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- DOI 10.18231/j.ijogr.v.12.i.3.32
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CrossMark
A longitudinal study of fetal growth using antenatal INTERGROWTH-21ST reference standard charts and perinatal outcome
- Author Details:
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Akshitha K
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Udayashree Voorkara *
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Sneha G. S
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Roopa M
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Sahana N Naik
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Rathnamala M Desai
Akshitha K
Udayashree Voorkara *
Sneha G. S
Roopa M
Sahana N Naik
Rathnamala M Desai
Background: Neonatal growth charts reveal compromised growth only at the extreme of growth abnormalities. They cannot be used to identify the fetus whose birth-weight is above the 10th percentile but has failed to achieve its growth potential. Hence we performed a longitudinal study of antenatal fetal growth assessment using INTERGROWTH-21st (IG-21st) reference standard charts and correlated with neonatal outcome.
Aim & Objectives: To assess the predictive value of antenatal fetal INTERGROWTH-21st (IG-21st) reference standard charts in diagnosing the neonatal growth abnormalities and the perinatal outcome
Materials and Methods: A prospective longitudinal study was done on 100 patients visiting outpatient department (OPD) of Department of OBG, SDMCMSH, Dharwad, Karnataka, for regular ante natal care (ANC), booked at <14 weeks of gestation.
Serial ultrasounds (USG) were done, i.e. Dating Scan, nuchal translucency scan (NT scan), Anomaly Scan, Growth Scan at >32weeks and one at near term. Fetal biometry measured (CRL-crown rump length, BPD-Biparietal diameter, HC-head circumference, AC-abdominal circumference, FL-femoral length, EFW-estimated fetal weight) were plotted on IG-21st charts and monitored the fetal growth. The neonatal parameters at birth and perinatal outcome were noted.
Results: Ninety six (96%) fetuses had normal growth curves (NGC) for all assessed parameters. Four (4%) had growth curves (GC) for AC and EFW falling below NGC indicating fetal growth restriction (FGR).At birth, all these 4 babies (100%) had LBW indicating that fetal monitoring using IG-21st had accurately identified all (100%) fetuses at risk for FGR and AC and EFW were better parameters for assessment of FGR compared to HC, BPD and FL.), but were AGA (appropriate for gestational age); thus, indicating applicability of IG-21st.
Conclusion: The IG-21st reference standards have a high predictive value for growth deviations and applicable to our population for antenatal fetal growth monitoring.
References
- Alberry M, Soothill P. Management of fetal growth restriction. Arch Dis Child Fetal Neonatal Ed. 2007;92(1):62–7.
- Lee AC, Kozuki N, Cousens S, Stevens GA, Blencowe H, Silveira MF, et al. Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH -21st standard: analysis of CHERG datasets. BMJ. 2017;358:j3677.
- Peleg D, Kennedy CM, Hunter SK. Intrauterine growth restriction: identification and management. Am Fam Physician . 1998;58(2):453–60.
- Centre for Maternal and Child Enquiries (CMACE). Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The eighth report on confidential enquiries into maternal deaths in the United Kingdom. BJOG. 2011;118(1):1–203. Akshitha et al. / Indian Journal of Obstetrics and Gynecology Research 2025;12(3):563–569 569
- Clausson B, Gardosi J, Francis A, Cnattingius S. Perinatal outcome in SGA births defined by customised versus population-based birthweight standards. BJOG. 2001;108(8):830–4.
- Figueras F, Figueras J, Meler E, Eixarch E, Coll O, Gratacos E, et al. Customised birthweight standards accurately predict perinatal morbidity. Arch Dis Child Fetal Neonatal Ed. 2007;92(4):F277–80.
- Odibo AO, Francis A, Cahill AG, Macones GA, Crane JP, Gardosi J. Association between pregnancy complications and small-for- gestational-age birth weight defined by customized fetal growth standard versus a population-based standard. J Matern Fetal Neonatal Med. 2011;24(3):411–7.
- Lees C, Marlow N, Arabin B, Bilardo CM, Brezinka C, Derks JB, et al. Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound Obstet Gynecol. 2013;42(4):400–8.
- Wolfe HM, Gross TL, Sokol RJ. Recurrent small for gestational age birth: perinatal risks and outcomes. Am J Obstet Gynecol. 1987;157(2):288–93.
- Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. Fetal nutrition and cardiovascular disease in adult life. Lancet. 1993;341(8850):938–41.
- Villar J, Ba'aqeel H, Piaggio G, Lumbiganon P, Belizán MJ, Farnot U, et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet. 2001;357(9268):1551–64.
- Carroli G, Rooney C, Villar J. How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatr Perinat Epidemiol. 2001;15(1):1–42.
- Whitworth M, Bricker L, Neilson JP, Dowswell T. Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev. 2010;14(4):CD007058.
- Neilson JP. Symphysis-fundal height measurement in pregnancy. Cochrane Database Syst Rev. 2000;1998(2):CD000944.
- Borghi E, de Onis M, Garza C, Van den Broeck J, Frongillo EA, Grummer-Strawn L, et al. Construction of the World Health Organization child growth standards: selection of methods for attained growth curves. Stat Med. 2006;25(2):247–65.
- de Onis M, Onyango AW, Van den Broeck J, Chumlea WC, Martorell R. Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference. Food Nutr Bull. 2004;25(1):27–36.
- Papageorghiou AT, Kennedy SH, Salomon LJ, Altman DJ, Ohuma EO, Stones W, et al. The INTERGROWTH-21st fetal growth standards: toward the global integration of pregnancy and pediatric care. Am J Obstet Gynecol. 2018;218(2S):630–40.
- Martins JG, Biggio JR, Abuhamad A. Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org; Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012). Am J Obstet Gynecol. 2020;223(4):B2–17.
- Stirnemann J, Villar J, Salomon LJ, Ohuma E, Ruyan P, Altman DG, et al. International estimated fetal weight standards of the INTERGROWTH -21st Project. Ultrasound Obstet Gynecol. 2017;49(4):478–86.
- Roro M, Deressa W, Lindtjørn B. Intrauterine growth patterns in rural Ethiopia compared with WHO and INTERGROWTH - 21st growth standards: A community-based longitudinal study. PLoS ONE. 2019;14(12):e0226881.
- Odibo AO, Nwabuobi C, Odibo L, Leavitt K, Obican S, Tuuli MG. Customized fetal growth standard compared with the INTERGROWTH-21st century standard at predicting small-for- gestational-age neonates. Acta Obstet Gynecol Scand. 2018;97(11):1381–7.
- Francis A, Hugh O, Gardosi J. Customized vs INTERGROWTH- 21st standards for the assessment of birthweight and stillbirth risk at term. Am J Obstet Gynecol. 2018;218(2S):692–9.