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Published on: June 29, 2013
Current use and performance of the different fetal growth charts in the Italian population
Tamara Stampalija1, Tullio Ghi2, Valentina Rosolen3
1Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell'Istria 65, 34100 Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
Insights
Discrepancies in fetal growth chart use among Italian centers highlight the need for standardization. International charts may lead to misdiagnosis of fetal growth abnormalities, necessitating national evaluation.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Fetal Development
Background:
- Fetal growth charts are crucial for identifying growth abnormalities.
- Current clinical practice in Italy shows significant variation in growth chart utilization.
- The choice of growth charts impacts screening, diagnosis, and management of fetal growth disorders.
Purpose of the Study:
- To evaluate the current clinical practice in Italian tertiary referral centers regarding fetal biometric growth charts.
- To assess the impact of existing national and international growth charts on fetal growth screening.
Main Methods:
- A national questionnaire survey was distributed to 14 Italian tertiary referral centers.
- International (Intergrowth-21st, WHO) and national growth charts were applied to a cohort of 7347 low-risk pregnancies.
- Quantile regressions were used to calculate percentile curves and identify fetuses above/below specific percentiles.
Main Results:
- A wide discrepancy in the use of fetal growth charts was observed among Italian centers.
- Application of Intergrowth-21st charts resulted in 3.9-46% of fetuses falling outside the 10th and 90th percentiles.
- WHO charts showed 5.3-31.9% of fetuses outside the 10th and 90th percentiles, indicating significant variations in classification.
Conclusions:
- The heterogeneity in fetal growth chart usage necessitates the adoption of a uniform set of charts.
- International growth charts may lead to under-diagnosis of small for gestational age and over-diagnosis of large for gestational age fetuses.
- There is an urgent need for prospective evaluation of international charts and development of robust national charts in Italy.
Objectives:
The choice of growth charts impacts on screening, diagnosis and clinical management of fetal growth abnormalities. The objectives of the study were to evaluate: 1) the clinical practice at a national level among tertiary referral centers in the use of fetal biometric growth charts; and 2) the impact on fetal growth screening of existing national and international growth charts.
Study Design:
A questionnaire was sent to 14 Italian tertiary referral centers to explore biometric reference growth charts used in clinical practice. National and international (Intergrowth-21st and World Health Organization) fetal growth charts were tested on a large national cohort of low risk women with singleton uneventful pregnancy derived from a retrospective cross-sectional multicenter study (21 centers). The percentage of fetuses with biometric measurements below and above the 10th and 90th percentile for each biometric parameter and gestational week were calculated for each growth chart. The percentile curves of the study population were calculated by non-linear quantile regressions.
Results:
Twelve Italian centers (86 %) answered to the questionnaire showing a wide discrepancy in the use of growth charts for fetal biometry. The cohort included 7347 pregnant women. By applying Intergrowth-21st growth charts the percentage of fetuses with head circumference, abdominal circumference and femur length below the 10th centile was 3.9 %, 3.6 % and 2.3 %, and above the 90th centile 29.9 %, 32.5 % and 46 %, respectively. The percentages for the World Health Organization growth charts for head and abdominal circumferences and femur length were: below the 10th centile 6.3 %, 7.2 % and 5.3 %, and above 90th centile 22.8 %, 21.3 % and 31.9 %, respectively.
Conclusions:
The wide discrepancy in clinical use of fetal growth charts in Italian centers warrants the adoption of an uniform set of charts. Our data suggest that immediate application into clinical practice of international growth charts might result into an under-diagnosis of small for gestational age fetuses and, especially, in an over-diagnosis of large for gestational age fetuses with major consequences for clinical practice. On these grounds, there is an urgent need for a nationwide study for the prospective evaluation of international growth charts and, if needed, the construction and adoption of methodologically robust national growth charts.
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