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INTERGROWTH-21st versus a customized method for the prediction of neonatal nutritional status in hypertensive
Juan Jesús Fernández-Alba1,2, Maria Castillo Lara3, Raquel Sánchez Mera1
1Department of Obstetrics and Gynaecology, University Hospital of Puerto Real, Puerto Real, Cadiz, Spain.
Insights
Customized fetal growth curves better identify newborns with malnutrition in pregnancies complicated by hypertensive disorders of pregnancy (HDP). This method shows higher predictive ability than INTERGROWTH-21st for identifying small for gestational age (SGA) infants at risk.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Maternal-Fetal Medicine
Background:
- Hypertensive disorders of pregnancy (HDP) are a leading global cause of maternal and neonatal mortality.
- HDP significantly increases the risk of fetal growth restriction, with small for gestational age (SGA) infants occurring twice as often compared to uncomplicated pregnancies.
- Accurate identification of SGA in HDP pregnancies is crucial for appropriate management and follow-up.
Purpose of the Study:
- To compare the effectiveness of the INTERGROWTH-21st standard and customized birthweight references in identifying neonatal malnutrition in pregnancies affected by HDP.
- To determine which method provides superior predictive accuracy for abnormal nutritional status in neonates born to mothers with HDP.
Main Methods:
- A comparative analysis was conducted on two diagnostic methods for predicting neonatal nutritional status in HDP pregnancies.
- Nutritional status was assessed using neonatal body mass index (BMI) or ponderal index below the 10th centile.
- Performance metrics including sensitivity, specificity, and predictive values were calculated for both INTERGROWTH-21st and customized references.
Main Results:
- The customized method identified a higher proportion of small for gestational age (SGA) fetuses (19.9%) compared to the INTERGROWTH-21st method (11.9%) in 226 HDP pregnancies (p < 0.01).
- Newborns identified as SGA by the customized method exhibited a significantly higher risk of malnutrition (based on BMI < 10th centile) than those identified by INTERGROWTH-21st (RR: 4.87 vs. 3.75).
- Similar trends were observed when using the ponderal index, with the customized method showing a greater risk of malnutrition for identified SGA infants (RR: 2.37 vs. 1.68).
Conclusions:
- Customized fetal growth curves demonstrate superior predictive ability for identifying neonatal malnutrition in pregnancies complicated by HDP.
- The findings suggest that customized references are more effective than INTERGROWTH-21st for risk stratification of newborns in HDP pregnancies.
- This highlights the importance of utilizing individualized growth standards for optimizing neonatal outcomes in hypertensive disorders of pregnancy.
Background:
Hypertensive disorders of pregnancy (HDP) generate complications and are one of the principal causes of maternal, foetal, and neonatal mortality worldwide. It has been observed that in pregnancies with HDP, the incidence of foetuses small for their gestational age (SGA) is twice as high as that in noncomplicated pregnancies. In women with HDP, the identification of foetuses (SGA) is substantially important, as management and follow-up are determined by this information.
Objective:
The objective of this study was to evaluate whether the INTERGROWTH-21st method or customized birthweight references better identify newborns with an abnormal nutritional status resulting from HDP.
Method:
A comparative analysis study was designed with two diagnostic methods for the prediction of neonatal nutritional status in pregnancies with HDP. The performance of both methods in identifying neonatal malnutrition (defined by a neonatal body mass index < 10th centile or a ponderal index < 10th centile) was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratio, Youden's index and probability ratios.
Results:
The study included 226 pregnant women diagnosed with HDP. The customized method identified 45 foetuses as small for gestational age (19.9%), while the INTERGROWTH-21st method identified 27 newborns with SGA (11.9%). The difference between proportions was statistically significant (p < 0.01). Using body mass index (< 10th centile) as a measure of nutritional status, newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH-21st (RR: 4.87 (95% CI: 1.86-12.77) vs. 3.75 (95% CI: 1.49-9.43)) (DOR: 5.56 (95% CI: 1.82-16.98) vs. 4.84 (95% CI: 1.51-15.54)) Even when using Ponderal index (< 10th centile), newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH-21st (RR 2.37 (95% CI: 1.11-5.05) vs. 1.68 (95% CI: 0.70-4.03))(DOR 2.62 (95% CI: 1.00-6.87) vs. 1.90 (95% CI: 0.61-5.92)).
Conclusion:
In pregnant women with HDP, the predictive ability of the customized foetal growth curves to identify neonatal malnutrition appears to surpass that of INTERGROWTH-21st.
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