Fetal size standards to diagnose a small- or a large-for-gestational-age fetus

Romero, Roberto; Tarca, Adi L.

doi:10.1016/j.ajog.2017.12.217

Cited by 19 publications

(15 citation statements)

References 6 publications

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“…More than 100 fetal growth standards have been proposed for fetal growth assessment. Several studies suggested that customized fetal growth and birth weight assessment better predicts morbidity, while other studies found the opposite or were inconclusive. Sovio and Smith reported that customized third‐trimester growth assessment did not improve the association with neonatal morbidity compared with non‐customized standards, while Blue et al .…”

Section: Discussionmentioning

confidence: 99%

“…The potential of customized birth‐weight standards to improve identification of neonates at risk for adverse perinatal morbidity and mortality is well established. Nevertheless, recent initiatives to develop growth standards did not implement customization of growth charts, or they customized only for a subset of non‐pathologic factors known to affect fetal growth.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of adverse perinatal outcome by fetal biometry: comparison of customized and population‐based standards

Kabiri

Romero²,

Gudicha

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To compare the predictive performance of estimated fetal weight (EFW) percentiles, according to eight growth standards, to detect fetuses at risk for adverse perinatal outcome. Methods This was a retrospective cohort study of 3437 African‐American women. Population‐based (Hadlock, INTERGROWTH‐21st, World Health Organization (WHO), Fetal Medicine Foundation (FMF)), ethnicity‐specific (Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)), customized (Gestation‐Related Optimal Weight (GROW)) and African‐American customized (Perinatology Research Branch (PRB)/NICHD) growth standards were used to calculate EFW percentiles from the last available scan prior to delivery. Prediction performance indices and relative risk (RR) were calculated for EFW < 10th and > 90th percentiles, according to each standard, for individual and composite adverse perinatal outcomes. Sensitivity at a fixed (10%) false‐positive rate (FPR) and partial (FPR < 10%) and full areas under the receiver‐operating‐characteristics curves (AUC) were compared between the standards. Results Ten percent (341/3437) of neonates were classified as small‐for‐gestational age (SGA) at birth, and of these 16.4% (56/341) had at least one adverse perinatal outcome. SGA neonates had a 1.5‐fold increased risk of any adverse perinatal outcome (P < 0.05). The screen‐positive rate of EFW < 10th percentile varied from 6.8% (NICHD) to 24.4% (FMF). EFW < 10th percentile, according to all standards, was associated with an increased risk for each of the adverse perinatal outcomes considered (P < 0.05 for all). The highest RRs associated with EFW < 10th percentile for each adverse outcome were 5.1 (95% CI, 2.1–12.3) for perinatal mortality (WHO); 5.0 (95% CI, 3.2–7.8) for perinatal hypoglycemia (NICHD); 3.4 (95% CI, 2.4–4.7) for mechanical ventilation (NICHD); 2.9 (95% CI, 1.8–4.6) for 5‐min Apgar score < 7 (GROW); 2.7 (95% CI, 2.0–3.6) for neonatal intensive care unit (NICU) admission (NICHD); and 2.5 (95% CI, 1.9–3.1) for composite adverse perinatal outcome (NICHD). Although the RR CIs overlapped among all standards for each individual outcome, the RR of composite adverse perinatal outcome in pregnancies with EFW < 10th percentile was higher according to the NICHD (2.46; 95% CI, 1.9–3.1) than the FMF (1.47; 95% CI, 1.2–1.8) standard. The sensitivity for composite adverse perinatal outcome varied substantially between standards, ranging from 15% for NICHD to 32% for FMF, due mostly to differences in FPR; this variation subsided when the FPR was set to the same value (10%). Analysis of AUC revealed significantly better performance for the prediction of perinatal mortality by the PRB/NICHD standard (AUC = 0.70) compared with the Hadlock (AUC = 0.66) and FMF (AUC = 0.64) standards. Evaluation of partial AUC (FPR < 10%) demonstrated that the INTERGROWTH‐21st standard performed better than the Hadlock standard for the prediction of NICU admission and mechanical ventilation (P < 0.05 for both). Although fetuses with EFW > 90t...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prediction of adverse perinatal outcome by fetal biometry: comparison of customized and population‐based standards

Kabiri

Romero²,

Gudicha

et al. 2020

Ultrasound in Obstet & Gyne

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“…Predominantly the 10th centile has been used. In some countries use of -2 standard deviations dominates [6]. Another alternative is a reference based on relative risk, where a weight correlation with a 2-fold, 2,5-fold and 3-fold risk of neonatal death at each gestational age has been established [7].…”

Section: A Historical Perspectivementioning

confidence: 99%

Growth charts and prediction of abnormal growth — what is known, what is not known and what is misunderstood

Kajdy

Modzelewski²,

Herman³

et al. 2019

Ginekol Pol

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Objectives: Assessment of fetal growth has an important effect on perinatal morbidity and mortality. To understand what tool to choose best for a given population a basic knowledge of how growth charts are developed and used has to be acquired. For this reason, this literature review was performed. Material and methods:An extensive literature review aimed at identifying articles related to the development of growth assessment in both spectrums of abnormal fetal growth -large and small. The analyzed articles were chosen and presented to show both the historical aspects of growth assessment, current trends and future considerations.Results: Identification of both large and small fetuses and neonates is equally crucial. Definitions and methodology vary worldwide and there is an ongoing discussion on the best tool to choose for a given population. An important part of the debate is how to differentiate between the physiologically small fetus and the truly growth restricted fetus who is at risk of perinatal complication. Similarly, the diagnosis of a large fetus is important in prevention of perinatal complications and surgical deliveries. Many clinical settings still lack growth standards. conclusions: Birthweight for gestational age charts are biased for weight in preterm birth. Prediction and management of outcome cannot be based solely on fetal size. Small is not the only problem, we have to think large as well. A common misunderstanding in clinical practice is not using uniform charts in defining growth.

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“…Resulta evidente que el reto a futuro es sustituir la representación clásica de los percentiles por las curvas de regresión cuantil, una estrategia metodológica introducida por Koenker y Bassett, en 1978 (11) . Estas curvas se desvían de los modelos de regresión lineal, cuyas ecuaciones utilizadas en la predicción del peso fetal muestran limitaciones en términos de certeza (12)(13)(14) , ya que la varianza entre los intervalos de clase no es homogénea. Esto se conoce como heterocedasticidad, contrario a la homocedasticidad requerida para la aplicación de modelos de regresión lineal, en datos cuya distribución se adapta a la curva de Gauss.…”

Section: Introductionunclassified

Índice cefálico/abdominal/femoral (C+A-F), herramienta antropométrica efectiva en la evaluación del crecimiento fetal y de sus desviaciones

Sosa-Olavarría

Álvarez-Moya²,

Giugni

et al. 2020

Rev peru ginecol obstet.

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Antecedentes. Lograr un método ideal que evalúe el potencial de crecimiento fetal es una aspiración incumplida en nuestra disciplina, e impone la necesidad de una evaluación individualizada, a través de nuevas herramientas y multiparámetros integrados. Objetivos. Evaluar la correlación y establecer valores de referencia del índice cefálico/abdominal/femoral (CAF) con la edad gestacional (EG) y el peso fetal estimado, para tipificar la evolución del crecimiento fetal como adecuado o no para la edad gestacional, y correlacionar con el peso del recién nacido a término. Pacientes y métodos. Se estudiaron 1 032 embarazos con embarazo simple y sin complicaciones, de 12 a 38 semanas de gestación, en el Centro Policlínico de Valencia, Venezuela, entre los años 2015 y 2017. Las medidas ecográficas y el peso fetal se estimaron a intervalos de 3 a 5 semanas. Los parámetros estudiados fueron circunferencia cefálica (CC), circunferencia abdominal (CA) y longitud del fémur (FL), integrados en la fórmula índice CAF = [(CC + CA) - FL]. Se aplicó el modelo de regresión cúbica y puntaje Z en 256 casos seguidos hasta el parto. Se establecieron tres grupos de CAF: a) CAF <50, b) CAF 50 a 57, y c) CAF ≥58, calculando la media ± desviación estándar de los pesos de los recién nacidos en cada grupo. Resultados. Según las semanas de gestación, el índice CAF reveló un R² = 0,96, p <0,05, mientras que para el peso fue R² = 0,92, p <0,05. En 256 casos seguidos hasta el parto, cuando el CAF tenía valor igual o superior a 58, el peso del recién nacido fue 3 361 ± 484 g, con diferencias estadísticamente significativas en relación al resto de grupos (prueba de student p <0,05). Conclusiones. El índice CAF es un método multiparméetrico que permite, a través de evaluaciones seriadas, determinar el potencial de crecimiento individual esperado y virtualmente también identificar sus desviaciones.

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Fetal size standards to diagnose a small- or a large-for-gestational-age fetus

Cited by 19 publications

References 6 publications

Prediction of adverse perinatal outcome by fetal biometry: comparison of customized and population‐based standards

Prediction of adverse perinatal outcome by fetal biometry: comparison of customized and population‐based standards

Growth charts and prediction of abnormal growth — what is known, what is not known and what is misunderstood

Índice cefálico/abdominal/femoral (C+A-F), herramienta antropométrica efectiva en la evaluación del crecimiento fetal y de sus desviaciones

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