Abstract
ObjectiveTo determine how various centile cut points on the INTERGROWTH-21st (INTERGROWTH), World Health Organization (WHO), and Hadlock fetal growth charts predict perinatal morbidity/mortality, and how this relates to choosing a fetal growth chart for clinical use.MethodsWe linked antenatal ultrasound measurements for fetuses > 28 weeks’ gestation from the British Columbia Women’s hospital ultrasound unit with the provincial perinatal database. We estimated the risk of perinatal morbidity/mortality (decreased cord pH, neonatal seizures, hypoglycemia, and perinatal death) associated with select centiles on each fetal growth chart (the 3rd, 10th, the centile identifying 10% of the population, and the optimal cut-point by Youden’s Index), and determined how well each centile predicted perinatal morbidity/mortality.ResultsAmong 10,366 pregnancies, the 10th centile cut-point had a sensitivity of 11% (95% CI 8, 14), 13% (95% CI 10, 16), and 12% (95% CI 10, 16), to detect fetuses with perinatal morbidity/mortality on the INTERGROWTH, WHO, and Hadlock charts, respectively. All charts performed similarly in predicting perinatal morbidity/mortality (area under the curve [AUC] =0.54 for all three charts). The statistically optimal cut-points were the 39th, 31st, and 32nd centiles on the INTERGROWTH, WHO, and Hadlock charts respectively.ConclusionThe INTERGROWTH, WHO, and Hadlock fetal growth charts performed similarly in predicting perinatal morbidity/mortality, even when evaluating multiple cut points. Deciding which cut-point and chart to use may be guided by other considerations such as impact on workflow and how the chart was derived.
Highlights
Despite the limitations of using size to identify fetal growth restriction [1], plotting estimated fetal size on a growth chart is one of the first steps in identifying which fetuses may benefit from closer monitoring in most jurisdictions
We aimed to estimate the risks of adverse perinatal outcomes across the continuum of estimated fetal weight centiles on the INTERGROWTH-21st (INTERGROWTH), World Health Organization (WHO), and Hadlock fetal growth charts in a large ultrasound cohort linked with population-based perinatal outcome records, and to determine the abilities of various cut-points on each chart to distinguish fetuses that have perinatal morbidity/mortality
We evaluated the accuracy of our estimated fetal weight measurements against neonatal birth weight among those who had their last ultrasound within 3 days of birth by calculating the mean percent difference ([estimated fetal weight- birthweight]/birthweight × 100) and the proportion of fetuses with an percent difference < 10%
Summary
Despite the limitations of using size to identify fetal growth restriction [1], plotting estimated fetal size on a growth chart is one of the first steps in identifying which fetuses may benefit from closer monitoring in most jurisdictions. Previous studies linking estimated fetal weight centiles on these charts with adverse outcomes have only evaluated the charts’ predictive ability at the 10th or 5th centiles [7,8,9,10,11]. This is an important limitation because more extreme cut-points may be needed on the new charts because they reflect patterns of growth under optimal conditions [6]. We aimed to demonstrate a practical, evidence-based approach to selecting a fetal growth chart and centile cut-point for clinical use
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