Format

Send to

Choose Destination
Lancet. 2014 Sep 6;384(9946):869-79. doi: 10.1016/S0140-6736(14)61490-2.

International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project.

Collaborators (248)

Katz M, Bhan MK, Garza C, Zaidi S, Langer A, Rothwell PM, Weatherall D, Bhutta ZA, Villar J, Kennedy S, Altman DG, Barros FC, Bertino E, Burton F, Carvalho M, Cheikh Ismail L, Chumlea WC, Gravett MG, Jaffer YA, Lambert A, Lumbiganon P, Noble JA, Pang RY, Papageorghiou AT, Purwar M, Rivera J, Victora C, Villar J, Altman DG, Bhutta ZA, Cheikh Ismail L, Kennedy S, Lambert A, Noble JA, Papageorghiou AT, Villar J, Kennedy S, Cheikh Ismail L, Lambert A, Papageorghiou AT, Shorten M, Hoch L, Knight HE, Ohuma EO, Cosgrove C, Blakey I, Altman DG, Ohuma EO, Villar J, Altman DG, Roseman F, Kunnawar N, Gu SH, Wang JH, Wu MH, Domingues M, Gilli P, Juodvirsiene L, Hoch L, Musee N, Al-Jabri H, Waller S, Cosgrove C, Muninzwa D, Ohuma EO, Yellappan D, Carter A, Reade D, Miller R, Papageorghiou AT, Salomon L, Leston A, Mitidieri A, Al-Aamri F, Paulsene W, Sande J, Al-Zadjali WK, Batiuk C, Bornemeier S, Carvalho M, Dighe M, Gaglioti P, Jacinta N, Jaiswal S, Noble JA, Oas K, Oberto M, Olearo E, Owende MG, Shah J, Sohoni S, Todros T, Venkataraman M, Vinayak S, Wang L, Wilson D, Wu QQ, Zaidi S, Zhang Y, Chamberlain P, Danelon D, Sarris I, Dhami J, Ioannou C, Knight CL, Napolitano R, Wanyonyi S, Pace C, Mkrtychyan V, Cheikh Ismail L, Chumlea WC, Al-Habsi F, Bhutta ZA, Carter A, Alija M, Jimenez-Bustos JM, Kizidio J, Puglia F, Kunnawar N, Liu H, Lloyd S, Mota D, Ochieng R, Rossi C, Sanchez Luna M, Shen YJ, Knight HE, Rocco DA, Frederick IO, Bhutta ZA, Albernaz E, Batra M, Bhat BA, Bertino E, Di Nicola P, Giuliani F, Rovelli I, McCormick K, Ochieng R, Pang RY, Paul V, Rajan V, Wilkinson A, Varalda A, Eskenazi B, Corra LA, Dolk H, Golding J, Matijasevich A, de Wet T, Zhang JJ, Bradman A, Finkton D, Burnham O, Farhi F, Barros FC, Domingues M, Fonseca S, Leston A, Mitidieri A, Mota D, Sclowitz IK, da Silveira MF, Pang RY, He YP, Pan Y, Shen YJ, Wu MH, Wu QQ, Wang JH, Yuan Y, Zhang Y, Purwar M, Choudhary A, Choudhary S, Deshmukh S, Dongaonkar D, Ketkar M, Khedikar V, Kunnawar N, Mahorkar C, Mulik I, Saboo K, Shembekar C, Singh A, Taori V, Tayade K, Somani A, Bertino E, Di Nicola P, Frigerio M, Gilli G, Gilli P, Giolito M, Giuliani F, Oberto M, Occhi L, Rossi C, Rovelli I, Signorile F, Todros T, Stones W, Carvalho M, Kizidio J, Ochieng R, Shah J, Vinayak S, Musee N, Kisiang'ani C, Muninzwa D, Jaffer YA, Al-Abri J, Al-Abduwani J, Al-Habsi FM, Al-Lawatiya H, Al-Rashidiya B, Al-Zadjali WK, Juangco FR, Venkataraman M, Al-Jabri H, Yellappan D, Kennedy S, Cheikh Ismail L, Papageorghiou AT, Roseman F, Lambert A, Ohuma EO, Lloyd S, Napolitano R, Ioannou C, Sarris I, Gravett MG, Batiuk C, Batra M, Bornemeier S, Dighe M, Oas K, Paulsene W, Wilson D, Frederick IO, Andersen HF, Abbott SE, Carter AA, Algren H, Rocco DA, Sorensen TK, Enquobahrie D, Waller S.

Author information

1
Nuffield Department of Obstetrics and Gynaecology, and Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.
2
Nuffield Department of Obstetrics and Gynaecology, and Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK; Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK.
3
Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK.
4
Università degli Studi di Torino, Torino, Italy.
5
Department of Family and Community Health, Ministry of Health, Muscat, Oman.
6
University of Washington School of Medicine, Seattle, WA, USA.
7
Nagpur INTERGROWTH-21(st) Research Centre, Ketkar Hospital, Nagpur, India.
8
Department of Engineering Science, University of Oxford, Oxford, UK.
9
School of Public Health, Peking University, Beijing, China.
10
Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
11
Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil; Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, RS, Brazil.
12
Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya.
13
Department of Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France.
14
Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.
15
Nuffield Department of Obstetrics and Gynaecology, and Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK. Electronic address: jose.villar@obs-gyn.ox.ac.uk.

Erratum in

  • Lancet. 2014 Oct 4;384(9950):1264.

Abstract

BACKGROUND:

In 2006, WHO produced international growth standards for infants and children up to age 5 years on the basis of recommendations from a WHO expert committee. Using the same methods and conceptual approach, the Fetal Growth Longitudinal Study (FGLS), part of the INTERGROWTH-21(st) Project, aimed to develop international growth and size standards for fetuses.

METHODS:

The multicentre, population-based FGLS assessed fetal growth in geographically defined urban populations in eight countries, in which most of the health and nutritional needs of mothers were met and adequate antenatal care was provided. We used ultrasound to take fetal anthropometric measurements prospectively from 14 weeks and 0 days of gestation until birth in a cohort of women with adequate health and nutritional status who were at low risk of intrauterine growth restriction. All women had a reliable estimate of gestational age confirmed by ultrasound measurement of fetal crown-rump length in the first trimester. The five primary ultrasound measures of fetal growth--head circumference, biparietal diameter, occipitofrontal diameter, abdominal circumference, and femur length--were obtained every 5 weeks (within 1 week either side) from 14 weeks to 42 weeks of gestation. The best fitting curves for the five measures were selected using second-degree fractional polynomials and further modelled in a multilevel framework to account for the longitudinal design of the study.

FINDINGS:

We screened 13,108 women commencing antenatal care at less than 14 weeks and 0 days of gestation, of whom 4607 (35%) were eligible. 4321 (94%) eligible women had pregnancies without major complications and delivered live singletons without congenital malformations (the analysis population). We documented very low maternal and perinatal mortality and morbidity, confirming that the participants were at low risk of adverse outcomes. For each of the five fetal growth measures, the mean differences between the observed and smoothed centiles for the 3rd, 50th, and 97th centiles, respectively, were small: 2·25 mm (SD 3·0), 0·02 mm (3·0), and -2·69 mm (3·2) for head circumference; 0·83 mm (0·9), -0·05 mm (0·8), and -0·84 mm (1·0) for biparietal diameter; 0·63 mm (1·2), 0·04 mm (1·1), and -1·05 mm (1·3) for occipitofrontal diameter; 2·99 mm (3·1), 0·25 mm (3·2), and -4·22 mm (3·7) for abdominal circumference; and 0·62 mm (0·8), 0·03 mm (0·8), and -0·65 mm (0·8) for femur length. We calculated the 3rd, 5th 10th, 50th, 90th, 95th and 97th centile curves according to gestational age for these ultrasound measures, representing the international standards for fetal growth.

INTERPRETATION:

We recommend these international fetal growth standards for the clinical interpretation of routinely taken ultrasound measurements and for comparisons across populations.

FUNDING:

Bill & Melinda Gates Foundation.

PMID:
25209488
DOI:
10.1016/S0140-6736(14)61490-2
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center