Performance of different fetal growth charts in prediction of large‐for‐gestational age and associated neonatal morbidity in multiethnic obese population

Verger, Chivon; Moraitis, Alexandros A; Barnfield, Lauren; Sovio, Ulla; Bamfo, Jacqueline

doi:10.1002/uog.20413

Cited by 13 publications

(26 citation statements)

References 26 publications

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“…Furthermore, we acknowledge that applying BW of the study population to the EFW standards introduced some bias into our results, particularly in preterm cases 6,7 . However, the diagnostic accuracy and sensitivity measures for perinatal mortality and neonatal morbidity when applying BW to the Hadlock-EFW and IG-21 st -EFW were similar to those of recent studies that applied ultrasound fetal measurements to the same EFW standards 37,38 . Finally, the use of the summary index of AUC from the ROC curve is a measure for predictive ability and might not provide clinically relevant meaning 35 .…”

Section: Strengths and Limitationssupporting

confidence: 75%

Performance of six birth‐weight and estimated‐fetal‐weight standards for predicting adverse perinatal outcome: a 10‐year nationwide population‐based study

Choi

Gordon

Hilder

et al. 2021

Ultrasound in Obstet & Gyne

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Objective To evaluate three birth‐weight (BW) standards (Australian population‐based, Fenton and INTERGROWTH‐21st) and three estimated‐fetal‐weight (EFW) standards (Hadlock, INTERGROWTH‐21st and WHO) for classifying small‐for‐gestational age (SGA) and large‐for‐gestational age (LGA) and predicting adverse perinatal outcomes in preterm and term babies. Methods This was a nationwide population‐based study conducted on a total of 2.4 million singleton births that occurred from 24 + 0 to 40 + 6 weeks' gestation between 2004 and 2013 in Australia. The performance of the growth charts was evaluated according to SGA and LGA classification, and relative risk (RR) and diagnostic accuracy based on the areas under the receiver‐operating‐characteristics curves (AUCs) for stillbirth, neonatal death, perinatal death, composite morbidity and a composite of perinatal death and morbidity outcomes. The analysis was stratified according to gestational age at delivery (< 37 + 0 vs ≥ 37 + 0 weeks). Results Following exclusions, 2 392 782 singleton births were analyzed. There were significant differences in the SGA and LGA classification and risk of adverse outcomes between the six BW and EFW standards evaluated. For the term group, compared with the other standards, the INTERGROWTH‐21st BW and EFW standards classified half the number of SGA (< 10th centile) babies (3–4% vs 7–11%) and twice the number of LGA (> 90th centile) babies (24–25% vs 8–15%), resulting in a smaller cohort of term SGA at higher risk of adverse outcome and a larger LGA cohort at lower risk of adverse outcome. For term SGA (< 3rd centile) babies, the RR of perinatal death using the two INTERGROWTH‐21st standards was up to 1.5‐fold higher than those of the other standards (including the WHO‐EFW and Hadlock‐EFW), while the INTERGROWTH‐21st‐EFW standard indicated a 12–26% reduced risk of perinatal death for LGA cases across centile thresholds. Conversely, for the preterm group, the WHO‐EFW and Hadlock‐EFW standards identified a higher SGA classification rate than did the other standards (18–19% vs 10–11%) and a 20–65% increased risk of perinatal death in term LGA babies. All BW and EFW charts had similarly poor performance in predicting adverse outcomes, including the composite outcome (AUC range, 0.49–0.62) for both preterm (AUC range, 0.58–0.62) and term (AUC range, 0.49–0.50) cases and across centiles. Furthermore, specific centile thresholds for identifying adverse outcomes varied markedly by chart between BW and EFW standards. Conclusions This study addresses the recurrent problem of identifying fetuses at risk of morbidity and perinatal mortality associated with growth disorders and provides new insights into the applicability of international growth standards. Our findings of marked variation in classification and the similarly poor performance of prescriptive international standards and the other commonly used standards raise questions about whether the prescriptive international standards that were constructed for universal adoption are indeed app...

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Section: Strengths and Limitationssupporting

confidence: 75%

Performance of six birth‐weight and estimated‐fetal‐weight standards for predicting adverse perinatal outcome: a 10‐year nationwide population‐based study

Choi

Gordon

Hilder

et al. 2021

Ultrasound in Obstet & Gyne

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“…They found that all charts perform well in both diagnosing LGA and predicting adverse outcomes, but the Hadlock and GROW have less false positives and may reduce the number of interventions. We must highlight that the study by Verger et al 16 was, however, specific to obese women. When we compare these 3 charts we found that they are all statistical predictors for LGA, but none of them accurately predicted adverse neonatal outcomes.…”

Section: Discussionmentioning

confidence: 81%

“…The optimal fetal growth chart to identify LGA is yet to be determined. Verger et al 16 compared the Hadlock, GROW, INTERGROWTH‐21 st , World Health Organization, and FMF fetal growth reference charts with the aim to identify the best growth chart to detect LGA in obese women at term. They found that all charts perform well in both diagnosing LGA and predicting adverse outcomes, but the Hadlock and GROW have less false positives and may reduce the number of interventions.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Large‐for‐Gestational‐Age Neonates by Different Growth Standards

Duncan

Odibo

Hoover

et al. 2020

J of Ultrasound Medicine

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Objective Compare the accuracy of the Hadlock, the NICHD, and the Fetal Medicine Foundation (FMF) charts to detect large‐for‐gestational‐age (LGA) and adverse neonatal outcomes (as a secondary outcome). Methods This is a secondary analysis from a prospective study that included singleton non‐anomalous gestations with growth ultrasound at 26–36 weeks. LGA was suspected with estimated fetal weight > 90th percentile by the NICHD, FMF, and Hadlock charts. LGA was diagnosed with birth weight > 90th percentile. We tested the performance of these charts to detect LGA and adverse neonatal outcomes (neonatal intensive care unit admission, Ph < 7.1, Apgar <7 at 5 minutes, seizures, and neonatal death) by calculating the area under the curve, sensitivity, specificity, positive predictive value, and negative predictive value. Results Of 1054 pregnancies, 123 neonates (12%) developed LGA. LGA was suspected in 58 (5.5%) by Hadlock, 229 (21.7%) by NICHD standard, and 231 (22%) by FMF chart. The NICHD standard (AUC: .79; 95% CI: .75–.83 vs. AUC .64; 95%CI: .6–.68; p = < .001) and FMF chart (AUC: .81 95% CI: .77–.85 vs. AUC .64; 95%CI: .6–.68; p = < .001) were more accurate than Hadlock. The FMF and NICHD had higher sensitivity (77.2 vs. 72.4 vs. 30.1%) but Hadlock had higher specificity for LGA (97.5 vs. 88.5 vs. 85.4%). All standards were poor predictors for adverse neonatal outcomes. Conclusions The NICHD and the FMF standards may increase the detection rate of LGA in comparison to the Hadlock chart. However, this may increase obstetrical interventions.

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“…Primary outcomes: Actual birthweight percentile at <10th (small for gestational age [SGA]), as previously defined (Sovio et al 7 ), and actual birthweight percentile at >90th (large for gestational age [LGA]), as previously defined (Verger et al 9 ), using the United Kingdom 1990 reference (Freeman et al 10 ).…”

Section: Resultsmentioning

confidence: 99%

Comparison of estimated fetal weight percentiles near term for predicting extremes of birthweight percentile

Sovio

Smith

2021

American Journal of Obstetrics and Gynecology

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BACKGROUND: The INTERGROWTH-21st estimated fetal weight percentiles are recommended for predicting extremes of birthweight percentile, although evidence for their superiority over the widely employed Hadlock method is lacking. OBJECTIVE: This study aimed to compare the ability of estimated fetal weight percentiles calculated using the Hadlock method and the INTERGROWTH-21st method to predict extremes of birthweight percentile. STUDY DESIGN: A prospective cohort study of blinded serial ultrasonography in nulliparous women with a singleton pregnancy, The Pregnancy Outcome Prediction study was conducted in Cambridge, United Kingdom. The study participants who had a research estimated fetal weight performed at 36 weeks' gestation were eligible for the analysis. Estimated fetal weight percentiles for gestational age calculated using (1) the Hadlock method or (2) the INTERGROWTH-21st method were used as exposures. Birthweight percentiles of <10th (small for gestational age) and >90th (large for gestational age) for gestational age and fetal sex using the United Kingdom 1990 reference or the INTERGROWTH-21st birthweight reference were analyzed as outcomes using receiver operating characteristic curve analysis. Screening statistics from 2Â2 tables were calculated for dichotomized exposures and each outcome. RESULTS: The Hadlock estimated fetal weight percentile performed better than the INTERGROWTH-21st estimated fetal weight percentile at discriminating both small for gestational age birthweight (areas under the receiver operating characteristic curves, 0.87 vs 0.85; 95% confidence intervals, 0.85e0.89 vs 0.83e0.87, respectively; P<.0001) and large for gestational age birthweight (areas under the receiver operating characteristic curves, 0.87 vs 0.86; 95% confidence intervals, 0.85e0.90 vs 0.83e0.89, respectively; P¼.005). When the estimated fetal weight percentiles were dichotomized and screen positive was defined at 90% specificity, the sensitivity for the Hadlock vs the INTERGROWTH-21st method was 58.6% vs 52.3%, respectively, for small for gestational age, and 71.0% vs 60.9%, respectively, for birthweight at less than the third percentile (United Kingdom 1990 reference). The results were similar when the birthweight percentile was defined using the INTERGROWTH-21st birthweight reference, when the estimated fetal weight was calculated without the inclusion of head measurements, or when the women who had clinically indicated scans and women who had their research scan result were excluded. CONCLUSION: Replacing the Hadlock method by the INTERGROWTH-21st method may lead to less effective screening for extremes of birthweight percentile.

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Performance of different fetal growth charts in prediction of large‐for‐gestational age and associated neonatal morbidity in multiethnic obese population

Cited by 13 publications

References 26 publications

Performance of six birth‐weight and estimated‐fetal‐weight standards for predicting adverse perinatal outcome: a 10‐year nationwide population‐based study

Performance of six birth‐weight and estimated‐fetal‐weight standards for predicting adverse perinatal outcome: a 10‐year nationwide population‐based study

Prediction of Large‐for‐Gestational‐Age Neonates by Different Growth Standards

Comparison of estimated fetal weight percentiles near term for predicting extremes of birthweight percentile

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