versus Intergrowth 21^st standard

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.

Prediction of Large for Gestational Age by Ultrasound at 35 Weeks and Impact of Ultrasound-Delivery Interval: Comparison of 6 Standards

“…EPWs were calculated according to 6 different customized and NC growth standards including population, population-customized, and international references. For the customized charts, Hadlock et al’s [6] and Gardosi et al’s [8] methodologies were used to develop (1) the MSUH standard customized for parity, age, BMI and maternal height, paternal height, and fetal gender, built using a modified version of Hadlock et al [6, 7] growth charts adjusted to our population with a coefficient of variation that changes with gestational age (Savirón-Cornudella et al [17]); (2) and the Barcelona Clinic Hospital (Figueras et al [16]). For the NC standards, we used (iii) a NC version of the MSUH standard (Savirón-Cornudella et al [17]); (4) the international population INTERGROWTH-21st [12, 13], a multilevel mixed model which includes pregnant women without any pathology; (5) the international WHO fetal growth standard [14]; and (6) the FMF local growth multilevel mixed model (Nicolaides et al [18]).…”

Adverse birth outcomes and their clinical phenotypes in an urban Zambian cohort

“…Finally, while the INTERGROWTH-21 st Project 49 intended to define universal fetal growth and newborn weight standards derived from an extensive multi-ethnic sample of women with adequate antenatal care and nutrition, its widespread use over ethnicity-specific or customized standards has been disputed. 43,[50][51][52][53][54][55][56] Despite this, we chose to define SGA in our cohort based on INTERGROWTH-21 st standards since local standards that include all pregnancies affected by undernutrition and/or pregnancy comorbidities tend to identify only the severest 10% of cases by definition.…”

Prediction of Late-Onset Small for Gestational Age and Fetal Growth Restriction by Fetal Biometry at 35 Weeks and Impact of Ultrasound–Delivery Interval: Comparison of Six Fetal Growth Standards

“…EPWs were calculated according to 6 different customized and NC growth standards, including population, population-customized, and international references. For the customized standards, the methodologies of Hadlock et al [18] and Gardosi et al [23] were used for (1) the MSUH standard customized for parity, age, BMI, maternal height, paternal height, and fetal gender, built using a modified version of Hadlock et al's growth charts adjusted to our population, with a coefficient of variation that changes with gestational age (Saviron-Cornudella et al [16]); (2) and the Barcelona Clinic Hospital (Figueras et al [15]). For the NC standards, we used (3) an NC version of the MSUH standard (Saviron-Cornudella et al [16]); (4) the international population INTERGROWTH-21st [20,21]-a multilevel mixed model whose main characteristic is that it includes pregnant women without pathology; (5) the international WHO fetal growth standard [17], and (6) the FMF local growth multilevel mixed model (Nicolaides at al [22]).…”

“…Several studies customized or not to maternal and fetal physiological variables have been proposed to predict SGA [14]; these fetal growth standards [15][16][17] are based on Hadlock et al's methodology [18,19], or on new multilevel models [20][21][22], and can be customized to maternal and fetal physiological variables [23]. The estimation of the percentile adjusted for maternal and fetal characteristics is the property that postulates customized standards as better detectors of adverse perinatal outcomes than population-based standards (non-customized (NC)) [24].…”