Unconditional and conditional standards for fetal abdominal circumference and estimated fetal weight in an ethnic Chinese population: a birth cohort study

BMC Pregnancy and Childbirth

Yap-Seng Chong⁷  Peter D. Gluckman¹  Seang-Mei Saw²  Shu-E Soh²  George S. H. Yeo⁵  Kenneth Y. C. Kwek⁵  Lin Lin Su⁶  Arijit Biswas⁶  Yin Bun Cheung⁸  Ngee Lek³  Ying Xu⁴ 

[1] Liggins Institute, University of Auckland, Auckland, New Zealand;Saw Swee Hock School of Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;Department of Pediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore;Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore;Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore, Singapore;Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore;Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore;Department of International Health, University of Tampere, Tampere, Finland

关键词: Ultrasound;    Fetal growth;    Estimated fetal weight;    Conditional standards;    Abdominal circumference;   

Others  :  1215942
DOI  :  10.1186/s12884-015-0569-1

 received in 2015-01-22, accepted in 2015-05-27,  发布年份 2015

【 摘 要 】

Background

Diagnosis of intrauterine fetal growth restriction and prediction of small-for-gestation age are often based on fetal abdominal circumference or estimated fetal weight (EFW). The present study aims to create unconditional (cross-sectional) and conditional (longitudinal) standards of fetal abdominal circumference and EFW for use in an ethnic Chinese population.

Methods

In the Growing Up in Singapore Towards healthy Outcome (GUSTO) birth cohort study in Singapore, fetal biometric measurements were obtained at enrolment to antenatal care (11-12 weeks) and up to three more time points during pregnancy. Singleton pregnancies with a healthy profile defined by maternal, pregnancy and fetal characteristics and birth outcomes were selected for this analysis. The Hadlock algorithm was used to calculate EFW. Mixed effects model was used to establish unconditional and conditional standards in z-scores and percentiles for both genders pooled and for each gender separately.

Results

A total of 313 women were included, of whom 294 had 3 and 19 had 2 ultrasound scans other than the gestational age dating scan. Fetal abdominal circumference showed a roughly linear trajectory from 18 to 36 weeks of gestation, while EFW showed an accelerating trajectory. Gender differences were more pronounced in the 10 ^thpercentile than the 50 ^thor 90 ^thpercentiles. As compared to other published charts, this population showed growth trajectories that started low but caught up at later gestations.

Conclusions

Unconditional and conditional standards for monitoring fetal size and fetal growth in terms of abdominal circumference and EFW are available for this ethnic-Chinese population. Electronic spreadsheets are provided for their implementation.

【 授权许可】

   
2015 Xu et al.

【 图 表 】

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【 参考文献 】

• [1]Barker DJP. Mothers, Babies and Health in Later Life. 2nd ed. Churchill Livingstone, Edinburgh; 1998.
• [2]Cnattingius S, Haglund B, Kramer MS. Differences in late fetal death rates in association with determinants of small for gestational age fetuses: population based cohort study. BMJ. 1998; 316:1483-7.
• [3]Roth S, Chang TC, Robson S, Spencer JA, Wyatt JS, Stewart AL. The neurodevelopmental outcome of term infants with different intrauterine growth characteristics. Early Hum Dev. 1999; 55:39-50.
• [4]Kramer MS. The epidemiology of adverse pregnancy outcomes: an overview. J Nutr. 2003; 133(5 Suppl 2):1592S-6.
• [5]Seravalli V, Block-Abraham DM, Turan OM, Doyle LE, Blitzer MG, Baschat AA. Second trimester prediction of delivery of a small-for-gestational-age neonate: integrating sequential Doppler information, fetal biometry, and maternal characteristics. Prenat Diagn. 2014 May 24. doi: 10.1002/pd.4418. [Epub ahead of print].
• [6]Chang TC, Robson SC, Boys RJ, Spencer JA. Prediction of the small for gestational age infant: which ultrasonic measurement is best? Obstet Gynecol. 1992; 80:1030-8.
• [7]Souka AP, Papastefanou I, Pilalis A, Michalitsi V, Kassanos D. Performance of third trimester ultrasound for prediction of small-for-gestational-age neonates and evaluation of contingency screening policies. Ultrasound Obstet Gynecol. 2012; 39:535-542.
• [8]Fetal growth restriction. Obstet Gyneco. 2013; 121:1122-33.
• [9]Royal College of Obstetricians and Gynaecologists: The Investigation and management of the small-for-gestational-age fetus. Green-top Guideline No. 31. 2nd edition. London, UK: RCOG; February 2013.
• [10]Lausman A, Kingdom J, Gagnon R, Basso M, Bos H, Crane J, Davies G, Delisle MF, Hudon L, Menticoglou S, Mundle W, Ouellet A, Pressey T, Pylypjuk C, Roggensack A, Sanderson F. Intrauterine growth restriction: screening, diagnosis, and management. J Obstet Gynaecol Can. 2013; 35:741-57.
• [11]Guideline for the Management of Suspected Small for Gestational Age Singleton Pregnancies after 34 weeks gestation. NZMFMN, Auckland; 2013.
• [12]Merialdi M, Caulfield LE, Zavaleta N, Figueroa A, Costigan KA, Dominici F, Dipietro JA. Fetal growth in Peru: comparisons with international fetal size charts and implications for fetal growth assessment. Ultrasound Obstet Gynecol. 2005; 14:123-8.
• [13]Kierans WJ, Joseph KS, Luo ZC, Platt R, Wilkins R, Kramer MS. Does one size fit all? The case for ethnic-specific standards of fetal growth. BMC Pregnancy Childbirth. 2008; 8:1. BioMed Central Full Text
• [14]Landis SH, Ananth CV, Lokomba V, Hartmann KE, Thorp JM, Horton A, Atibu J, Ryder RW, Tshefu A, Meshnick SR. Ultrasound-derived fetal size nomogram for a sub-Saharan African population: a longitudinal study. Ultrasound Obstet Gynecol. 2009; 34:379-86.
• [15]Gaillard R, de Ridder MA, Verburg BO, Witteman JC, Mackenbach JP, Moll HA, Hofman A, Steegers EA, Jaddoe VW. Individually customised fetal weight charts derived from ultrasound measurements: the Generation R Study. Eur J Epidemiol. 2011; 26:919-26.
• [16]Jiang X, Zhang YH, Li Y, Ma X, Zhu YS, Shang L. Reference charts and equations of fetal biometry for normal singleton pregnant women in Shaanxi, China. Clin Exp Obstet Gynecol. 2013; 40:393-8.
• [17]Merialdi M, Widmer M, Gülmezoglu AM, Abdel-Aleem H, Bega G, Benachi A, Carroli G, Cecatti JG, Diemert A, Gonzalez R, Hecher K, Jensen LN, Johnsen SL, Kiserud T, Kriplani A, Lumbiganon P, Tabor A, Talegawkar SA, Tshefu A, Wojdyla D, Platt L. WHO multicentre study for the development of growth standards from fetal life to childhood: the fetal component. BMC Pregnancy Childbirth. 2014; 14:157. BioMed Central Full Text
• [18]Kwon JY, Park IY, Wie JH, Choe S, Kim CJ, Shin JC. Fetal biometry in the Korean population: reference charts and comparison with charts from other populations. Prenat Diagn. 2014; 34:927-34.
• [19]Parikh LI, Nolan J, Tefera E, Driggers R. Fetal biometry: does patient ethnicity matter? J Matern Fetal Neonatal Med. 2014; 27:500-4.
• [20]Villar J, Papageorghiou AT, Ohuma EO, Ismail LC, Barros FC, Lambert A, Carvalho M, Jaffer YA, Bertino E, Gravett MG, Altman DG, Purwar M, Frederick IO, Noble JA, Victora CG, Bhutta ZA, Kennedy SH. The likeness of fetal growth and newborn size across non-isolated populations in the INTERGROWTH-21st Project: the Fetal Growth Longitudinal Study and Newborn Cross-Sectional Study. Lancet Diabetes Endocrinol. 2014; 2:781-92.
• [21]Mikolajczyk RT, Zhang J, Betran AP, Souza JP, Mori R, Gulmezoglu AM, Merialdi M. A global reference for fetal-weight and birthweight percentiles. Lancet. 2011; 377:1855-61.
• [22]Gardosi J. Fetal growth standards: individual and global perspectives. Lancet. 2011; 377:1812-4.
• [23]Royston P, Altman DG. Design and analysis of longitudinal studies of fetal size. Ultrasound Obstet Gynecol. 1995; 6:307-12.
• [24]Xu J, Luntamo M, Kulmala T, Ashorn P, Cheung YB. A longitudinal study of weight gain in pregnancy in Malawi: unconditional and conditional standards. Am J Clin Nutr. 2014; 99:296-301.
• [25]Owen P, Burton K, Ogston S, Khan KS, Howie PW. Using unconditional and conditional standard deviation scores of fetal abdominal area measurements in the prediction of intrauterine growth restriction. Ultrasound Obstet Gynecol. 2000; 16:439-44.
• [26]Census of Population 2010, Statistical Release 1. Department of Statistics, Singapore; 2011.
• [27]Soh SE, Tint MT, Gluckman PD, Godfrey KM, Rifkin-Graboi A, Chan YH, Stünkel W, Holbrook JD, Kwek K, Chong YS, Saw SM. Cohort profile: Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study. Int J Epidemiol. 2014; 43:1401-9.
• [28]World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus. WHO/NCD/NCS/99.2 ed. Geneva: World Health Organization; 1999.
• [29]World Health Organization. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. Geneva; 2013.
• [30]WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height, and Body Mass Index-for-Age: Methods and Development. WHO Press, Geneva, Switzerland; 2006.
• [31]Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363:157-163.
• [32]Pilu G, Nicolaides K, Ximenes R, Jeanty P. The 18-23 weeks scan. Diploma in Fetal Medicine & ISUOG Educational Series; 2002.
• [33]Robinson HP, Fleming JEE. A critical evaluation of sonar “crown–rump length” measurements. Br J Obstet Gynaecol. 1975; 82:702-10.
• [34]Butt K, Lim K. Determination of gestational age by ultrasound. J Obstet Gynaecol Can. 2014; 36:171-83.
• [35]Selbing A, Kjessler B. Conceptual dating by ultrasonic measurement of the fetal biparietal diameter in early pregnancy. Acta Obstet Gynecol Scand. 1985; 64:593-7.
• [36]Hadlock F, Harrist R, Sharman R, Deter R, Park S. Estimation of fetal weight with the use of the head, body and femur measurements – a prospective study. Am J Obstet Gynecol. 1985; 151:333-7.
• [37]Royston P. Calculation of unconditional and conditional reference intervals for foetal size and growth from longitudinal measurements. Stat Med. 1995; 14:1417-36.
• [38]Cheung YB. Statistical Analysis of Human Growth and Development. CRC Press, Boca Raton, FL; 2014.
• [39]Johnsen SL, Rasmussen S, Wilsgaard T, Sollien R, Kiserud T. Longitudinal reference ranges for estimated fetal weight. Acta Obstet Gynecol Scand. 2006; 85:286-97.
• [40]van Buuren S, Fredriks AM. Worm plot: a simple diagnostic device for modeling growth reference curves. Stat Med. 2001; 20:1259-77.
• [41]Williams RL. A note on robust variance estimation for cluster-correlated data. Biometrics. 2000; 56:645-6.
• [42]Stata Corporation. Stata Statistical Software: Release 12. College Station, Texas 77845-4512, USA, Stata Corporation; 2011.
• [43]Bertino E, Milani S, Fabris C, De Curtis M. Neonatal anthropometric charts: what they are, what they are not. Arch Dis Child Fetal Neonatal Ed. 2007; 92:F7-10.
• [44]Papageorghiou AT, Ohuma EO, Altman DG, Todros T, Cheikh Ismail L, Lambert A, Jaffer YA, Bertino E, Gravett MG, Purwar M, Noble JA, Pang R, Victora CG, Barros FC, Carvalho M, Salomon LJ, Bhutta ZA, Kennedy SH, Villar J. International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. Lancet. 2014; 384:869-79.
• [45]Cheon K, Albert PS, Zhang Z. The impact of random-effect misspecification on percentile estimation for longitudinal growth data. Stat Med. 2012; 31:3708-18.
• [46]Method for estimating due date. Committee Opinion No. 611. Obstet Gynecol. 2014; 124:863-866.
• [47]Delaney M, Roggensack A, Leduc DC, Ballermann C, Biringer A, Delaney M, Dontigny L, Gleason TP, Shek-Yn Lee L, Martel MJ, Morin V, Polsky JN, Rowntree C, Shepherd DJ, Wilson K. Guidelines for the management of pregnancy at 41 + 0 to 42 + 0 weeks. J Obstet Gynaecol Can. 2008; 30:800-823.
• [48]Lai FM, Yeo GSH. Reference charts of foetal biometry in Asians. Singapore Medical Journal. 1995; 36:628-36.
• [49]Lei H, Wen SW. Ultrasonographic examination of intrauterine growth for multiple fetal dimensions in a Chinese population. Central-South China Fetal Growth Study Group. Am J Obstet Gynecol. 1998; 178:916-21.
• [50]Munim S, Morris T, Baber N, Ansari Y, Azam SI. Growth charts of fetal biometry: a longitudinal study. J Matern Fetal Neonatal Med. 2012; 25:692-8.
• [51]Gallivan S, Robson SC, Chang TC, Vaughan J, Spencer JAD. An investigation of fetal growth using serial ultrasound data. Ultrasound Obstet Gynecol. 1993; 3:109-14.
• [52]Pang MW, Leung TN, Sahota DS, Lau TK, Chang AM. Customizing fetal biometric charts. Ultrasound Obstet Gynecol. 2003; 22:271-6.
• [53]Salomon LJ, Bernard JP, Ville Y. Estimation of fetal weight: reference range at 20-36 weeks’ gestation and comparison with actual birth-weight reference range. Ultrasound Obstet Gynecol. 2007; 29:550-5.