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Customized growth charts: rationale, validation and clinical benefits
Jason Gardosi1, Andre Francis1, Sue Turner1
1Perinatal Institute, Birmingham, UK.
American Journal of Obstetrics and Gynecology
|February 10, 2018
Summary
Customized fetal growth charts, accounting for individual maternal characteristics, offer a more accurate assessment of fetal growth and birthweight than universal or country-specific standards. This approach improves the detection of growth restriction and has been linked to reduced stillbirth rates.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Fetal Development
Background:
- Accurate assessment of fetal growth and birthweight is crucial for optimal clinical care.
- Adverse outcomes related to fetal growth are increasingly recognized as potentially preventable.
- Existing standards for fetal growth assessment face challenges in accurately identifying abnormal growth due to physiological variations.
Purpose of the Study:
- To evaluate the effectiveness of different fetal growth standards.
- To advocate for customized fetal growth charts that account for individual maternal factors.
- To demonstrate the clinical utility of individualized growth assessment in improving pregnancy outcomes.
Main Methods:
- Review of proposals for a single international fetal growth standard (Intergrowth consortium).
- Analysis of evidence supporting country-specific charts versus customized growth standards.
- Evaluation of the impact of the Growth Assessment Protocol (GAP) using customized charts in the UK.
Main Results:
- The Intergrowth single standard lacks strong evidence for identifying malnutrition and overlooks normal ethnic and intercountry variations.
- Country-specific charts fail to account for individual physiological variations within populations.
- Customized standards, adjusting for maternal ethnicity, height, weight, and parity, better correlate abnormal growth with adverse outcomes.
- Implementation of customized charts in the UK (GAP) increased detection of fetal growth restriction and contributed to a significant drop in stillbirth rates.
Conclusions:
- A one-size-fits-all approach to fetal growth standards may be ineffective and potentially harmful.
- Customized fetal growth charts provide a more accurate and individualized assessment, enhancing clinical confidence and improving pregnancy outcomes.
- The development and global launch of customized growth charts offer a universally applicable yet individualized standard for fetal growth assessment.
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