Predictors Of Birth Weight Research Articles

Two-dimensional fetal biometry versus three-dimensional fractional thigh volume for ultrasonographic prediction ofbirthweight.

To develop and validate birthweight prediction models using fetal fractional thigh volume (TVol) in an Indian population, comparing them with existing prediction models developed for other ethnicities. A prospective observational study was conducted among 131 pregnant women (>36weeks) attending a tertiary hospital in New Delhi, India, for prenatal care between December 1, 2014, and November 1, 2016. Participants were randomly divided into formulating (n=100) and validation (n=31) groups. Multiple regression analysis was performed to generate four models to predict birthweight using various combinations of two-dimensional (2D) ultrasonographic parameters and a three-dimensional (3D) ultrasonographic parameter (TVol). The best fit model was compared with previously published 2D and 3D models. The best fit model comprised biparietal diameter, head circumference, abdominal circumference, and TVol. This model had the lowest mean percentage error (0.624±8.075) and the highest coefficient of determination (R2 =0.660). It correctly predicted 70.2% and 91.6% of birthweights within 5% and 10% of actual weight, respectively. Compared with previous models, attributability for the 2D and 3D models was 0.65 and 0.55, respectively. Accuracy was -0.05±1.007 and -2.54±1.11, respectively. Models that included TVol provided good prediction of birthweight in the target population.

A Study on Prediction of Birth Weight for Infants using Transition Probability Matrix with respect to Haemoglobin Count

A Study on Prediction of Birth Weight for Infants using Transition Probability Matrix with respect to Haemoglobin Count

Influence of maternal obesity on the accuracy of ultrasonography birth weight prediction

Objective: The aim of the study was to investigate whether the accuracy of ultrasound estimates of fetal weight (EFW) was dependent on maternal obesity.Study design: A prospective cross-sectional study of 1064 singleton pregnant women classified according to body mass index (BMI) into two categories: normal (BMI < 25 kg/m2, n = 863) and obese (BMI ≥ 35 kg/m2, n = 201) was conducted. EFW were calculated using Hadlock’s formula, and the difference between EFW and the actual birthweight (absolute percent error) was analyzed in both groups. Spearman’s correlation was used to assess the relationship between ultrasound performance (absolute error), maternal BMI, and actual birth weight.Results: Median absolute error of sonographic EFW was 5.90 and 6.47% for the normal and obese groups, respectively (p .38). A correlation between EFW and birth weight (BW) was found in both groups, r = 0.755 (p < .001) and r = 0.753 (p < .001), respectively. The correlation between absolute error, maternal BMI, and fetal birth weight was poor.Conclusions: Maternal obesity is unrelated to the accuracy of sonographic EFW, and regardless of maternal or fetal size, ultrasound is currently an accurate method of prediction for both obese and normal weight pregnant women.

Antenatal Risk Scoring Scale for Predication of Low Birth Weight and Its Validity.

Background:Prediction of low birth weight (LBW) early during pregnancy may prevent LBW by appropriate interventions.Aims/Objective:The aim of the study is to develop an antenatal risk scoring scale for prediction of LBW.Subject and Methods:Routine and in-depth information on diet, occupation, and rest was collected from November 1, 2013, to November 13, 2015. A cohort of 1876 and subset of 380 pregnant women attending Krishna Hospital Karad, Maharashtra, India.Statistical Analysis:Multivariate analysis and relative risks (RRs) were found out by SPSS version 16 and tested on a separate set of 251 mothers.Results:The frequency of meals of <4, hard work <6 h of sleep and illiteracy, antenatal morbidity, <10 kg weight gain, <40 kg maternal weight, and anemia during the first trimester were the risk factors identified from subset and cohort, respectively. Based on their RRs, a new scoring system with a total score of 24 and cutoff “12” was identified by using receiver operating characteristics (ROC) curve analysis with 98.6% sensitivity and 41.1% specificity as tested on 251-independent individuals. The second cutoff of “15” score was identified based on the prevalence of LBW in babies of these 251 mothers.Conclusions:The identification of low-, moderate-, and high-risk of LBW was possible at <12, between 12 and 15, and >15 scores, respectively, with good sensitivity and specificity.

An observational study of the risk of neonatal macrosomia, and early gestational diabetes associated with selected candidate genes for type 2 diabetes mellitus polymorphisms in women with gestational diabetes mellitus.

1) to analyse the prevalence of selected candidate genes for type 2 diabetes mellitus polymorphisms (IRS1 G972R; ENPP1 K121Q; ADRB3 W64R) among women with gestational diabetes; and 2) to investigate any association between variants of these genes and risk of neonatal macrosomia. We conducted a prospective observational study of a group of women (N = 140) in singleton pregnancies who delivered at term. Characteristics of the study group at enrolment: age: 32.0 ± 4.9 years; GA: 26.6 ± 7.5 weeks; HbA1c: 5.6 ± 0.6%; fasting blood glucose: 102.3 ± 16.3 mg/dL; insulin treatment (G2DM): 65.7%; chronic hypertension: 11.4%; gestational hypertension: 17.9%; preeclampsia: 1.4%; birth weight: 3590 ± 540 g; birth weight ≥ 4000 g (macrosomia): 18.6%; caesarean section: 44.3%; and female newborns: 57.1%. The maternal metabolic characteristics at the time of booking did not differ between polymorphisms. Macrosomia was insignificantly more frequent in females (22.5%) than in males (13.3%) (p = 0.193). Only maternal height and body weight at the time of booking significantly predicted birth weight (R = 0.27, p = 0.007; R = 0.25, p = 0.005, respectively). IRS1 G972R GR and ENPP1 K121Q KQ polymorphisms were associated with an insignificantly increased risk for macrosomia. Carriers of the heterozygotic variant of the IRS 1 gene were significantly more likely to be diagnosed with GDM/DiP in the first trimester: OR 5.2, 95% CI: 1.4; 19.2; p = 0.014. 1) having similar metabolic characteristics, carriers of specific variants of T2DM candidate genes might be at increased risk of delivery of macrosomic newborns; 2) any association between genetic variants and macrosomia in this population might be gender-specific; and 3) allelic variation in the IRS1 gene is associated with early GDM/DiP.

Malaria in Early Pregnancy and the Development of the Placental Vasculature.

Pregnancy malaria has a negative impact on fetal outcome. It is uncertain whether infections in early pregnancy have a clinical impact by impeding the development of the placental vasculature. Tanzanian women (n = 138) were closely monitored during pregnancy. Placentas collected at birth were investigated using stereology to establish the characteristics of placental villi and vessels. Placental vasculature measures were compared between women infected with malaria and controls. Compared with controls, placentas from women infected with malaria before a gestational age (GA) of 15 weeks had a decreased volume of transport villi (mean decrease [standard deviation], 12.45 [5.39] cm3; P = .02), an increased diffusion distance in diffusion vessels (mean increase, 3.33 [1.27] µm; P = .01), and a compensatory increase in diffusion vessel surface area (mean increase, 1.81 [0.74 m2]; P = .02). In women who had malaria before a GA of 15 weeks diffusion vessel surface area and transport vessel length distance were positive predictors for birth weight (multilinear regression: P = .007 and P = .055 for diffusion surface area and transport length, respectively) and GA at delivery (P = .005 and P = .04). Malaria infection in early pregnancy impedes placental vascular development. The resulting phenotypic changes, which can be detected at delivery, are associated with birth weight and gestational length. NCT02191683.

Effect of Prenatal Smoke Exposure on Birth Weight: The Moderating Role of Maternal Depressive Symptoms.

Both prenatal smoke exposure and depression have been linked to lower birth weight, a risk factor for morbidity and mortality. Few studies have looked at the interaction between these risk factors and none have used a biomarker to objectively measure prenatal smoke exposure. The current study sought to examine independent and interactive effects of cotinine and depression on birth weight. The effect of race was also explored. Data were drawn from a prospective study of pregnant women (N = 568) in the southeastern United States. Maternal demographic, health information, depressive symptoms, and birth data were collected via self-report and medical record abstraction. Prenatal blood samples were assayed for cotinine. Controlling for covariates, multiple regression analyses indicated that both cotinine and depressive symptoms independently predicted lower birth weight and a significant interaction was also observed. Upon probing the interaction, a negative association between cotinine levels and birth weight was found in the context of higher depression but not lower depression scores. Similarly, logistic regression analyses revealed a significant interaction between cotinine and depression, such that cotinine predicted having a baby less than 2500 g among women who fell above the indicated cutoff score. African American women had the highest levels of cotinine and lowest weight babies; however, race was not a significant moderator. Results suggest prenatal smoke exposure has a greater negative effect on birth weight for women endorsing co-occurring depressive symptoms. Findings can inform targeted interventions and assist medical providers with identifying women at increased risk for poor perinatal outcomes. Despite the common occurrence of smoking during pregnancy and prenatal depression, the interaction between these risk factors on birth weight has rarely been examined. Further, the extant results have been mixed, likely due in part to difficulties in measurement. The current study was the first to use prenatal cotinine to assess bias-free, continuous levels of prenatal smoke exposure. Results indicate that prenatal cotinine was a significant predictor of birth weight only in the context of maternal depressive symptoms. These findings have important implications for mitigating negative perinatal outcomes for pregnant women and their children.

Maternal Pre-Pregnancy Cardiovascular Risk Factors and Offspring and Grandoffspring Health: Bogalusa Daughters.

Both maternal pre-pregnancy body mass index (BMI) and gestational weight gain have been associated with cardiovascular health in the offspring beyond two generations. A total of 274 daughters (aged 12–54) of 208 mothers who participated in the Bogalusa Heart Study were interviewed about their reproductive history. Mothers’ data was taken from the original study, and cardiovascular measures at the visit prior to pregnancy were correlated with daughter’s measures. Maternal pre-pregnancy BMI, skinfold, and waist circumference were examined as a predictor of daughters’ blood pressure, lipids, and glucose, as well as a predictor of birthweight and gestational age of grandchildren. Maternal pre-pregnancy BMI was associated with higher blood pressure and lower low-density lipoprotein (LDL) and cholesterol in the daughters. Most maternal cardiometabolic risk factors were not associated with grandchildren’s birth outcomes, even though higher cholesterol and LDL was associated with lower gestational age, and higher BMI and skinfold thickness with an increased risk of preterm birth. In this pilot study, some associations were found between maternal adiposity and cardiovascular risk, daughters’ cardiovascular risk, and grandchild birth outcomes. Lack of conclusive associations could be due to a true lack of effect, effects being primarily mediated through daughter’s BMI, or the low power of the study.

Influence of aerobic exercise on maternal lipid levels and offspring morphometrics

Maternal BMI, lipid levels (cholesterol, triglyceride, LDL, HDL), and exercise amount are interrelated and each influence offspring body size. This study proposed to determine the influence of exercise on maternal lipid levels and infant body size. We had 36 participants complete these measures. Participants in the aerobic exercise intervention (n = 14) completed three 50-min sessions weekly from 16 weeks gestation to delivery and were compared with a non-exercise control group (n = 22). Maternal lipid profiles were assessed at 16 and at 36 weeks gestation. Fetal body size was measured at 36 weeks gestational age using ultrasound assessment. Neonatal body size measures were acquired from birth records. Statistical analysis included two-sample t-tests, correlations, and regression models. Participants were similar in age, pre-pregnancy BMI, gravida, parity, education, and gestational weight gain (GWG). There were no differences in gestational age, Apgar scores at 1 and 5 min for infants of exercisers relative to controls. Exercisers had higher pre-training triglycerides (p = 0.004) and pregnancy change in triglycerides (p = 0.049) compared to controls. Head circumference was significantly larger in exercise exposed infants relative to infants of controls. Pregnancy METs had a positive relationship with birth length (r = .445, p = .006) and birth weight (r = .391, p = .02). GWG had a moderate, positive relationship with fetal abdominal circumference (r = .570, p = .004). Regression analysis indicated 5 predictors explained 61.7% of the variance in birth weight (Adj.R2 = 0.469, F(5,13) = 5,13, p = 0.02); it was found that pregnancy METs (β = .724, p = .007), 36 week cholesterol (β = 1.066, p = .02), and 36 week LDL (β = -1.267, p = .006) significantly predict birth weight. Regression analysis indicated 4 predictors explained 43.8% of the variance in birth length (Adj.R2 = 0.306, F(4,17) = 3.32, p = 0.04); it was found that pregnancy METs (β = .530, p = .03), and 36 week LDL (β = -.891, p = .049) significantly predict birth length. The primary association and predictors of infant body size was related to pregnancy exercise and late pregnancy cholesterol and LDL levels. Considering these relationships, it is essential that women maintain aerobic exercise during pregnancy, but should also be cognizant of lipid levels during their pregnancy. Therefore intervention during pregnancy focused on infant body size should involve exercise and and quality nutritional intake foods during pregnancy.

Maternal Anthropometry and it’s Relationship to Birth Weight

Introduction: Nutrition plays a major role in maternal and child health and it is perhaps the most influential non-genetic factor in foetal development. Understanding the relation between maternal nutrition and birth outcomes may provide a basis for developing nutritional interventions that will improve birth outcomes and long-term quality of life. Many research projects have studied maternal anthropometric indicators as predictors of birth weight; not many of them have focused on the question as to which is the best indicator for prediction of pregnancy outcomes with greater accuracy. Hence this study was taken up to assess the relationship between specific maternal anthropometric indicator including Mid-upper arm circumference (MUAC) and pregnancy outcome. The objective of the study was to assess the relationship between maternal anthropometric indicators and birth weight, crown-heel length and new-born’s head circumference. Methods: A cross-sectional study was conducted among mothers who come for safe confinement to District Hospital, Tumkur during June - August 2018. Data was collected using pre-tested, semi structured proforma. Anthropometric measurements like weight, height &amp; MUAC of mother and new-borns’ birthweight &amp; length was collected. Data was analysed using SPSS and linear regression analysis was used to assess the relationship between maternal &amp; newborn anthropometric measures. Results: There was a statistically significant positive correlation between: Birth-weight and maternal height (r=0.301), MUAC (r=0.222) &amp; gestational weight-gain (r=0.233); Crown-heel length of new born and MUAC (r=0.209); Head circumference and MUAC (r=0.475) and gestational weight-gain (r=0.263). Conclusion: MUAC as an indicator of maternal nutritional status is having a positive correlation with birth weight, and can be used as a predictor of new-born’s anthropometry.

Maternal hemodynamics, fetal biometry and Doppler indices in pregnancies followed up for suspected fetal growth restriction.

To assess whether, in a cohort of patients with a small-for-gestational-age (SGA) fetus with estimated fetal weight ≤ 10th percentile, maternal hemodynamics, fetal biometry and Doppler indices at presentation can predict the subsequent development of an abnormal fetal Doppler index or delivery of a baby with birth weight < 3rd percentile. This was a prospective observational cohort study conducted at a specialist clinic for the management of pregnancies with a SGA fetus at King's College Hospital, London, UK. The study population comprised 86 singleton pregnancies with a SGA fetus, presenting at a median gestational age of 32 (range, 26-35) weeks. We measured maternal cardiac function using a non-invasive transthoracic bioreactance monitor, as well as mean arterial pressure, fetal biometry, and umbilical artery (UA), fetal middle cerebral artery (MCA) and uterine artery (UtA) pulsatility indices (PI), and the deepest vertical pool of amniotic fluid. Z-scores of these variables were calculated based on reported reference ranges and the values were compared between pregnancies with evidence of an abnormal fetal Doppler index at presentation (Group 1), those that had developed an abnormal Doppler index at a subsequent visit (Group 2) and those that did not develop an abnormal Doppler index throughout pregnancy (Group 3). Abnormal fetal Doppler was defined as UA-PI > 95th percentile and/or MCA-PI < 5th percentile. Differences in measured variables at presentation were also compared between pregnancies delivering a baby with birth weight < 3rd percentile and those delivering a baby with birth weight ≥ 3rd percentile. Multivariate logistic regression analysis was used to determine significant predictors of birth weight < 3rd percentile and evolution from normal to abnormal fetal Doppler. In the study population, 14 (16%) cases were in Group 1, 19 (22%) in Group 2 and 53 (62%) in Group3. Birth weight was < 3rd percentile in 39 (45%) cases and ≥ 3rd percentile in 47 (55%). There was decreased cardiac output and stroke volume and increased peripheral vascular resistance compared with a normal population, and the deviations from normal were most marked in Group 1. Pregnancies with birth weight < 3rd percentile, compared with those with birth weight ≥ 3rd percentile, had greater deviations from normal in fetal biometry, maternal cardiac output, stroke volume, heart rate, peripheral vascular resistance and UtA-PI. Multivariate logistic regression analysis demonstrated that, in the prediction of birth weight <3rd percentile, maternal hemodynamic profile provided significant improvement to the prediction provided by maternal demographics, fetal biometry, UtA-PI, UA-PI and MCA-PI (difference between areas under receiver-operating characteristics curves, 0.18 (95% CI, 0.06-0.29); P= 0.002). In contrast, there was no significant independent contribution from maternal hemodynamics in the prediction of the subsequent development of abnormal fetal Doppler. In pregnancies with a SGA fetus, there is decreased maternal cardiac output and stroke volume and increased peripheral vascular resistance, and the deviations from normal are most marked in cases of redistribution in the fetal circulation and reduced amniotic fluid volume. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

OP14.05: INTERGROWTH‐21st versus Hadlock birthweight prediction in pregnant obese women

OP14.05: INTERGROWTH‐21st versus Hadlock birthweight prediction in pregnant obese women

Providers adherence to essential contents of antenatal care services increases birth weight in Bahir Dar City Administration, north West Ethiopia: a prospective follow up study

BackgroundLow birth weight (LBW) is one of the most important factors affecting child morbidity and mortality worldwide. Antenatal care (ANC) is an opportunity for reaching pregnant women with a number of interventions that may be vital to their health and well-being of their infants. However, data on the link between ANC quality and LBW remain limited especially in developing countries. Therefore, this study was aimed at investigating the effect of ANC service quality on birth weight among pregnant women attending ANC at public health facilities of Bahir Dar City Administration, Bahir Dar, Ethiopia using provision of essential services by providers as proxy for quality of care.MethodsNine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit and selected by systematic sampling were enrolled and followed until delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist. Women who gave birth at home and those who deliver a premature or still birth baby were excluded as data on birth weight could not be obtained for home deliveries and as the birth weight of the baby might be affected due to prematurity and still birth. Completed data were obtained from 718 women (since the rest women gave birth at home, we could not obtain birth weight data and we exclude them from analysis). The overall ANC service was considered as acceptable quality if women received ≥75th percentile of the essential ANC services. Generalized Estimating Equation was carried out to identify predictors of birth weight by controlling the cluster effect among women who received ANC services in the same facility.ResultsThe prevalence of low birth weight (< 2500 g) was 7.8% (95%CI = 6.0%, 9.7%) with 1.4% versus 10.5% among those who received acceptable and not acceptable quality ANC services respectively, P-value< 0.001. Maternal nutritional advice, iron-folic acid supplementation, tetanus toxoid vaccination, maternal educational status, parity and age were determinants for birth weight.Conclusion and recommendationThe study showed that access to quality ANC services led to good birth weight outcome. Strengthening adherence of providers to essential components of antenatal care through regular monitoring and need based capacity building is very important for reducing the risk of low birth weight.

Accuracy of sonographic estimated fetal weight in suspected macrosomia: the likelihood of overestimating and underestimating the true birthweight

Objective: Macrosomia has increased risk of serious adverse outcomes for both infants and their mothers. As such, many providers recommend induction of labor or cesarean delivery (CD) based on sonographic estimated fetal weight (sonoEFW) cutoffs. It is known that sonoEFW is a poor predictor of birthweight (BW), especially at the extremes of weight. It is not clear, however, whether sonoEFWs tend to underestimate or overestimate the true BW among fetuses with suspected macrosomia. The objective of this study was to compare rates of overestimation of BW among women with suspected macrosomia by sonoEFW.Methods: This was a retrospective cohort study of women who presented to a single maternal–fetal medicine ultrasound unit within 2 weeks prior to delivery from January 2011 to November 2017. We identified women who received a sonoEFW ≥4000 g. The study sample was divided into four sonoEFW categories: 4000–4249, 4250–4499, 4500–4749, and ≥4750 g. Accuracy of sonoEFW was compared across groups, with the primary outcome being overestimation of BW.Results: A total of 502 patients were included, of whom 301 (60.1%) had a sonoEFW 4000–4249 g, 135 (26.9%) had a sonoEFW 4250–4499 g, 45 (9.0%) had a sonoEFW 4500–4749 g, and 21 (4.2%) had a sonoEFW ≥4750 g. In each sonoEFW group, the risk of overestimating BW was greater than 50%, and the likelihood of overestimation of BW increased significantly across sonoEFW groups (69.4, 76.3, 80.0, 95.2%, p < .001). This held true after adjusting for differences in baseline characteristics, including diabetes and amniotic fluid index. BW ≥4500 g was not accurately predicted. Among women with sonoEFW 4500–4749 g, only 28.9% delivered a neonate with a BW >4500 g; for women with a sonoEFW ≥4750 g, only 47.6% had a BW >4500 g. One hundred sixty-one (32.1%) women underwent CD for suspected macrosomia. Of these CDs, 48 (29.8%) of neonates had a BW <4000 g and 134 (83.2%) had a BW <4500 g.Conclusion: In patients undergoing sonoEFW within 2 weeks of delivery, sonoEFWs ≥4000 g are significantly more likely to overestimate than underestimate the true BW. Obstetricians should be cautious about intervening based on sonoEFW alone, given the high risk that this value is an overestimation of the true weight.

Ultrasonographic measurements in first trimester concepti identify predictors of birth weight and postnatal development in cattle.

The placenta is a major driver of prenatal growth and involved in programming of postnatal performance. We therefore determined placental and embryo-fetal ultrasonographic parameters in early pregnancy and their relationships with birth weight and postnatal weights in a Bos indicus-Bos taurus composite beef cattle population. Pregnancies were generated in 2-yr-old Droughtmaster heifers by artificial insemination after estrus synchronization in 2 consecutive years (2009, n = 36 and 2010, n = 57), with a subset of 2010 heifers used again as lactating 3-yr-old cows in 2011 (n = 24). Each cohort was managed as 1 contemporary group for measurements of Corpus luteum diameter, amnion length and width, placentome width and thickness, and embryo-fetal crown-rump length, at 7 and 8 wk of gestation. This was followed by recordings of birth weight, branding weight at 5 to 6 mo of age and weaning weight 2 mo later. At a significance threshold of P < 0.05, placentome thickness at week 7 was negatively correlated with weights at birth (r = -0.23), branding (r = -0.25), and weaning (r = -0.35), whereas placentome width at week 7 (r = 0.24) and thickness at week 8 (r = 0.29) were positively correlated with birth weight. Thicker placentomes in males at week 7 (7%) difference mirrored sex differences in weights at birth (7%), branding (10%), and weaning (6%). The sex difference trend for birth weight was not consistent across sire-year combinations, ranging from -3.2 to +4.7 kg (birth weight of males - females per sire). These results support the hypothesis that placental parameters at the transition from embryo to fetal stage are major predictors of fetal and postnatal growth, albeit with significant environmentally induced plasticity, in stabilized B. indicus-B. taurus composite populations, and suggest that elements of B. indicus-B. taurus reciprocal differences in birth weight persist in composite populations.

Comparison of Estimation of Fetal Weight by Clinical Method, Ultrasonography and its Correlation with Actual Birth Weight in Term Pregnancy

Objective: To make a comparative evaluation of estimated fetal weight with actual birth weight by using: 1. Aymphysiofundal height x abdominal girth (dares formulae) 2. Ultrasonography (hadlock formulae). Materials and Methods: A prospective comparative study was carried out at the Obstetrics and Gynecology Department and USG section of Department of Radiodiagnosis of Dr. Vasantrao Pawar Medical College and research centre from August 2014 to December 2016, to compare the accuracy of clinical and ultrasonographic estimation of foetal weight with actual birth weight at term. One hundred pregnant women who fulfilled the inclusion criteria had their foetal weight estimated independently using clinical and ultrasonographic methods. Results: About three fourth of the study subjects were in normal weight range of 2.5-4 Kg while 16% were LBW and 8% were VLBW babies. Both Dare's and Hadlock's formulae shows good co-relation with actual birth weight across all weight ranges (r- 0.77 and 0.72; p&lt;0.05 for both) with best correlation observed at weight range of 2.5 to 3.5 Kg. Correlation was slightly lower at extremes of weight at both end. In present study, on comparing prospectively clinical and sonographic methods of predicting birth weight prior to induction of labor at term, we found that clinical estimates appear to be as accurate as ultrasonographic ones. Conclusion: In developing country where ultrasound is not available in many health care delivery system, clinical estimation of foetal weight is an easy, cost effective and simple method.

Development of Modified Screening Criteria for Retinopathy of Prematurity

Current retinopathy of prematurity (ROP) guidelines, which are based on studies of high-risk infants and expert opinion, have low specificity for disease requiring treatment. Postnatal weight gain-based models improve specificity but have been limited by complexity and small development cohorts, which results in model overfitting and resultant decreased sensitivity in validation studies. To develop a birth weight (BW), gestational age (GA), and weight gain (WG) prediction model using data from a broad-risk cohort of premature infants. The Postnatal Growth and ROP Study was a retrospective multicenter cohort study conducted in 29 hospitals in the United States and Canada from 2006 to 2012 that included 7483 premature infants at risk for ROP with a known ROP outcome. A hybrid modeling approach was used that combined BW/GA criteria, weight comparison with expected growth from infants without ROP, multiple growth-interval assessments, consideration of nonphysiological WG, and user-friendly screening criteria. Numerous BW/GA levels, postnatal age periods, time intervals, and WG percentile thresholds were evaluated to identify the most robust parameters. Sensitivity for Early Treatment of ROP Study type 1 ROP and potential reduction in infants who require examinations. Of 7483 infants, the median (SD) BW was 1099 (359) g, the median GA was 28 weeks (range, 22-35), 3575 (47.8%) were female, 3615 (48.4%) were white, 2310 (30.9%) were black, 233 (3.1%) were Asian, 93 (1.2%) were Pacific Islander, and 40 (0.5%) were American Indian/Alaskan Native. Infants who met any of 6 criteria would undergo examinations: (1) a GA of younger than 28 weeks; (2) a BW of less than 1051 g; a WG of less than 120 g, 180 g, or 170 g during ages 10 to 19, 20 to 29, or 30 to 39 days, respectively; or hydrocephalus. These criteria predicted 459 of 459 (100%) type 1 (sensitivity, 100%; 95% CI, 99.2%-100%), 524 of 524 (100%) treated, and 466 of 472 (98.7%) type 2 cases while reducing the number of infants who required examinations by 2269 (30.3%). This cohort study, broadly representative of infants who are undergoing ROP examinations, provides evidence-based screening criteria. With validation, the Postnatal Growth and ROP Study criteria could be incorporated into ROP screening guidelines to reduce the number of infants who require examinations in North America.

Comparison of Estimation of Fetal Weight by Clinical Method, Ultrasonography and its Correlation with Actual Birth Weight in Term Pregnancy

Objective: To make a comparative evaluation of estimated fetal weight with actual birth weight by using: 1. Aymphysiofundal height x abdominal girth (dares formulae) 2. Ultrasonography (hadlock formulae). Materials and Methods: A prospective comparative study was carried out at the Obstetrics and Gynecology Department and USG section of Department of Radiodiagnosis of Dr. Vasantrao Pawar Medical College and research centre from August 2014 to December 2016, to compare the accuracy of clinical and ultrasonographic estimation of foetal weight with actual birth weight at term. One hundred pregnant women who fulfilled the inclusion criteria had their foetal weight estimated independently using clinical and ultrasonographic methods. Results: About three fourth of the study subjects were in normal weight range of 2.5-4 Kg while 16% were LBW and 8% were VLBW babies. Both Dare’s and Hadlock’s formulae shows good co-relation with actual birth weight across all weight ranges (r- 0.77 and 0.72; p<0.05 for both) with best correlation observed at weight range of 2.5 to 3.5 Kg. Correlation was slightly lower at extremes of weight at both end. In present study, on comparing prospectively clinical and sonographic methods of predicting birth weight prior to induction of labor at term, we found that clinical estimates appear to be as accurate as ultrasonographic ones. Conclusion: In developing country where ultrasound is not available in many health care delivery system, clinical estimation of foetal weight is an easy, cost effective and simple method.

Maternal body height is a stronger predictor of birth weight than ethnicity: analysis of birth weight percentile charts.

Background Anthropometric parameters such as birth weight (BW) and adult body height vary between ethnic groups. Ethnic-specific percentile charts are currently being used for the assessment of newborns. However, due to globalization and interethnic families, it is unclear which charts should be used. A correlation between a mother's height and her child's BW (1 cm accounts for a 17 g increase in BW) has been observed. The study aims to test differences in small for gestational age (SGA) and large for gestational age (LGA) rates, employing BW percentile charts based on maternal height between ethnic groups. Methods This retrospective study of 2.3 million mother/newborn pairs analyzed BW, gestational age, sex, maternal height and ethnicity from the German perinatal survey (1995-2000). These data were stratified for maternal height (≤157, 158-163, 164-169, 170-175, ≥176 cm) and region of origin (Germany, Central and Northern Europe, North America, Mediterranean region, Eastern Europe, Middle East and North Africa, and Asia excluding Middle East). Percentile charts were calculated for each maternal height group. Results The average BW and maternal height differ significantly between ethnic groups. On current percentile charts, newborns of taller mothers (≥176 cm) have a low rate of SGA and a high rate of LGA, whereas newborns of shorter mothers (≤157 cm) have a high rate of SGA and a low rate of LGA. When the BW data are stratified based on the maternal height, mothers of similar height from different ethnic groups show similar average BWs, SGA and LGA rates. Conclusion Maternal body height has a greater influence on BW than maternal ethnicity. The use of BW percentile charts for maternal height should be considered.

Ultrasonographic estimation of fetal weight: development of new model and assessment of performance of previous models.

To develop a new formula for ultrasonographic estimation of fetal weight and evaluate the accuracy of this and all previous formulae in the prediction of birth weight. The study population consisted of 5163 singleton pregnancies with fetal biometry at 22-43 weeks' gestation and live birth of a phenotypically normal neonate within 2 days of the ultrasound examination. Multivariable fractional polynomial analysis was used to determine the combination of variables that provided the best-fitting models for estimated fetal weight (EFW). A systematic review was also carried out of articles reporting formulae for EFW and comparing EFW to actual birth weight. The accuracy of each model for EFW was assessed by comparing mean percentage error, absolute mean error (AE), proportion of pregnancies with AE ≤ 10% and Euclidean distance. The most accurate models, with the lowest Euclidean distance and highest proportion of AE ≤ 10%, were provided by the formulae incorporating ≥ 3 rather than < 3 biometrical measurements. The systematic review identified 45 studies describing a total of 70 models for EFW by various combinations of measurements of fetal head circumference (HC), biparietal diameter, femur length (FL) and abdominal circumference (AC). The most accurate model with the lowest Euclidean distance and highest proportion of AE ≤ 10% was provided by the formula of Hadlock et al., published in 1985, which incorporated measurements of HC, AC and FL; there was a highly significant linear association between EFW and birth weight (r= 0.959; P< 0.0001), and EFW was within 10% of birth weight in 80% of cases. The performance of the best model developed in this study, utilizing HC, AC and FL, was very similar to that of Hadlock et al. CONCLUSION: Despite many efforts to develop new models for EFW, the one reported in 1985 by Hadlock et al., from measurements of HC, AC and FL, provides the most accurate prediction of birth weight and can be used for assessment of all babies, including those suspected to be either small or large. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.