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INTERGROWTH-21st compared with GROW customized centiles in the detection of adverse perinatal outcomes at term

Natasha Pritchard1,2, Anthea Lindquist1,2, Isabela Dos Anjos Siqueira1

  • 1Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia.

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|October 30, 2018
PubMed

Insights

Customized weight charts better identify at-risk infants, including those born to obese mothers, compared to INTERGROWTH-21st standards. Customized charts identified more small for gestational age (SGA) infants with adverse outcomes like stillbirth.

Area of Science:

  • Obstetrics and Gynecology
  • Neonatal Health
  • Perinatal Medicine

Background:

  • INTERGROWTH-21st charts offer optimal growth standards but their utility in general populations is uncertain.
  • Comparison with customized Gestation Related Optimal Weight (GROW) charts is needed to identify at-risk infants.
  • Retrospective analysis of term births from 1994-2016 at a tertiary center was performed.

Purpose of the Study:

  • To evaluate if INTERGROWTH-21st charts or customized GROW charts better identify infants at risk.
  • To compare the identification of small for gestational age (SGA) infants and their associated adverse outcomes.
  • To assess chart performance in identifying infants of obese mothers.

Main Methods:

  • Retrospective cohort analysis of 71,487 term births.
  • Infants classified as SGA using INTERGROWTH-21st <10th centile (SGA_IG10th), INTERGROWTH-21st z-score < -1 (SGA_IGzscore), or customized GROW <10th centile (SGA_cust).
  • Primary outcome: Apgar score <7 at 5 min; secondary outcomes: Apgar <5, stillbirth, NICU admission.

Main Results:

  • Customized charts identified significantly more SGA infants (10.6%) compared to INTERGROWTH-21st (4.6% or 8.2%).
  • SGA infants identified only by customized charts (SGA_cust-only) showed increased risk of Apgar <7 and stillbirth.
  • Customized charts identified a higher proportion of SGA infants born to obese mothers (19.3%) versus INTERGROWTH-21st charts (9.9-10.0%).

Conclusions:

  • Customized GROW charts are superior to INTERGROWTH-21st charts in identifying SGA infants in a general obstetric population.
  • Customized charts identify a subgroup of SGA infants with significantly higher risks of adverse perinatal outcomes.
  • INTERGROWTH-21st charts underestimate SGA identification, particularly in infants of obese mothers.

Keywords:
Customized centilesintergrowthmaternal obesityperinatal morbidityperinatal mortality

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