Abstract
BackgroundDifferent formulae have been developed globally to estimate gestational age (GA) by ultrasonography in the first trimester of pregnancy. In this study, we develop an Indian population-specific dating formula and compare its performance with published formulae. Finally, we evaluate the implications of the choice of dating method on preterm birth (PTB) rate. This study’s data was from GARBH-Ini, an ongoing pregnancy cohort of North Indian women to study PTB.MethodsComparisons between ultrasonography-Hadlock and last menstrual period (LMP) based dating methods were made by studying the distribution of their differences by Bland-Altman analysis. Using data-driven approaches, we removed data outliers more efficiently than by applying clinical parameters. We applied advanced machine learning algorithms to identify relevant features for GA estimation and developed an Indian population-specific formula (Garbhini-GA1) for the first trimester. PTB rates of Garbhini-GA1 and other formulae were compared by estimating sensitivity and accuracy.ResultsPerformance of Garbhini-GA1 formula, a non-linear function of crown-rump length (CRL), was equivalent to published formulae for estimation of first trimester GA (LoA, − 0.46,0.96 weeks). We found that CRL was the most crucial parameter in estimating GA and no other clinical or socioeconomic covariates contributed to GA estimation. The estimated PTB rate across all the formulae including LMP ranged 11.27–16.50% with Garbhini-GA1 estimating the least rate with highest sensitivity and accuracy. While the LMP-based method overestimated GA by 3 days compared to USG-Hadlock formula; at an individual level, these methods had less than 50% agreement in the classification of PTB.ConclusionsAn accurate estimation of GA is crucial for the management of PTB. Garbhini-GA1, the first such formula developed in an Indian setting, estimates PTB rates with higher accuracy, especially when compared to commonly used Hadlock formula. Our results reinforce the need to develop population-specific gestational age formulae.
Highlights
Different formulae have been developed globally to estimate gestational age (GA) by ultrasonography in the first trimester of pregnancy
An accurate estimation of GA is crucial for the management of preterm birth (PTB)
Garbhini-GA1, the first such formula developed in an Indian setting, estimates PTB rates with higher accuracy, especially when compared to commonly used Hadlock formula
Summary
Different formulae have been developed globally to estimate gestational age (GA) by ultrasonography in the first trimester of pregnancy. The estimation of gestational age (GA) during the antenatal period called as the dating of pregnancy has been conventionally done using the first day of the recallbased last menstrual period (LMP) or measurement of foetal biometry by ultrasonography (USG) [4, 5]. Each of these methods poses a unique set of challenges. The accuracy of dating by LMP method is dependent on accurate recall, and regularity of menstrual cycle [4, 6] which, is affected by numerous physiological and pathological conditions such as obesity [7], polycystic ovarian syndrome [8], breastfeeding [9] and use of contraceptive methods [10]
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