Intrauterine growth standards in a developing country: a study of singleton livebirths at 28–42 weeks' gestation

Abstract

This study aimed to develop fetal growth charts for the population of Greater Beirut, Lebanon, and compare them with previously established references. A survey of consecutive singleton livebirths admitted to normal nurseries and neonatal intensive care units of major hospitals, through the database project of the National Collaborative Perinatal Neonatal Network was used as a design. The study was conducted in nine major healthcare institutions serving the population of Beirut and its suburbs. A total of 24 767 singleton livebirths delivered between 28 and 42 weeks' gestation, with known data on gender, gestational age and anthropometric characteristics were recorded between 1 April 1999 and 31 March 2002. Growth charts were developed by plotting birthweight, length and head circumference percentiles against gestational age for male and female infants separately. Overall, 1348 (5.4%) pregnancies were delivered before 37 weeks' gestation and 1227 (4.9%) were low birthweight. Male infants were delivered slightly earlier than their female counterparts and the mean birthweight, length and head circumference were consistently higher in males. A total of 2247 (9.1%) infants were small-for-gestational-age, with a male-to-female sex ratio of 1.03. Using previously established growth references that overestimated small-for-gestational-age prevalence resulted in a greater proportion of false positives. The opposite was true for growth references that underestimated small-for-gestational-age prevalence. The current growth charts present useful tools for assessing the general health status of newborn infants delivered at sea level in the urban areas of Lebanon and other East Mediterranean countries.

Canonical Correlation Analysis of Infant's Size at Birth and Maternal Factors: A Study in Rural Northwest Bangladesh

“…The maternal factors affecting or not affecting infant size at birth, isolated through canonical correlation analysis, were consistent with evidence of these kinds of associations in the literature [11], [12], [13], [39], [40], [41], [42], [43], [44]. CCA may offer an efficient, practical and more biologically comprehensive approach to assessing the association between two sets of variables, by taking into account the innate complexity of interactions and biological pathways that between variables.…”

Association of Pre‐Pregnancy Body Mass Index and Gestational Weight Gain with Preterm Births and Fetal Size: an Observational Study from Lebanon

“…In the Lebanese community, there is a misconception about the extent of weight gain during gestation and healthy pregnancy. Other strengths of our analysis include the use of the classification of gestational size (SGA or LGA) according to a previously published study pertaining to the Lebanese population and the adjustment by several possible confounding factors …”

“…Preterm birth (PTB), defined as birth before 37 weeks of gestation, is now the second leading cause of neonatal mortality and a major contributor to neonatal morbidities and infections . Similarly, suboptimal fetal growth, categorised as small for gestational age (SGA) and large for gestational age (LGA), increases the risk of stillbirth and neonatal morbidities such as PTB . PTB and suboptimal fetal growth are associated with long‐term morbidities such as cardiac, pulmonary, and neurodevelopmental complications, leading to a significant health and economic burden .…”

“…PTB and suboptimal fetal growth are associated with long‐term morbidities such as cardiac, pulmonary, and neurodevelopmental complications, leading to a significant health and economic burden . More than 60% of PTB occur in Africa and South Asia, but rates are also high in developed countries ranging between 5% and 13% in Europe and USA . The PTB rates in some African and South Asian countries are estimated to be up to 16% of total livebirths …”

Small for gestational age neonates – are we missing some by only using standard population growth standards and does it matter?

“…This is not surprising as SGA prevalence as low as 3% have been reported by the Reproductive Health Indicators Database (World Health Organisation, July 2006), 6% in some industrialised countries such as Canada and below 5% in other individual studies [19,20]. The reasons for such variations are not clear.…”