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Published on: June 29, 2013
Comparison of Five Growth Charts for Identifying Small-Sized Fetuses and Their Predictive Value for Adverse Neonatal
Ayse Cigdem Bayrak1, Erdem Fadiloglu1, Betul Gungor1
1Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Türkiye, Ankara.
Insights
The World Health Organization (WHO) fetal growth chart better identifies high-risk pregnancies and predicts adverse neonatal outcomes compared to other charts at the 10th percentile. All charts performed similarly at the 3rd percentile.
Area of Science:
- Perinatal Medicine
- Maternal-Fetal Medicine
- Neonatology
Background:
- Accurate fetal growth monitoring is crucial for identifying fetuses at risk of poor outcomes.
- Existing growth charts vary in their ability to predict adverse neonatal events.
- Comparing the performance of different fetal growth charts is essential for clinical practice.
Purpose of the Study:
- To compare the performance of five common fetal growth charts (Hadlock, FMF, NICHD, INTERGROWTH-21st, WHO) in identifying small-for-gestational-age fetuses.
- To assess the predictive accuracy of these charts for adverse neonatal outcomes.
- To determine the optimal chart for clinical use in fetal growth assessment.
Main Methods:
- Retrospective analysis of 572 singleton pregnancies with estimated fetal weight (EFW) below the 10th percentile using the Hadlock chart.
- Recalculation of EFW and birthweight percentiles using Hadlock, FMF, NICHD, INTERGROWTH-21st, and WHO charts.
- Statistical analysis to evaluate the association between growth chart classification and adverse neonatal outcomes, including NICU admission and severe outcomes.
Main Results:
- The WHO chart identified the fewest pregnancies below the 10th percentile and showed significant differences in composite adverse outcomes (p < 0.05).
- At the 3rd percentile cutoff, all charts demonstrated comparable performance for NICU admission and adverse outcomes (p < 0.01).
- The WHO and FMF charts significantly differentiated severe adverse outcomes at the 3rd percentile (p = 0.043, p = 0.029).
Conclusions:
- The WHO chart exhibits superior performance in identifying high-risk pregnancies at the 10th percentile cutoff.
- All evaluated charts show comparable predictive accuracy for neonatal outcomes at the 3rd percentile cutoff.
- The WHO and FMF charts demonstrate potential for improved diagnosis and prediction of neonatal outcomes in fetuses identified as small-for-gestational-age.
Purpose:
The main goal of fetal growth monitoring is to identify fetuses at increased risk of morbidity and mortality. This study compares 5 commonly used growth charts (Hadlock, FMF, NICHD, INTERGROWTH-21st, WHO) to assess their ability to identify pregnancies below the 10th percentile and predict adverse neonatal outcomes.
Materials And Methods:
We retrospectively analyzed 572 singleton pregnancies with an estimated fetal weight (EFW) <10th percentile according to Hadlock, excluding multiple pregnancies or cases with maternal comorbidities. Maternal and neonatal data were collected, and EFW and birthweight percentiles were recalculated using the different growth charts. Statistical analyses assessed the association between these charts and adverse neonatal outcomes.
Results:
The WHO chart classified the fewest pregnancies below the 10th percentile and showed significant differences in composite adverse outcomes between the groups (p < 0.05). Despite a lack of statistical significance, the WHO chart had better prediction for NICU admission compared to others. At the 3rd percentile cutoff, all charts showed similar results for NICU admission and adverse outcomes (p < 0.01). For severe adverse outcomes, only the WHO and FMF charts showed significant differences (p = 0.043, p = 0.029).
Conclusion:
The WHO chart showed superior performance at the 10th percentile cutoff, while all charts were comparable at the 3rd percentile. Notably, the WHO and FMF charts significantly differentiated between patients with severe composite adverse outcomes at the 3rd percentile to improve the accuracy of diagnosing and predicting neonatal outcomes in small-sized fetuses.
