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Ultrasound Obstet Gynecol. 2017 Apr;49(4):478-486. doi: 10.1002/uog.17347. Epub 2017 Mar 5.

International estimated fetal weight standards of the INTERGROWTH-21st Project.

Collaborators (360)

Katz M, Bhan MK, Garza C, Zaidi S, Langer A, Rothwell PM, Weatherall SD, Bhutta ZA, Villar J, Kennedy S, Altman DG, Barros FC, Bertino E, Burton F, Carvalho M, Ismail LC, Chumlea WC, Gravett MG, Jaffer YA, Lambert A, Lumbiganon P, Noble JA, Pang RY, Papageorghiou AT, Purwar M, Rivera J, Victora C, Uauy R, Kennedy S, Villar J, Altman DG, Barros FC, Berkley J, Burton F, Carvalho M, Ismail LC, Chumlea WC, Lambert A, Munim S, Norris S, Nosten F, Papageorghiou AT, Victora C, Villar J, Altman DG, Ismail LC, Kennedy S, Lambert A, Noble JA, Papageorghiou AT, Bhutta ZA, Craik R, Uauy R, Villar J, Ismail LC, Kennedy S, Lambert A, Papageorghiou AT, Shorten M, Hoch L, Knight HE, Ohuma EO, Cosgrove C, Blakey I, Ash S, Craik R, Altman DG, Ohuma EO, Urias ES, 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, Ahmed I, Ash S, Condon C, Mainwaring M, Muninzwa D, da Silveira MF, Urias ES, Walusuna L, Wiladphaingern S, Papageorghiou AT, Salomon L, Leston A, Mitidieri A, Al-Aamri F, Paulsene W, Sande J, Al-Zadjali W, 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, Buckle M, Jackson N, Mitidieri A, Munim S, Mwangudzah H, Norris T, Shah J, Zainab G, Ismail LC, 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, Luna MS, Shen YJ, Knight HE, Rocco DA, Frederick IO, Kizidio J, Monyepote B, Salim M, Salam R, Carrara VI, Craik R, Alam D, Guman Y, Kilonzo J, Min A, Ngami V, Olivera I, Deutsch G, Bhutta ZA, Albernaz E, Batra M, Bhat BA, Bertino E, Nicola PD, Giuliani F, Rovelli I, McCormick K, Ochieng R, Pang RY, Paul V, Rajan V, Wilkinson A, Uauy R, Varalda A, Eskenazi B, Bradman A, Burnham O, Corra LA, Dolk H, Farhi F, Finkton D, Golding J, Matijasevich A, de Wet T, Villar J, Zhang JJ, Stein A, Fernandes M, Abubakar A, Acedo J, Aranzeta L, Ismail LC, Giuliani F, Ibanez D, Kennedy S, Kihara M, de Leon E, Newton CR, Savini S, Soria-Frisch A, Villar J, Wulff K, 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, Nicola PD, 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, Kilonzo J, Sande J, Berkley J, Kemp B, Barsosio H, Mwakio S, Mwangudzah H, Ngami V, Salim M, Seale A, Walusuna L, Jaffer YA, Al-Abri J, Al-Abduwani J, Al-Habsi FM, Al-Lawatiya H, Al-Rashidiya B, Al-Zadjali W, Juangco FR, Venkataraman M, Al-Jabri H, Yellappan D, Munim S, Zainab G, Ahmed I, Alam D, Raza A, Salam R, Norris S, Guman Y, Lephoto T, Macauley S, Malgas L, Nosten F, Jackson N, McGready R, Min A, Cararra VI, Wiladphaingern S, Kennedy S, Ismail LC, Lambert A, Lloyd S, Napolitano R, Ohuma EO, Papageorghiou AT, Patel B, Puglia F, Roseman F, Roseman S, Ioannou C, Sarris I, Ash S, Baricco M, Capp A, Craik R, Hussein S, Laister A, Lewis T, Maggiora E, Norris T, Sharps M, Varalda A, Carew R, 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
Maternité Necker-Enfants Malades, AP-HP & EA7328 Université Paris Descartes, Paris, France.
2
Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.
3
Collège Français d'Echographie Foetale - CFEF, France.
4
Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK.
5
School of Public Health, Peking University, Beijing, China.
6
Shoklo Malaria Research Unit, Maesod, Tak, Thailand.
7
Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
8
Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, RS, Brazil.
9
Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
10
Developmental Pathways For Health Research Unit, Department of Paediatrics & Child Health, University of the Witwatersrand, Johannesburg, South Africa.
11
Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya.
12
Department of Family & Community Health, Ministry of Health, Muscat, Sultanate of Oman.
13
Department of Engineering Science, University of Oxford, Oxford, UK.
14
Dipartimento di Scienze Pediatriche e dell'Adolescenza, Cattedra di Neonatologia, Università degli Studi di Torino, Torino, Italy.
15
Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), Seattle, WA, USA.
16
Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India.
17
Division of Paediatrics, Pontifical Universidad Catolica de Chile, Chile.
18
London School of Hygiene and Tropical Medicine, London, UK.
19
Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.

Abstract

OBJECTIVE:

Estimated fetal weight (EFW) and fetal biometry are complementary measures used to screen for fetal growth disturbances. Our aim was to provide international EFW standards to complement the INTERGROWTH-21st Fetal Growth Standards that are available for use worldwide.

METHODS:

Women with an accurate gestational-age assessment, who were enrolled in the prospective, international, multicenter, population-based Fetal Growth Longitudinal Study (FGLS) and INTERBIO-21st Fetal Study (FS), two components of the INTERGROWTH-21st Project, had ultrasound scans every 5 weeks from 9-14 weeks' until 40 weeks' gestation. At each visit, measurements of fetal head circumference (HC), biparietal diameter, occipitofrontal diameter, abdominal circumference (AC) and femur length (FL) were obtained blindly by dedicated research sonographers using standardized methods and identical ultrasound machines. Birth weight was measured within 12 h of delivery by dedicated research anthropometrists using standardized methods and identical electronic scales. Live babies without any congenital abnormality, who were born within 14 days of the last ultrasound scan, were selected for inclusion. As most births occurred at around 40 weeks' gestation, we constructed a bootstrap model selection and estimation procedure based on resampling of the complete dataset under an approximately uniform distribution of birth weight, thus enriching the sample size at extremes of fetal sizes, to achieve consistent estimates across the full range of fetal weight. We constructed reference centiles using second-degree fractional polynomial models.

RESULTS:

Of the overall population, 2404 babies were born within 14 days of the last ultrasound scan. Mean time between the last scan and birth was 7.7 (range, 0-14) days and was uniformly distributed. Birth weight was best estimated as a function of AC and HC (without FL) as log(EFW) = 5.084820 - 54.06633 × (AC/100)3  - 95.80076 × (AC/100)3  × log(AC/100) + 3.136370 × (HC/100), where EFW is in g and AC and HC are in cm. All other measures, gestational age, symphysis-fundus height, amniotic fluid indices and interactions between biometric measures and gestational age, were not retained in the selection process because they did not improve the prediction of EFW. Applying the formula to FGLS biometric data (n = 4231) enabled gestational age-specific EFW tables to be constructed. At term, the EFW centiles matched those of the INTERGROWTH-21st Newborn Size Standards but, at < 37 weeks' gestation, the EFW centiles were, as expected, higher than those of babies born preterm. Comparing EFW cross-sectional values with the INTERGROWTH-21st Preterm Postnatal Growth Standards confirmed that preterm postnatal growth is a different biological process from intrauterine growth.

CONCLUSIONS:

We provide an assessment of EFW, as an adjunct to routine ultrasound biometry, from 22 to 40 weeks' gestation. However, we strongly encourage clinicians to evaluate fetal growth using separate biometric measures such as HC and AC, as well as EFW, to avoid the minimalist approach of focusing on a single value. © 2016 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

KEYWORDS:

birth weight; fetal growth; gestational age; screening; ultrasound

PMID:
27804212
PMCID:
PMC5516164
DOI:
10.1002/uog.17347
[Indexed for MEDLINE]
Free PMC Article

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