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Estimating gestational age at birth from fundal height and additional anthropometrics: a prospective cohort study
S J Pugh1, A M Ortega-Villa2, W Grobman3
1Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
Insights
Accurate gestational age (GA) prediction is vital for infant care, especially where ultrasounds are unavailable. Longitudinal fundal height measurements alone offer a reliable method for estimating GA at birth in low-risk pregnancies.
Area of Science:
- Maternal-fetal medicine
- Neonatal care
- Biostatistics
Background:
- Accurate gestational age (GA) assessment is crucial for optimal pediatric care.
- Ultrasound accessibility for GA determination is limited in many developing countries.
- Alternative methods for GA estimation are needed.
Purpose of the Study:
- To evaluate the accuracy of anthropometric measures for predicting GA at birth.
- To assess the utility of these measures in classifying preterm births.
- To develop and validate prediction models for GA using routinely collected data.
Main Methods:
- A prospective cohort study was conducted with 2334 non-obese and 468 obese pregnant women.
- Gestational age (GA) was initially determined by last menstrual period and first-trimester ultrasound.
- Predictor models were developed using longitudinal fundal height (FH) and maternal/neonatal anthropometry, with linear mixed and shared parameter models employed.
Main Results:
- Prediction errors for various anthropometric combinations ranged from 13.9 to 14.9 days.
- Longitudinal FH alone predicted GA within 14.9 days, showing stable errors across ethnicities.
- This method correctly identified 75% of preterm births and proved robust under varied scenarios.
Conclusions:
- Longitudinal fundal height measurements alone provide a reasonably accurate assessment of GA when ultrasound is unavailable.
- This approach is particularly valuable for low-risk, non-obese women in resource-limited settings.
- Routine anthropometry offers a viable alternative for critical GA estimation in pediatric care.
Objective:
Accurate assessment of gestational age (GA) is critical to paediatric care, but is limited in developing countries without access to ultrasound. Our objectives were to assess the accuracy of prediction of GA at birth and preterm birth classification using routinely collected anthropometry measures.
Design:
Prospective cohort study.
Setting:
United States.
Population Or Sample:
A total of 2334 non-obese and 468 obese pregnant women.
Methods:
Enrolment GA was determined based on last menstrual period, confirmed by first-trimester ultrasound. Maternal anthropometry and fundal height (FH) were measured by a standardised protocol at study visits; FH alone was additionally abstracted from medical charts. Neonatal anthropometry measurements were obtained at birth. To estimate GA at delivery, we developed three predictor models using longitudinal FH alone and with maternal and neonatal anthropometry. For all predictors, we repeatedly sampled observations to construct training (60%) and test (40%) sets. Linear mixed models incorporated longitudinal maternal anthropometry and a shared parameter model incorporated neonatal anthropometry. We assessed models' accuracy under varied scenarios.
Main Outcome Measures:
Estimated GA at delivery.
Results:
Prediction error for various combinations of anthropometric measures ranged between 13.9 and 14.9 days. Longitudinal FH alone predicted GA within 14.9 days with relatively stable prediction errors across individual race/ethnicities [whites (13.9 days), blacks (15.1 days), Hispanics (15.5 days) and Asians (13.1 days)], and correctly identified 75% of preterm births. The model was robust to additional scenarios.
Conclusions:
In low-risk, non-obese women, longitudinal FH measures alone can provide a reasonably accurate assessment of GA when ultrasound measures are not available.
Tweetable Abstract:
Longitudinal fundal height alone predicts gestational age at birth when ultrasound measures are unavailable.
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