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Am J Obstet Gynecol. 2015 Oct;213(4):494-9. doi: 10.1016/j.ajog.2015.07.002. Epub 2015 Jul 14.

Monitoring human growth and development: a continuum from the womb to the classroom.

Author information

1
Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK. Electronic address: jose.villar@obs-gyn.ox.ac.uk.
2
Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.
3
School of Public Health, Peking University, Beijing, China.
4
Department of Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France.
5
Maternal Health Task Force at the Women & Health Initiative, Harvard School of Public Health, Boston, MA.
6
Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
7
Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India.
8
Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH.
9
Beijing Obstetrics & Gynaecology Hospital, Maternal & Child Health Centre, Capital Medical University, Beijing, China.
10
University of Groningen, University Medical Center of Groningen, Groningen, The Netherlands.
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
Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK.
14
Dipartimento di Scienze della Sanita Pubblica e Pediatriche, Struttura Complessa di Neonatologia Universitaria, Università degli Studi di Torino, Torino, Italy.
15
Department of Family & Community Health, Ministry of Health, Muscat, Sultanate of Oman.
16
Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK; Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK.
17
Department of Engineering Science, University of Oxford, Oxford, UK.
18
Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), Seattle Children's, Seattle, WA.
19
Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan and Center for Global Child Health, Hospital for Sick Children, Toronto, Canada.

Abstract

A comprehensive set of fully integrated anthropometric measures is needed to evaluate human growth from conception to infancy so that consistent judgments can be made about the appropriateness of fetal and infant growth. At present, there are 2 barriers to this strategy. First, descriptive reference charts, which are derived from local, unselected samples with inadequate methods and poor characterization of their putatively healthy populations, commonly are used rather than prescriptive standards. The use of prescriptive standards is justified by the extensive biologic, genetic, and epidemiologic evidence that skeletal growth is similar from conception to childhood across geographic populations, when health, nutrition, environmental, and health care needs are met. Second, clinicians currently screen fetuses, newborn infants, and infants at all levels of care with a wide range of charts and cutoff points, often with limited appreciation of the underlying population or quality of the study that generated the charts. Adding to the confusion, infants are evaluated after birth with a single prescriptive tool: the World Health Organization Child Growth Standards, which were derived from healthy, breastfed newborn infants, infants, and young children from populations that have been exposed to few growth-restricting factors. The International Fetal and Newborn Growth Consortium for the 21st Century Project addressed these issues by providing international standards for gestational age estimation, first-trimester fetal size, fetal growth, newborn size for gestational age, and postnatal growth of preterm infants, all of which complement the World Health Organization Child Growth Standards conceptually, methodologically, and analytically. Hence, growth and development can now, for the first time, be monitored globally across the vital first 1000 days and all the way to 5 years of age. It is clear that an integrative approach to monitoring growth and development from pregnancy to school age is desirable, scientifically supported, and likely to improve care, referral patterns, and reporting systems. Such integration can be achieved only through the use of international growth standards, especially in increasingly diverse, mixed ancestry populations. Resistance to new scientific developments has been hugely problematic in medicine; however, we are confident that the obstetric and neonatal communities will join their pediatric colleagues worldwide in the adoption of this integrative strategy.

KEYWORDS:

continuity of care; growth monitoring; prescriptive standards

PMID:
26184778
DOI:
10.1016/j.ajog.2015.07.002
[Indexed for MEDLINE]
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