Weight estimation for low birth weight fetuses and macrosomic fetuses in Chinese population

Abstract

Compared with normal birth weight fetuses (2,500-4,000 g), accurate fetal weight estimation for fetuses with low or excessive weight is considered more important for fetal compromise prediction and labor management. New formulas were developed to estimate weight for low birth weight (LBW) fetuses and macrosomic fetuses, respectively. A total of 523 fetuses with birth weight less than 2,500 g, 652 fetuses with normal birth weight, and 239 fetuses with birth weight more than 4,000 g were included in the study. As much as 25 existing formulas which incorporate regularly defined fetal measurements were evaluated and compared. Performance evaluation of existing formulas showed that no formulas can provide consistently accurate weight estimation both for LBW fetuses and macrosomic fetuses. A total of 1,034 cases were utilized to generate an overall regression formula. If the pre-estimated weight fell into the suspicious LBW and macrosomia range, the value was then updated by using the new regression formulas for LBW fetuses and macrosomic fetuses. As the training group, 262 LBW fetuses and 120 macrosomic fetuses were employed in a stepwise linear regression to obtain two update regression formulas for suspicious LBW fetuses and macrosomic fetuses. As the validation group, another 261 LBW fetuses and 119 macrosomic fetuses were assessed. The new overall formula has the form of Log(10)BW = 0.180(HC) + 0.00628(AC) - 0.00318(HC)(2) + 0.00173(AC)(FL) + 0.0000430(BPD)(HC)(2). The update formula for suspicious LBW fetuses is LnBW = 1.470(BPD) + 0.0169(HC) - 0.0873(BPD)(2) + 0.00518(AC)(FL) and for macrosomic fetuses is Log(10)BW = 0.730(BPD) - 0.0375(BPD)(2) + 0.000264(AC)(FL). For LBW fetuses, the new method gave 7.6 ± 209.0 (g) of estimation error and 8.3 ± 7.8 (%) of absolute percentage error, while the best existing formula provided -0.7 ± 226.0 (g) and 9.1 ± 8.3 (%). With the new method, 71.3% of estimates fell within ±10% of the actual birth weight, while the best existing formula gave 65.5%. For macrosomic fetuses, the new method gave -87.9 ± 231.0 (g) of estimation error and 4.4 ± 3.9 (%) of absolute percentage error, while the best existing formula provided 115.6 ± 345.1 (g) and 6.8 ± 5.4 (%). With the new method, 89.1% of estimates fell within ±10% of the actual birth weight, while the best existing formula gave 75.6%. To improve the weight estimation accuracy for low or excessive weight fetuses, separate formulas are necessary. The new method provides significant improvement on fetal weight estimation for LBW fetuses and macrosomic fetuses.