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Which chart and which cut-point: deciding on the INTERGROWTH, World Health Organization, or Hadlock fetal growth
Jessica Liauw1, Chantal Mayer2, Arianne Albert3
1Department of Obstetrics and Gynecology, University of British Columbia, C420-4500 Oak Street, BC Women's Hospital, Vancouver, BC, V6H 3N1, Canada. Jessica.liauw@medportal.ca.
Insights
Choosing a fetal growth chart like INTERGROWTH, WHO, or Hadlock for predicting perinatal morbidity is similar across all three. Optimal cut-points vary, suggesting clinical use may depend on workflow and chart derivation.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Fetal Development
Background:
- Accurate fetal growth assessment is crucial for identifying fetuses at risk of adverse outcomes.
- Existing fetal growth charts, including INTERGROWTH-21st, World Health Organization (WHO), and Hadlock, have varying centile cut-points.
- The predictive performance of different centile cut-points on these charts for perinatal morbidity/mortality requires further investigation.
Purpose of the Study:
- To evaluate how various centile cut-points on INTERGROWTH-21st, WHO, and Hadlock fetal growth charts predict perinatal morbidity/mortality.
- To compare the predictive accuracy of these charts and centile cut-points.
- To inform the selection of appropriate fetal growth charts for clinical practice.
Main Methods:
- Linked antenatal ultrasound data (>28 weeks gestation) with a provincial perinatal database.
- Estimated risks of perinatal morbidity/mortality (e.g., cord pH, neonatal seizures, hypoglycemia, perinatal death) associated with specific centiles (3rd, 10th, 10% population, Youden's Index optimal cut-point).
- Assessed predictive performance using sensitivity and area under the curve (AUC).
Main Results:
- All three charts (INTERGROWTH-21st, WHO, Hadlock) demonstrated similar performance in predicting perinatal morbidity/mortality (AUC = 0.54).
- The 10th centile had low sensitivity (11-13%) for detecting fetuses with adverse outcomes.
- Statistically optimal cut-points identified by Youden's Index were the 39th, 31st, and 32nd centiles for INTERGROWTH-21st, WHO, and Hadlock charts, respectively.
Conclusions:
- INTERGROWTH-21st, WHO, and Hadlock fetal growth charts perform comparably in predicting perinatal morbidity/mortality across different centile cut-points.
- The choice of fetal growth chart and cut-point may be influenced by factors beyond statistical prediction, such as workflow integration and the chart's developmental methodology.
- Further research may explore the clinical utility and impact of different chart selection criteria on patient outcomes.
Objective:
To determine how various centile cut points on the INTERGROWTH-21st (INTERGROWTH), World Health Organization (WHO), and Hadlock fetal growth charts predict perinatal morbidity/mortality, and how this relates to choosing a fetal growth chart for clinical use.
Methods:
We linked antenatal ultrasound measurements for fetuses > 28 weeks' gestation from the British Columbia Women's hospital ultrasound unit with the provincial perinatal database. We estimated the risk of perinatal morbidity/mortality (decreased cord pH, neonatal seizures, hypoglycemia, and perinatal death) associated with select centiles on each fetal growth chart (the 3rd, 10th, the centile identifying 10% of the population, and the optimal cut-point by Youden's Index), and determined how well each centile predicted perinatal morbidity/mortality.
Results:
Among 10,366 pregnancies, the 10th centile cut-point had a sensitivity of 11% (95% CI 8, 14), 13% (95% CI 10, 16), and 12% (95% CI 10, 16), to detect fetuses with perinatal morbidity/mortality on the INTERGROWTH, WHO, and Hadlock charts, respectively. All charts performed similarly in predicting perinatal morbidity/mortality (area under the curve [AUC] =0.54 for all three charts). The statistically optimal cut-points were the 39th, 31st, and 32nd centiles on the INTERGROWTH, WHO, and Hadlock charts respectively.
Conclusion:
The INTERGROWTH, WHO, and Hadlock fetal growth charts performed similarly in predicting perinatal morbidity/mortality, even when evaluating multiple cut points. Deciding which cut-point and chart to use may be guided by other considerations such as impact on workflow and how the chart was derived.
