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Table of Contents
Vol. 25, No. 3, 2009
Issue release date: September 2009
Section title: Mini-Review
Free Access
Fetal Diagn Ther 2009;25:297–303
(DOI:10.1159/000235875)

Should We Customize Fetal Growth Standards?

Figueras F.a, b · Gardosi J.c
aMaternal-Fetal Medicine Department, Hospital Clínic, Universitat de Barcelona, and bPerinatal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; cWest Midlands Perinatal Institute, Birmingham, UK
email Corresponding Author

Abstract

Several maternal and fetal physiological characteristics account for a substantial proportion of the variation in birth weight. These characteristics can be used to calculate an individualized optimal birth weight and to adjust or ‘customize’ the birth weight standard. Customized birth weight standards improve the distinction between constitutional and pathological smallness, and there is evidence that this finding can be extrapolated into the fetal period to evaluate intrauterine growth, but further studies are required to evaluate and quantify the effectiveness of customized versus conventional charts in improving the diagnosis of pathological smallness before birth.

© 2009 S. Karger AG, Basel


  

Key Words

  • Intrauterine growth restriction
  • Small for gestational age
  • Birth weight

References

  1. Kady S, Gardosi J: Perinatal mortality and fetal growth restriction. Best Pract Res Clin Obstet Gynaecol 2004;18:397–410.
  2. Jarvis S, et al: Cerebral palsy and intrauterine growth in single births: European collaborative study. Lancet 2003;362:1106–1111.
  3. Leitner Y, et al: Neurodevelopmental outcome of children with intrauterine growth retardation: a longitudinal, 10-year prospective study. J Child Neurol 2007;22:580–587.
  4. Godfrey KM, Barker DJ: Fetal nutrition and adult disease. Am J Clin Nutr 2000;71(suppl 5):1344S–1352S.
  5. Lee PA, et al: International Small for Gestational Age Advisory Board consensus development conference statement: management of short children born small for gestational age, April 24–October 1, 2001. Pediatrics 2003;111:1253–1261.
  6. Lackman F, et al: Fetal umbilical cord oxygen values and birth to placental weight ratio in relation to size at birth. Am J Obstet Gynecol 2001;185:674–682.
  7. Royal College of Obstetrics and Gynaecology Green-Top Guidelines: The Investigation and Management of the Small-for-Gestational-Age Fetus. London, RCOG, 2002.
  8. SOGC Clinical Practice Guidelines. The use of fetal Doppler in obstetrics. J Obstet Gynecol Can 2003;25:601–607.
  9. ACOG committee opinion. Utility of antepartum umbilical artery Doppler velocimetry in intrauterine growth restriction. Number 188, October 1997 (replaces No 116, November 1992). Committee on Obstetric Practice. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 1997;59:269–270.
  10. Neilson JP, Alfirevic Z: Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev 2000:CD000073.
  11. McCowan LM, Harding JE, Stewart AW: Umbilical artery Doppler studies in small for gestational age babies reflect disease severity. BJOG 2000;107:916–925.
  12. Figueras F, et al: Predictiveness of antenatal umbilical artery Doppler for adverse pregnancy outcome in small-for-gestational-age babies according to customised birthweight centiles: population-based study. BJOG 2008;115:590–594.
  13. Valcamonico A, et al: Absent end-diastolic velocity in umbilical artery: risk of neonatal morbidity and brain damage. Am J Obstet Gynecol 1994;170:796–801.
  14. Soothill PW, et al: Prediction of morbidity in small and normally grown fetuses by fetal heart rate variability, biophysical profile score and umbilical artery Doppler studies. Br J Obstet Gynaecol 1993;100:742–745.
  15. Soothill PW, Bobrow CS, Holmes R: Small for gestational age is not a diagnosis. Ultrasound Obstet Gynecol 1999;13:225–228.
  16. Bobrow CS, Soothill PW: Fetal growth velocity: a cautionary tale. Lancet 1999;353:1460.
  17. Hershkovitz R, et al: Fetal cerebral blood flow redistribution in late gestation: identification of compromise in small fetuses with normal umbilical artery Doppler. Ultrasound Obstet Gynecol 2000;15:209–212.
  18. Chang TC, et al: Prediction of perinatal morbidity at term in small fetuses: comparison of fetal growth and Doppler ultrasound. Br J Obstet Gynaecol 1994;101:422–427.
  19. Mongelli M, Gardosi J: Longitudinal study of fetal growth in subgroups of a low-risk population. Ultrasound Obstet Gynecol 1995;6:340–344.
  20. Wilcox M, et al: Birth weight from pregnancies dated by ultrasonography in a multicultural British population. BMJ 1993;307:588–591.
  21. Gardosi J, et al: An adjustable fetal weight standard. Ultrasound Obstet Gynecol 1995;6:168–174.
  22. Bukowski R, et al: Individualized norms of optimal fetal growth: fetal growth potential. Obstet Gynecol 2008;111:1065–1076.
  23. Figueras F, et al: Customized birthweight standards for a Spanish population. Eur J Obstet Gynecol Reprod Biol 2008;136:20–24.
  24. McCowan L, et al: A customised birthweight centile calculator developed for a New Zealand population. Aust NZ J Obstet Gynaecol 2004;44:428–431.
  25. Pain S, et al: Customised birthweight: coefficients for an Australian population and validation of the model. Aust NZ J Obstet Gynaecol 2006;46:388–394.
  26. Sahota DS, et al: Customized birth weight: coefficients and validation of models in a UK population. Ultrasound Obstet Gynecol 2008;32:884–889.
  27. Ego A, et al: Customized versus population-based birth weight standards for identifying growth restricted infants: a French multicenter study. Am J Obstet Gynecol 2006;194:1042–1049.
  28. Mongelli M, et al: A customized birthweight centile calculator developed for an Australian population. Aust NZ J Obstet Gynaecol 2007;47:128–131.
  29. Drooger JC, et al: Ethnic differences in prenatal growth and the association with maternal and fetal characteristics. Ultrasound Obstet Gynecol 2005;26:115–122.
  30. Graafmans WC, et al: Birth weight and perinatal mortality: a comparison of ‘optimal’ birth weight in seven Western European countries. Epidemiology 2002;13:569–574.
  31. Arntzen A, Nybo Andersen AM: Social determinants for infant mortality in the Nordic countries, 1980–2001. Scand J Public Health 2004;32:381–389.
  32. Arntzen A, et al: Socioeconomic status and risk of infant death. A population-based study of trends in Norway, 1967–1998. Int J Epidemiol 2004;33:279–288.
  33. Raatikainen K, Heiskanen N, Heinonen S: Marriage still protects pregnancy. BJOG 2005;112:1411–1416.
  34. Yip R: Altitude and birth weight. J Pediatr 1987;111:869–876.
  35. Morrison J, et al: The influence of paternal height and weight on birth-weight. Aust NZ J Obstet Gynaecol 1991;31:114–116.
  36. Windham GC, et al: Prenatal active or passive tobacco smoke exposure and the risk of preterm delivery or low birth weight. Epidemiology 2000;11:427–433.
  37. Rasmussen S, Irgens LM: The effects of smoking and hypertensive disorders on fetal growth. BMC Pregnancy Childbirth 2006;6:16.
  38. Pollack H, Lantz PM, Frohna JG: Maternal smoking and adverse birth outcomes among singletons and twins. Am J Public Health 2000;90:395–400.
  39. Gardosi J, Francis A: A customized standard to assess fetal growth in an American population. Am J Obstet Gynecol DOI: 10.1016/j.ajog.2009.04.035.

    External Resources

  40. Nikkila A, Kallen B, Marsal K: Fetal growth and congenital malformations. Ultrasound Obstet Gynecol 2007;29:289–295.
  41. Groom KM, et al: Small-for-gestational-age infants classified by customized or population birthweight centiles: impact of gestational age at delivery. Am J Obstet Gynecol 2007;197:239 e1–e5.
  42. Gardosi JO: Prematurity and fetal growth restriction. Early Hum Dev 2005;81:43–49.
  43. Zeitlin J, et al: The relationship between intrauterine growth restriction and preterm delivery: an empirical approach using data from a European case-control study. BJOG 2000;107:750–758.
  44. Santamaria R, et al: Tablas españolas de pesos neonatales según edad gestacional. Barcelona, Laboratorios Menarini, 1998.
  45. Gardosi J, et al: Customised antenatal growth charts. Lancet 1992;339:283–287.
  46. Verburg BO, et al: New charts for ultrasound dating of pregnancy and assessment of fetal growth: longitudinal data from a population-based cohort study. Ultrasound Obstet Gynecol 2008;31:388–396.
  47. Clausson B, et al: Perinatal outcome in SGA births defined by customised versus population-based birthweight standards. BJOG 2001;108:830–834.
  48. Bonellie SR: Effect of maternal age, smoking and deprivation on birthweight. Paediatr Perinat Epidemiol 2001;15:19–26.
  49. Gardosi J: Customized fetal growth standards: rationale and clinical application. Semin Perinatol 2004;28:33–40.
  50. Sciscione AC, Gorman R, Callan NA: Adjustment of birth weight standards for maternal and infant characteristics improves the prediction of outcome in the small-for-gestational-age infant. Am J Obstet Gynecol 1996;175:544–547.
  51. Hadlock FP, Harrist RB, Martinez-Poyer J: In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991;181:129–133.
  52. Gardosi J, et al: Gestation related optimal weight (GROW) program. 2003. www.gestation.net.
  53. Figueras F, et al: Customized birthweight standards accurately predict perinatal morbidity. Arch Dis Child Fetal Neonatal Ed 2007;92:F277–F280.
  54. McCowan LM, Harding JE, Stewart AW: Customized birthweight centiles predict SGA pregnancies with perinatal morbidity. BJOG 2005;112:1026–1033.
  55. De Jong CL, et al: Customized fetal weight limits for antenatal detection of fetal growth restriction. Ultrasound Obstet Gynecol 2000;15:36–40.
  56. Jacobsson B, et al: Cerebral palsy and restricted growth status at birth: population-based case-control study. BJOG 2008;115:1250–1255.
  57. Verkauskiene R, et al: Birth weight and long-term metabolic outcomes: does the definition of smallness matter? Horm Res 2008;70:309–315.
  58. Zhang X, et al: The use of customised versus population-based birthweight standards in predicting perinatal mortality. BJOG 2007;114:474–477.
  59. Gardosi J, Clausson B, Francis A: The value of customized centiles in assessing perinatal mortality risk associated with parity and maternal size. BJOG DOI: 10.111/j.1471-0528.2009.02245.

    External Resources

  60. Schwarzler P, et al: Sex-specific antenatal reference growth charts for uncomplicated singleton pregnancies at 15–40 weeks of gestation. Ultrasound Obstet Gynecol 2004;23:23–29.
  61. de Jong CL, et al: Fetal weight gain in a serially scanned high-risk population. Ultrasound Obstet Gynecol 1998;11:39–43.
  62. Mongelli M, Gardosi J: Reduction of false-positive diagnosis of fetal growth restriction by application of customized fetal growth standards. Obstet Gynecol 1996;88:844–848.
  63. Dua A, Schram C: An investigation into the applicability of customised charts for the assessment of fetal growth in antenatal population at Blackburn, Lancashire, UK. J Obstet Gynaecol 2006;26:411–413.
  64. Owen P, et al: Prediction of intrauterine growth restriction with customised estimated fetal weight centiles. BJOG 2003;110:411–415.
  65. Mongelli M, Gardosi J: Symphysis-fundus height and pregnancy characteristics in ultrasound-dated pregnancies. Obstet Gynecol 1999;94:591–594.
  66. Gardosi J, Francis A: Controlled trial of fundal height measurement plotted on customised antenatal growth charts. Br J Obstet Gynaecol 1999;106:309–317.
  67. Lindqvist PG, Molin J: Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome? Ultrasound Obstet Gynecol 2005;25:258–264.

  

Author Contacts

Francesc Figueras
Maternal-Fetal Medicine Department
Hospital Clinic
ES–08028 Barcelona (Spain)
Tel. +34 932 275 600, Fax +34 932 275 605, E-Mail ffiguera@clinic.ub.es

  

Article Information

Received: June 5, 2009
Accepted: June 9, 2009
Published online: September 22, 2009
Number of Print Pages : 7
Number of Figures : 2, Number of Tables : 0, Number of References : 67

  

Publication Details

Fetal Diagnosis and Therapy (Clinical Advances and Basic Research)

Vol. 25, No. 3, Year 2009 (Cover Date: September 2009)

Journal Editor: Gratacós E. (Barcelona)
ISSN: 1015-3837 (Print), eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT


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References

  1. Kady S, Gardosi J: Perinatal mortality and fetal growth restriction. Best Pract Res Clin Obstet Gynaecol 2004;18:397–410.
  2. Jarvis S, et al: Cerebral palsy and intrauterine growth in single births: European collaborative study. Lancet 2003;362:1106–1111.
  3. Leitner Y, et al: Neurodevelopmental outcome of children with intrauterine growth retardation: a longitudinal, 10-year prospective study. J Child Neurol 2007;22:580–587.
  4. Godfrey KM, Barker DJ: Fetal nutrition and adult disease. Am J Clin Nutr 2000;71(suppl 5):1344S–1352S.
  5. Lee PA, et al: International Small for Gestational Age Advisory Board consensus development conference statement: management of short children born small for gestational age, April 24–October 1, 2001. Pediatrics 2003;111:1253–1261.
  6. Lackman F, et al: Fetal umbilical cord oxygen values and birth to placental weight ratio in relation to size at birth. Am J Obstet Gynecol 2001;185:674–682.
  7. Royal College of Obstetrics and Gynaecology Green-Top Guidelines: The Investigation and Management of the Small-for-Gestational-Age Fetus. London, RCOG, 2002.
  8. SOGC Clinical Practice Guidelines. The use of fetal Doppler in obstetrics. J Obstet Gynecol Can 2003;25:601–607.
  9. ACOG committee opinion. Utility of antepartum umbilical artery Doppler velocimetry in intrauterine growth restriction. Number 188, October 1997 (replaces No 116, November 1992). Committee on Obstetric Practice. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 1997;59:269–270.
  10. Neilson JP, Alfirevic Z: Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev 2000:CD000073.
  11. McCowan LM, Harding JE, Stewart AW: Umbilical artery Doppler studies in small for gestational age babies reflect disease severity. BJOG 2000;107:916–925.
  12. Figueras F, et al: Predictiveness of antenatal umbilical artery Doppler for adverse pregnancy outcome in small-for-gestational-age babies according to customised birthweight centiles: population-based study. BJOG 2008;115:590–594.
  13. Valcamonico A, et al: Absent end-diastolic velocity in umbilical artery: risk of neonatal morbidity and brain damage. Am J Obstet Gynecol 1994;170:796–801.
  14. Soothill PW, et al: Prediction of morbidity in small and normally grown fetuses by fetal heart rate variability, biophysical profile score and umbilical artery Doppler studies. Br J Obstet Gynaecol 1993;100:742–745.
  15. Soothill PW, Bobrow CS, Holmes R: Small for gestational age is not a diagnosis. Ultrasound Obstet Gynecol 1999;13:225–228.
  16. Bobrow CS, Soothill PW: Fetal growth velocity: a cautionary tale. Lancet 1999;353:1460.
  17. Hershkovitz R, et al: Fetal cerebral blood flow redistribution in late gestation: identification of compromise in small fetuses with normal umbilical artery Doppler. Ultrasound Obstet Gynecol 2000;15:209–212.
  18. Chang TC, et al: Prediction of perinatal morbidity at term in small fetuses: comparison of fetal growth and Doppler ultrasound. Br J Obstet Gynaecol 1994;101:422–427.
  19. Mongelli M, Gardosi J: Longitudinal study of fetal growth in subgroups of a low-risk population. Ultrasound Obstet Gynecol 1995;6:340–344.
  20. Wilcox M, et al: Birth weight from pregnancies dated by ultrasonography in a multicultural British population. BMJ 1993;307:588–591.
  21. Gardosi J, et al: An adjustable fetal weight standard. Ultrasound Obstet Gynecol 1995;6:168–174.
  22. Bukowski R, et al: Individualized norms of optimal fetal growth: fetal growth potential. Obstet Gynecol 2008;111:1065–1076.
  23. Figueras F, et al: Customized birthweight standards for a Spanish population. Eur J Obstet Gynecol Reprod Biol 2008;136:20–24.
  24. McCowan L, et al: A customised birthweight centile calculator developed for a New Zealand population. Aust NZ J Obstet Gynaecol 2004;44:428–431.
  25. Pain S, et al: Customised birthweight: coefficients for an Australian population and validation of the model. Aust NZ J Obstet Gynaecol 2006;46:388–394.
  26. Sahota DS, et al: Customized birth weight: coefficients and validation of models in a UK population. Ultrasound Obstet Gynecol 2008;32:884–889.
  27. Ego A, et al: Customized versus population-based birth weight standards for identifying growth restricted infants: a French multicenter study. Am J Obstet Gynecol 2006;194:1042–1049.
  28. Mongelli M, et al: A customized birthweight centile calculator developed for an Australian population. Aust NZ J Obstet Gynaecol 2007;47:128–131.
  29. Drooger JC, et al: Ethnic differences in prenatal growth and the association with maternal and fetal characteristics. Ultrasound Obstet Gynecol 2005;26:115–122.
  30. Graafmans WC, et al: Birth weight and perinatal mortality: a comparison of ‘optimal’ birth weight in seven Western European countries. Epidemiology 2002;13:569–574.
  31. Arntzen A, Nybo Andersen AM: Social determinants for infant mortality in the Nordic countries, 1980–2001. Scand J Public Health 2004;32:381–389.
  32. Arntzen A, et al: Socioeconomic status and risk of infant death. A population-based study of trends in Norway, 1967–1998. Int J Epidemiol 2004;33:279–288.
  33. Raatikainen K, Heiskanen N, Heinonen S: Marriage still protects pregnancy. BJOG 2005;112:1411–1416.
  34. Yip R: Altitude and birth weight. J Pediatr 1987;111:869–876.
  35. Morrison J, et al: The influence of paternal height and weight on birth-weight. Aust NZ J Obstet Gynaecol 1991;31:114–116.
  36. Windham GC, et al: Prenatal active or passive tobacco smoke exposure and the risk of preterm delivery or low birth weight. Epidemiology 2000;11:427–433.
  37. Rasmussen S, Irgens LM: The effects of smoking and hypertensive disorders on fetal growth. BMC Pregnancy Childbirth 2006;6:16.
  38. Pollack H, Lantz PM, Frohna JG: Maternal smoking and adverse birth outcomes among singletons and twins. Am J Public Health 2000;90:395–400.
  39. Gardosi J, Francis A: A customized standard to assess fetal growth in an American population. Am J Obstet Gynecol DOI: 10.1016/j.ajog.2009.04.035.

    External Resources

  40. Nikkila A, Kallen B, Marsal K: Fetal growth and congenital malformations. Ultrasound Obstet Gynecol 2007;29:289–295.
  41. Groom KM, et al: Small-for-gestational-age infants classified by customized or population birthweight centiles: impact of gestational age at delivery. Am J Obstet Gynecol 2007;197:239 e1–e5.
  42. Gardosi JO: Prematurity and fetal growth restriction. Early Hum Dev 2005;81:43–49.
  43. Zeitlin J, et al: The relationship between intrauterine growth restriction and preterm delivery: an empirical approach using data from a European case-control study. BJOG 2000;107:750–758.
  44. Santamaria R, et al: Tablas españolas de pesos neonatales según edad gestacional. Barcelona, Laboratorios Menarini, 1998.
  45. Gardosi J, et al: Customised antenatal growth charts. Lancet 1992;339:283–287.
  46. Verburg BO, et al: New charts for ultrasound dating of pregnancy and assessment of fetal growth: longitudinal data from a population-based cohort study. Ultrasound Obstet Gynecol 2008;31:388–396.
  47. Clausson B, et al: Perinatal outcome in SGA births defined by customised versus population-based birthweight standards. BJOG 2001;108:830–834.
  48. Bonellie SR: Effect of maternal age, smoking and deprivation on birthweight. Paediatr Perinat Epidemiol 2001;15:19–26.
  49. Gardosi J: Customized fetal growth standards: rationale and clinical application. Semin Perinatol 2004;28:33–40.
  50. Sciscione AC, Gorman R, Callan NA: Adjustment of birth weight standards for maternal and infant characteristics improves the prediction of outcome in the small-for-gestational-age infant. Am J Obstet Gynecol 1996;175:544–547.
  51. Hadlock FP, Harrist RB, Martinez-Poyer J: In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991;181:129–133.
  52. Gardosi J, et al: Gestation related optimal weight (GROW) program. 2003. www.gestation.net.
  53. Figueras F, et al: Customized birthweight standards accurately predict perinatal morbidity. Arch Dis Child Fetal Neonatal Ed 2007;92:F277–F280.
  54. McCowan LM, Harding JE, Stewart AW: Customized birthweight centiles predict SGA pregnancies with perinatal morbidity. BJOG 2005;112:1026–1033.
  55. De Jong CL, et al: Customized fetal weight limits for antenatal detection of fetal growth restriction. Ultrasound Obstet Gynecol 2000;15:36–40.
  56. Jacobsson B, et al: Cerebral palsy and restricted growth status at birth: population-based case-control study. BJOG 2008;115:1250–1255.
  57. Verkauskiene R, et al: Birth weight and long-term metabolic outcomes: does the definition of smallness matter? Horm Res 2008;70:309–315.
  58. Zhang X, et al: The use of customised versus population-based birthweight standards in predicting perinatal mortality. BJOG 2007;114:474–477.
  59. Gardosi J, Clausson B, Francis A: The value of customized centiles in assessing perinatal mortality risk associated with parity and maternal size. BJOG DOI: 10.111/j.1471-0528.2009.02245.

    External Resources

  60. Schwarzler P, et al: Sex-specific antenatal reference growth charts for uncomplicated singleton pregnancies at 15–40 weeks of gestation. Ultrasound Obstet Gynecol 2004;23:23–29.
  61. de Jong CL, et al: Fetal weight gain in a serially scanned high-risk population. Ultrasound Obstet Gynecol 1998;11:39–43.
  62. Mongelli M, Gardosi J: Reduction of false-positive diagnosis of fetal growth restriction by application of customized fetal growth standards. Obstet Gynecol 1996;88:844–848.
  63. Dua A, Schram C: An investigation into the applicability of customised charts for the assessment of fetal growth in antenatal population at Blackburn, Lancashire, UK. J Obstet Gynaecol 2006;26:411–413.
  64. Owen P, et al: Prediction of intrauterine growth restriction with customised estimated fetal weight centiles. BJOG 2003;110:411–415.
  65. Mongelli M, Gardosi J: Symphysis-fundus height and pregnancy characteristics in ultrasound-dated pregnancies. Obstet Gynecol 1999;94:591–594.
  66. Gardosi J, Francis A: Controlled trial of fundal height measurement plotted on customised antenatal growth charts. Br J Obstet Gynaecol 1999;106:309–317.
  67. Lindqvist PG, Molin J: Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome? Ultrasound Obstet Gynecol 2005;25:258–264.