Establishment of Fetal Biometric Charts Using Quantile Regression Analysis

Daniel-Spiegel, Etty; Weiner, Ehud; Yarom, Ilan; Doveh, Etti; Friedman, Perry; Cohen, Ayala; Shalev, Eliezer

doi:10.7863/jum.2013.32.1.23

Cited by 24 publications

(29 citation statements)

References 24 publications

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“…In consequence, it provides a more direct representation of the observed measurements. This is nicely demonstrated in a recent large study establishing population-specific fetal growth charts [35]. The technique is especially useful when the quantiles vary differently with a covariate such as, in the present study, gestational age.…”

Section: Discussionmentioning

confidence: 55%

The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight

et al. 2017

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BackgroundPerinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common noncommunicable diseases in adulthood. Against this background, WHO made it a high priority to provide the present fetal growth charts for estimated fetal weight (EFW) and common ultrasound biometric measurements intended for worldwide use.Methods and FindingsWe conducted a multinational prospective observational longitudinal study of fetal growth in low-risk singleton pregnancies of women of high or middle socioeconomic status and without known environmental constraints on fetal growth. Centers in ten countries (Argentina, Brazil, Democratic Republic of the Congo, Denmark, Egypt, France, Germany, India, Norway, and Thailand) recruited participants who had reliable information on last menstrual period and gestational age confirmed by crown–rump length measured at 8–13 wk of gestation. Participants had anthropometric and nutritional assessments and seven scheduled ultrasound examinations during pregnancy. Fifty-two participants withdrew consent, and 1,387 participated in the study.At study entry, median maternal age was 28 y (interquartile range [IQR] 25–31), median height was 162 cm (IQR 157–168), median weight was 61 kg (IQR 55–68), 58% of the women were nulliparous, and median daily caloric intake was 1,840 cal (IQR 1,487–2,222).The median pregnancy duration was 39 wk (IQR 38–40) although there were significant differences between countries, the largest difference being 12 d (95% CI 8–16). The median birthweight was 3,300 g (IQR 2,980–3,615). There were differences in birthweight between countries, e.g., India had significantly smaller neonates than the other countries, even after adjusting for gestational age. Thirty-one women had a miscarriage, and three fetuses had intrauterine death.The 8,203 sets of ultrasound measurements were scrutinized for outliers and leverage points, and those measurements taken at 14 to 40 wk were selected for analysis. A total of 7,924 sets of ultrasound measurements were analyzed by quantile regression to establish longitudinal reference intervals for fetal head circumference, biparietal diameter, humerus length, abdominal circumference, femur length and its ratio with head circumference and with biparietal diameter, and EFW. There was asymmetric distribution of growth of EFW: a slightly wider distribution among the lower percentiles during early weeks shifted to a notably expanded distribution of the higher percentiles in late pregnancy.Male fetuses were larger than female fetuses as measured by EFW, but the disparity was smaller in the lower quantiles of the distribution (3.5%) and larger in the upper quantiles (4.5%). Maternal age and maternal height were associated with a positive effect on EFW, particularly in the lower tail of the distribution, of the order of 2% to 3% for each additional 10 y of age o...

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Section: Discussionmentioning

confidence: 55%

The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight

et al. 2017

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“…As a consequence, quantile regression yields a more accurate estimation of the true distribution of the fetal measurement for each percentile considered. Quantile regression has been used before for calculation of fetal biometric charts, 15 but we are not aware of its use for customized charts. The relatively higher complexity of the calculation of individual percentiles by quantile regression with respect to least mean squares should be acknowledged.…”

Section: Discussionmentioning

confidence: 99%

“…For a given quantile value p , it uses the entire population to estimate the p quantile of the distribution of y as a linear function of the covariates. Compared with least squares regression, quantile regression has numerous advantages: it does not make any normality assumption; it is robust to outliers; and it allows inference on the entire shape of the distribution and not just on the mean 14 , 15 …”

Section: Methodsmentioning

confidence: 99%

Customized Fetal Growth Charts for Parents' Characteristics, Race, and Parity by Quantile Regression Analysis

Ghi

Cariello

Rizzo

et al. 2016

J of Ultrasound Medicine

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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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“…Statistical analysis was performed using SAS version 9.3 for Windows (SAS Institute Inc., Cary, NC, USA). Centile curves for fetal weight were constructed using quantile regression, a statistical technique previously used in the construction of growth charts [21], with the explanatory variables of gestational age, sex, labour onset (spontaneous vs. iatrogenic), and the interaction term of labour onset × gestational age.…”

Section: Discussionmentioning

confidence: 99%

A New Approach to Developing Birth Weight Reference Charts: A Retrospective Observational Study

et al. 2017

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Introduction: Birth weight reference charts based on historical infant birth weights have significant bias at preterm gestations because many preterm births are associated with abnormal growth. This study aims to determine whether more accurate birth weight charts can be constructed using data only from births that follow spontaneous onset of labour. Materials and Methods: This study was a single-centre retrospective observational study of 115,712 singleton live births. Births were classified as spontaneous or iatrogenic. Quantile regression was used to model the relationship between gestational age, sex, labour onset, and birth weight. Comparison was made of birth weights in the spontaneous and iatrogenic cohorts by gestation, and to existing ultrasound-based charts. Results: Birth weights of spontaneous and iatrogenic births were significantly different for gestational age at the median and 10th centiles. Iatrogenic preterm infants weighed less than their spontaneous preterm counterparts. Median and 10th centile birth weights derived from the spontaneous birth cohort closely approximate previous ultrasound-based curves. Discussion: Iatrogenic births are more likely to be associated with pre-existing growth disturbance. Inclusion of these data has significant impact on centile charts. Birth weight charts derived from only spontaneous births may offer a more accurate reference for clinicians.

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Establishment of Fetal Biometric Charts Using Quantile Regression Analysis

Cited by 24 publications

References 24 publications

The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight

The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight

Customized Fetal Growth Charts for Parents' Characteristics, Race, and Parity by Quantile Regression Analysis

A New Approach to Developing Birth Weight Reference Charts: A Retrospective Observational Study

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