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Published on: June 29, 2013
Fetal growth and birthweight standards as screening tools: methods for evaluating performance
K Hemming1, S Bonellie, J L Hutton
1Department of Public Health, University of Birmingham, UK. k.hemming@bham.ac.uk
Objective:
To discuss different methods for evaluating fetal growth and population-based birthweight standards relevant to different uses: either in antenatal care or in epidemiology.
Design:
Population-based cohort study.
Setting:
Routinely collected data in Scotland.
Population:
A total of 540,849 singletons born after 24 weeks between 1980 and 2003.
Methods:
The performance of a fetal growth standard and a population-based birthweight standard are compared in two ways. First, we consider the accuracy of estimated risks of stillbirth at any point during the remaining pregnancy, a measure that is relevant in antenatal care. Second, the rates of stillbirth at each gestation, which are measures relevant in epidemiology, are compared with the actual rates.
Main Outcome Measures:
Standard measures of screening and diagnostic performance: sensitivity, specificity, and positive and negative predictive values.
Results:
In clinical care, the evidence points towards using fetal growth standards: sensitivity at term is about 30%, increasing to 43% for preterm births (24-31 weeks of gestation), compared with about 29% across all ages under the birthweight standard. Positive predictive values are about 1% across gestations. For epidemiology, the evidence is not so clear-cut: preterm, the population birthweight standard has higher sensitivity and specificity, but this is not the case in the full-term weeks.
Conclusions:
The performance of fetal growth and birthweight standards should be evaluated in different ways, depending on whether they are intended for use in antenatal care or in epidemiological investigations.
