Systematic misclassification of gestational age by ultrasound biometry: implications for clinical practice and research methodology in the Nordic countries

Skalkidou, Alkistis; Kullinger, Merit; Georgakis, Marios K.; Kieler, Helle; Kesmodel, Ulrik Schiøler

doi:10.1111/aogs.13300

Cited by 22 publications

(26 citation statements)

References 36 publications

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“…Given the noted site-specific differences in maternal PTSD and other key phenotypes (e.g., tobacco use), we also included study site as a covariate in the multivariable regression model. Fifth, gestational age estimation (including by ultrasound) may be prone to notable measurement error [ 66 – 68 ], which may in turn have biased our primary outcome variable (gestational EA residuals at birth). Finally, inconsistencies between our results and the null findings of the well-powered epigenome-wide meta-analysis of maternal stress [ 6 ] (discussed in the Introduction, above) may be accounted for by differences in analytic approaches (e.g., differential DNAm versus EA deviation analysis); in microarray chip used (only 450K data were included in the meta-analysis); in sample size; or in phenotype variables (e.g., ancestral diversity in our study sample, differing prevalence of prenatal maternal smoking and variable definitions of stress, trauma and PTSD).…”

Section: Discussionmentioning

confidence: 99%

Maternal psychosocial risk factors and child gestational epigenetic age in a South African birth cohort study

et al. 2021

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Accelerated epigenetic aging relative to chronological age has been found to be associated with higher risk of mortality in adults. However, little is known about whether and how in utero exposures might shape child gestational epigenetic age (EA) at birth. We aimed to explore associations between maternal psychosocial risk factors and deviation in child gestational EA at birth (i.e., greater or lower EA relative to chronological age) in a South African birth cohort study—the Drakenstein Child Health Study. Maternal psychosocial risk factors included trauma/stressor exposure; posttraumatic stress disorder (PTSD); depression; psychological distress; and alcohol/tobacco use. Child gestational EA at birth was calculated using an epigenetic clock previously devised for neonates; and gestational EA deviation was calculated as the residuals of the linear model between EA and chronological gestational age. Bivariate linear regression was then used to explore unadjusted associations between maternal/child risk factors and child gestational EA residuals at birth. Thereafter, a multivariable regression method was used to determine adjusted associations. Data from 271 maternal-child dyads were included in the current analysis. In the multivariable regression model, maternal PTSD was significantly and negatively associated with child gestational EA residuals at birth (β = −1.95; p = 0.018), controlling for study site, sex of the child, head circumference at birth, birthweight, mode of delivery, maternal estimated household income, body mass index (BMI) at enrolment, HIV status, anaemia, psychological distress, and prenatal tobacco or alcohol use. Given the novelty of this preliminary finding, and its potential translational relevance, further studies to delineate underlying biological pathways and to explore clinical implications of EA deviation are warranted.

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Section: Discussionmentioning

confidence: 99%

Maternal psychosocial risk factors and child gestational epigenetic age in a South African birth cohort study

et al. 2021

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“…Another example would be comparison of different measures of gestational age calculated from either the last menstrual period or from ultrasound measurements. This problem is dealt with elsewhere .…”

Section: Validation Studiesmentioning

confidence: 99%

Cross‐sectional studies – what are they good for?

Kesmodel

2018

Acta Obstet Gynecol Scand

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260

131

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Cross-sectional studies serve many purposes, and the cross-sectional design is the most relevant design when assessing the prevalence of disease, attitudes and knowledge among patients and health personnel, in validation studies comparing, for example, different measurement instruments, and in reliability studies. This paper describes the use of cross-sectional studies and provides examples within obstetrics and gynecology. Caveats are also described; for example, when cross-sectional data is used for analytical purposes of associations between an exposure and an outcome, authors and readers should be careful not to make causal inferences, unless the exposure may safely be assumed to be stable over time and not influenced by experiencing the outcome. In such cases, analyses are also subject to selection and information bias as well as confounding.

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“…The observed two definitions of gestational age at EDD (39 weeks + 6 days or 40 weeks + 0 days, respectively) imply a risk when patients move between counties as 1 day of difference in gestational age could affect the induction of postterm pregnancies or differentiation of miscarriage from extremely preterm delivery [23]. Also, using the same definition would facilitate comparisons in research [24].…”

Section: Discussionmentioning

confidence: 99%

Adherence to Swedish national pregnancy dating guidelines and management of discrepancies between pregnancy dating methods: a survey study

2019

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Background Swedish national guidelines for pregnancy dating were published in 2010. Follow-up is needed to assess adherence and to identify whether any clinical topics are not covered in the guidelines. Methods All units in Sweden that performed ultrasound-based pregnancy dating were asked to complete a web-based questionnaire comprising multiple-response questions and commentary fields. Information was collected regarding baseline information, current and previous clinical practice, and management of discrepancies between last-menstrual-period- and ultrasound-based methods for pregnancy dating. Results The response rate was 79%. Half of the units offered first-trimester ultrasound to all pregnant women. However, contrary to the guidelines, the crown–rump length was not used for ultrasound-based pregnancy dating in most units. Instead, ultrasound-based pregnancy dating was performed only if the biparietal diameter was between 21 and 55 mm. Management of discrepancies between methods for pregnancy dating varied widely. Conclusions The units reported high adherence to national guidelines, except for early pregnancy dating, for which many units followed unwritten or informal guidelines. The management of discrepancies between last-menstrual-period-based and ultrasound-based estimated day of delivery varied widely. These findings emphasize the need for regular updating of national written guidelines and efforts to improve their implementation in all units.

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Systematic misclassification of gestational age by ultrasound biometry: implications for clinical practice and research methodology in the Nordic countries

Cited by 22 publications

References 36 publications

Maternal psychosocial risk factors and child gestational epigenetic age in a South African birth cohort study

Maternal psychosocial risk factors and child gestational epigenetic age in a South African birth cohort study

Cross‐sectional studies – what are they good for?

Adherence to Swedish national pregnancy dating guidelines and management of discrepancies between pregnancy dating methods: a survey study

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