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

Abstract

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...

Perinatal Outcomes of Fetuses with Early Growth Restriction, Late Growth Restriction, Small for Gestational Age, and Adequate for Gestational Age

“…Our findings are consistent with previous studies that correlated FGR with adverse perinatal outcomes, 7,[19][20][21][22][23] but the classification of FGR in studies used different criteria. Our study was the first one that used the criteria established by the Delphi procedure.…”

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

“…In our study, the prevalence of LGA was 20.9% when the UK reference birth-weight standards were used, but differed greatly using other standards, from 10.3% when using the GROW standard to 24.1% when using the IG-21 standard. These large differences in the incidence of LGA have been confirmed by other studies that used different fetal growth and birth-weight charts 18 . Hence, the choice of fetal growth and birth-weight chart is likely to affect the rate of medical intervention within a maternity unit.…”

Modern approaches to the problem of intrauterine growth restriction: from causes to long-term consequences

“…У цих новона роджених виявлено вищий ризик захворювано сті та смертності. Тому наразі існує термін «обмеження росту плода» (fetal growth restriction, FGR, ОРП), що уособлює досягнен ня останніх років у фундаментальних і клі нічних дослідженнях, а також пояснює філосо фію й клінічний менеджмент цієї патології [4,6,9,11,13,16].…”

“…Пізній початок ОРП (>32 тижні) -два основні параметри (ОЖ або ОМП <3 го центилю) і чотири допоміжні параме три (ОМП або ОЖ <10 го центилю, ОЖ або ОМП, що перетинають центилі на >2 чверті на графіках росту, цереброплацентарне співвід ношення <5 го центилю або пульсаційний індекс на пуповинній артерії (PI] >95 го центилю) [3,5,9,12,15].…”

“…За показниками кількості амніотичної ріди ни можна підтвердити наявність «ворожого внутрішньоутробного середовища». У жінок із нормальним перебігом вагітності в терміні >24 тижні при амніотичному індексі <5-9% показник ОРП становить 19% [9,10,14].…”