Should We Customize Fetal Growth Standards?

Figueras, F.; Gardosi, Jason

doi:10.1159/000235875

Cited by 33 publications

(25 citation statements)

References 121 publications

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“…This is comparable to detection rates reported in routine clinical practice and with the use of customised antenatal growth charts respectively [7]. We defined SGA as birthweight less than the tenth customised centile, which is better associated with pathological fetal growth than SGA defined as birthweight less than the tenth population centile [3], [18], [19]. However a proportion of these small babies will inevitably still be constitutionally small and healthy.…”

Section: Discussionsupporting

confidence: 61%

Clinical Prediction in Early Pregnancy of Infants Small for Gestational Age by Customised Birthweight Centiles: Findings from a Healthy Nulliparous Cohort

et al. 2013

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ObjectiveSmall for gestational age (SGA) infants comprise up to 50% of all stillbirths and a minority are detected before birth. We aimed to develop and validate early pregnancy predictive models for SGA infants.Methods5628 participants from SCOPE, a prospective study of nulliparous pregnant women, were interviewed at 15±1 weeks’ gestation. Fetal anthropometry, uterine and umbilical Doppler studies were performed at 20±1 weeks’. The cohort was divided into training (n = 3735) and validation datasets (n = 1871). All-SGA (birthweight <10th customised centile), Normotensive-SGA (SGA with normotensive mother) and Hypertensive-SGA (SGA with mother who developed hypertension) were the primary outcomes. Multivariable analysis was performed using stepwise logistic regression firstly using clinical variables and then with clinical and ultrasound variables. Receiver operator curves were constructed and areas under the curve (AUC) calculated.Results633 infants (11.3%) in the whole cohort were SGA; 465 (8.3%) Normotensive-SGA and 165 (3.0%) Hypertensive-SGA. In the training dataset risk factors for All-SGA at 15±1 weeks’ included: family history of coronary heart disease, maternal birthweight <3000 g and 3000 g to 3499 g compared with ≥3500 g, >12 months to conceive, university student, cigarette smoking, proteinuria, daily vigorous exercise and diastolic blood pressure ≥80. Recreational walking ≥4 times weekly, rhesus negative blood group and increasing random glucose were protective. AUC for clinical risk factors was 0.63. Fetal abdominal or head circumference z scores <10th centile and increasing uterine artery Doppler resistance at 20±1 weeks’ were associated with increased risk. Addition of these parameters increased the AUC to 0.69. Clinical predictors of Normotensive and Hypertensive-SGA were sub-groups of All-SGA predictors and were quite different. The combined clinical and ultrasound AUC for Normotensive and Hypertensive-SGA were 0.69 and 0.82 respectively.ConclusionPredictors for SGA of relevance to clinical practice were identified. The identity and predictive potential differed in normotensive women and those who developed hypertension.

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Section: Discussionsupporting

confidence: 61%

Clinical Prediction in Early Pregnancy of Infants Small for Gestational Age by Customised Birthweight Centiles: Findings from a Healthy Nulliparous Cohort

et al. 2013

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“…[45][46][47] Measurements of foetal head circumference (HC), abdominal circumference (AC) and femur length (FL) allow for the comparison of individual growth and local reference values or customized growth charts. 48 Beside the comparison with standard growth curves and an auxologic assessment of head to abdomen proportion, these measurements allow the calculation of estimated foetal weight (EFW). 49,50 The validity of both symphysisfundal height (SFH) determined by clinical examination and estimated foetal weight (EFW) determined by ultrasound to identify FGR foetuses may be improved though customized standards that are designed to identify foetuses that measure < 10th percentile of their expected genetic growth potential.…”

Section: Screening and Diagnosismentioning

confidence: 99%

Fetal growth restriction: aetiology, screening, diagnosis and management

Augusthy

2015

Int J Reprod Contracept Obstet Gynecol

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Foetal growth restriction (FGR) is a pathological condition that refers to a foetus that fails to reach his/her genetically predetermined growth potential. FGR remains a leading contributor to perinatal mortality and morbidity and metabolic syndrome in later life. The purpose of this review is to provide the summary statements of the aetiology of FGR and to establish a framework for screening, diagnosis, and management of pregnancies affected with foetal growth restriction. For this study, published literature was retrieved through searches of PubMed (Medline), Highwire, Google Scholar, Scopus, Cochrane Database of Systematic Reviews. Conference/Seminar proceedings, textbooks, previously published systematic reviews, controlled clinical trials, high quality prospective and retrospective observational studies, research articles and unpublished studies were also used for this study. The identification of FGR begins with assessment of maternal, foetal, placental and environmental risk factors and the diagnosis is made by Ultrasound biometry examination. Functional assessment of placental and foetal circulation by Doppler velocimetry and blood flow volume, together with computerized assessment of foetal heart rate variability, are key examinations in early and late FGR to assess severity of the disease and monitor foetal wellbeing. Appropriate timing of delivery in early FGR might change the outcome, and appropriate monitoring in late and term FGR might avoid unnecessary interventions.

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“…However, the definition of IUGR remains elusive as growth potential cannot be precisely quantified. Therefore, most cases of growth restriction are also considered small for their gestational age (SGA), but birth weight or estimated fetal weight can also be used as a surrogate[12]. This could be misleading because not all small babies are growth-restricted, and not all growth-restricted infants are small[13].…”

Section: Introductionmentioning

confidence: 99%

Maternal risk factors for low birth weight for term births in a developed region in China: a hospital-based study of 55,633 pregnancies

Bian¹,

Zhang²,

Li³

et al. 2013

J Biomed Res

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Low birth weight (LBW) is an important risk factor for neonatal and infant mortality and morbidity in adults.. However, no large scale study on the prevalence of LBW and related maternal risk factors in China has been published. To explore the effects of maternal factors on LBW for term birth in China, we conducted a hospital-based retrospective study of 55, 633 Chinese pregnancy cases between 2001 and 2008. Maternal sociodemographic data, history of infertility and contraceptive use were obtained. Their medical status and diseases during pre-pregnancy were examined by physical examination at the first antenatal care visit. Maternal medical status before childbirth and pregnancy outcomes, including body weight, infant gender, multiple pregnancy and congenital anomalies, were recorded. Univariate and multivariate logistic regression, and linear regression were used to investigate the relationship between maternal factors and term LBW. The general incidence of term LBW was 1.70% in the developed area of China. After preliminary analysis using the univariate model, low primary education, anemia, hypertensive disorders, placental previa, oligohydramnios and premature rupture of membrane were predicted as independent factors of term LBW in the multivariate model. Furthermore, the decrease in annual frquencies of these risk factors were major causes of gradual decline in the incidence of LBW (from 2.43% in 2001 to 1.21% in 2008). The study demonstrated that among maternal factors, primary education, anemia and hypertensive disorders could contribute to LBW for term birth even in the most developed area of China.

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Should We Customize Fetal Growth Standards?

Cited by 33 publications

References 121 publications

Clinical Prediction in Early Pregnancy of Infants Small for Gestational Age by Customised Birthweight Centiles: Findings from a Healthy Nulliparous Cohort

Clinical Prediction in Early Pregnancy of Infants Small for Gestational Age by Customised Birthweight Centiles: Findings from a Healthy Nulliparous Cohort

Fetal growth restriction: aetiology, screening, diagnosis and management

Maternal risk factors for low birth weight for term births in a developed region in China: a hospital-based study of 55,633 pregnancies

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