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Updated: Jul 7, 2025
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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
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Comparing population-based fetal growth standards in a US cohort
Jessica L Gleason1, Uma M Reddy2, Zhen Chen3
1Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
American Journal of Obstetrics and Gynecology
|December 27, 2023
Summary
No single fetal growth standard is universally endorsed in the US. While different standards classify fetal growth restriction and estimated fetal weight differently, their ability to predict neonatal outcomes remains similar across populations.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Fetal Development Research
Background:
- No universally endorsed fetal growth standard exists in the United States.
- Evaluating newer fetal growth standards is crucial for identifying fetal growth abnormalities and predicting neonatal outcomes.
Purpose of the Study:
- To compare the classification of estimated fetal weight (<5th, 10th, or >90th percentiles) using six different population-based fetal growth standards.
- To assess the predictive ability of these standards for neonatal morbidity and mortality.
Main Methods:
- Utilized data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be cohort (N=9534).
- Calculated rates of fetal growth restriction (FGR) and estimated fetal weight >90th percentile using INTERGROWTH-21, WHO, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) race-ethnic-specific and unified, and Hadlock references.
- Compared the area under the curve and sensitivity of each standard in predicting small/large for gestational age at birth and composite perinatal morbidity/mortality.
Main Results:
- Different standards classified varying proportions of fetuses as FGR or estimated fetal weight >90th percentile at different gestational ages.
- The World Health Organization (WHO) standard showed the highest area under the curve (0.64) for predicting small for gestational age with composite neonatal morbidity/mortality at 22-29 weeks.
- Sensitivity for predicting adverse outcomes was generally low across all standards.
Conclusions:
- Despite variations in classifying fetal growth abnormalities, all evaluated standards demonstrated similar performance in predicting perinatal morbidity and mortality.
- The differing classification rates may have clinical implications for pregnancy management, such as antenatal monitoring or delivery decisions.
- Further research is needed to determine if any specific standard offers superior risk identification for perinatal complications.
