Fetal Growth Patterns with Customized Growth Charts in South India

Abstract

We conducted this study to determine the diagnostic effectiveness of these customized GROW charts to predict abnormal fetal growth pattern in an antenatal population attending an advanced tertiary care perinatal hospital in south India. Serial SFH of pregnant women with singleton babies booked for antenatal care up to 22 weeks was measured from 24 weeks of gestation and plotted on customized growth charts that were developed using the gestation related optimal weight (GROW) software During the prenatal period, ultrasound was used to determine fetal development patterns, which were then validated at birth using a neonatal growth classification. Using sensitivity, specificity, area under the ROC curve, and likelihood ratio tests, the diagnostic effectiveness of SFH was compared to ultrasound and neonatal classifications. The study included 666 pregnant women who presented at the antenatal clinics from January 2010 to October 2010. On ultrasound examination, 564 (84.6%) fetuses were AGA, 78 (11.7%) fetuses were LGA and 19 (2.9%) were SGA and 5 (0.8%) showed crossing centile from higher to lower pattern. On serial SFH measures, 426 (64.0%) of the fetuses were normal growth, 180 (27.0%) were excessive growth and 40 (6.0%) were slow growth. Serial SFH measures had a positive likelihood ratio of 4.7 (8.5 for USG) for the identification of SGA and a negative likelihood ratio of 0.06 for the detection of LGA. The SFH measurements plotted on a customized GROW curve have the potential to become a low-cost screening tool for identifying fetuses with abnormal growth patterns. Before being used on a larger scale, the diagnostic efficiency of SFH plotted on customized growth charts needs to be improved further by developing appropriate customized growth charts for India.