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Gestational Age-Specific Biometric and Estimated Fetal Weight Curves in Gastroschisis: A Brazilian Multicenter Cohort
Karina Felippe Monezi Pontes1, Liliam Cristine Rolo1, Gustavo Yano Callado2
1Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, Brazil.
Insights
Fetuses with gastroschisis exhibit unique growth patterns. Standard fetal weight charts are inaccurate; tailored growth curves are crucial for precise prenatal assessment.
Area of Science:
- Perinatal medicine
- Fetal development
- Medical imaging
Background:
- Gastroschisis is a congenital defect impacting fetal growth.
- Accurate fetal weight estimation is vital for managing pregnancies with gastroschisis.
- Existing fetal growth charts may not reflect the unique growth trajectory in gastroschisis.
Purpose of the Study:
- To establish gestational age-specific biometric and estimated fetal weight (EFW) patterns in fetuses with gastroschisis.
- To assess the agreement between prenatal EFW and actual birth weight in this population.
Main Methods:
- Retrospective analysis of singleton pregnancies diagnosed with gastroschisis across four Brazilian centers (2010-2024).
- Collected biometric data (biparietal diameter, head circumference, femur length) and EFW using Hadlock IV and Siemer formulas.
- Developed gestational age-specific curves using polynomial regression and analyzed EFW-birth weight agreement with Bland-Altman plots and concordance correlation coefficient (CCC).
Main Results:
- Polynomial models demonstrated strong associations between gestational age and EFW, head circumference, and femur length (R² values ranging from 0.728 to 0.877).
- The 50th percentile curves for fetuses with gastroschisis were consistently lower than standard growth charts.
- Both Siemer (CCC=0.55) and Hadlock (CCC=0.44) formulas showed poor agreement with birth weight, underestimating actual weight.
Conclusions:
- Fetuses with gastroschisis display distinct growth patterns that deviate from typical references.
- Standardized growth curves are inadequate for accurate prenatal assessment in gastroschisis.
- Development of tailored growth curves and cautious interpretation of EFW are essential for improved prenatal care in gastroschisis cases.
Abstract:
Objective: This study aimed to describe gestational age-specific biometric and estimated fetal weight (EFW) patterns derived from a multicenter cohort of fetuses with gastroschisis and to evaluate the agreement between prenatal EFW and birth weight. Methods: This retrospective study included singleton pregnancies with a prenatal diagnosis of gastroschisis and at least two ultrasound evaluations between 20 and 37 weeks. Data were collected from four Brazilian tertiary centers between 2010 and 2024. Biometric parameters (biparietal diameter, head circumference [HC], abdominal circumference, and femur length) and EFW were recorded. EFW was calculated using Hadlock IV and Siemer formulas. Polynomial regression models were applied to generate gestational age-specific curves for HC, femur length (FL), and EFW. Agreement between prenatal EFW and birth weight (in cases assessed within 14 days of delivery) was analyzed using Bland-Altman plots and the concordance correlation coefficient (CCC). Results: A total of 116 pregnancies and 355 ultrasound tests were included. Polynomial models showed a strong association between gestational age and EFW (R2 = 0.837 for Siemer; R2 = 0.728 for Hadlock), HC (R2 = 0.849), and FL (R2 = 0.877). The 50th percentile curves for gastroschisis were consistently lower than those from standard growth charts. In the birthweight concordance analysis (n = 46), the Siemer formula showed low agreement (CCC = 0.55), while the Hadlock formula showed even lower concordance (CCC = 0.44), with both formulas underestimating actual birth weight. Conclusions: Fetuses with gastroschisis have distinct growth patterns not captured by standard references. Tailored growth curves and careful interpretation of EFW are essential to improve prenatal assessment in this population.
