Which fetal growth charts should be used? A retrospective observational study in China
Abstract. Background:. The fetal growth charts in widest use in China were published by Hadlock >35 years ago and were established on data from several hundred of American pregnant women. After that, >100 fetal growth charts were published around the world. We attempted to assess the impact of...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-08-01
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| Series: | Chinese Medical Journal |
| Online Access: | http://journals.lww.com/10.1097/CM9.0000000000002335 |
| _version_ | 1797978537105293312 |
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| author | Jianxin Zhao Ying Yuan Jing Tao Chunyi Chen Xiaoxia Wu Yimei Liao Linlin Wu Qing Zeng Yin Chen Ke Wang Xiaohong Li Zheng Liu Jiayuan Zhou Yangwen Zhou Shengli Li Jun Zhu Jing Ni |
| author_facet | Jianxin Zhao Ying Yuan Jing Tao Chunyi Chen Xiaoxia Wu Yimei Liao Linlin Wu Qing Zeng Yin Chen Ke Wang Xiaohong Li Zheng Liu Jiayuan Zhou Yangwen Zhou Shengli Li Jun Zhu Jing Ni |
| author_sort | Jianxin Zhao |
| collection | DOAJ |
| description | Abstract. Background:. The fetal growth charts in widest use in China were published by Hadlock >35 years ago and were established on data from several hundred of American pregnant women. After that, >100 fetal growth charts were published around the world. We attempted to assess the impact of applying the long-standing Hadlock charts and other charts in a Chinese population and to compare their ability to predict newborn small for gestational age (SGA).
Methods:. For this retrospective observational study, we reviewed all pregnant women (n = 106,455) who booked prenatal care with ultrasound measurements for fetal biometry at the Shenzhen Maternity and Child Healthcare Hospital between 2012 and 2019. A fractional polynomial regression model was applied to generate Shenzhen fetal growth chart ranges for head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL). The differences between Shenzhen charts and published charts were quantified by calculating the Z-score. The impact of applying these published charts was quantified by calculating the proportions of fetuses with biometric measurements below the 3rd centile of these charts. The sensitivity and area under the receiver operating characteristic curves of published charts to predict neonatal SGA (birthweight <10th centile) were assessed.
Results:. Following selection, 169,980 scans of fetal biometry contributed by 41,032 pregnancies with reliable gestational age were analyzed. When using Hadlock references (<3rd centile), the proportions of small heads and short femurs were as high as 8.9% and 6.6% in late gestation, respectively. The INTERGROWTH-21st standards matched those of our observed curves better than other charts, in particular for fat-free biometry (HC and FL). When using AC<10th centile, all of these references were poor at predicting neonatal SGA.
Conclusions:. Applying long-standing Hadlock references could misclassify a large proportion of fetuses as SGA. INTERGROWTH-21st standard appears to be a safe option in China. For fat-based biometry, AC, a reference based on the Chinese population is needed. In addition, when applying published charts, particular care should be taken due to the discrepancy of measurement methods. |
| first_indexed | 2024-04-11T05:24:35Z |
| format | Article |
| id | doaj.art-119334df1cd0435bbbf5e392e7d1f8bc |
| institution | Directory Open Access Journal |
| issn | 0366-6999 2542-5641 |
| language | English |
| last_indexed | 2024-04-11T05:24:35Z |
| publishDate | 2022-08-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Chinese Medical Journal |
| spelling | doaj.art-119334df1cd0435bbbf5e392e7d1f8bc2022-12-23T07:54:46ZengWolters KluwerChinese Medical Journal0366-69992542-56412022-08-01135161969197710.1097/CM9.0000000000002335202208200-00009Which fetal growth charts should be used? A retrospective observational study in ChinaJianxin ZhaoYing YuanJing TaoChunyi ChenXiaoxia WuYimei LiaoLinlin WuQing ZengYin ChenKe WangXiaohong LiZheng LiuJiayuan ZhouYangwen ZhouShengli LiJun ZhuJing NiAbstract. Background:. The fetal growth charts in widest use in China were published by Hadlock >35 years ago and were established on data from several hundred of American pregnant women. After that, >100 fetal growth charts were published around the world. We attempted to assess the impact of applying the long-standing Hadlock charts and other charts in a Chinese population and to compare their ability to predict newborn small for gestational age (SGA). Methods:. For this retrospective observational study, we reviewed all pregnant women (n = 106,455) who booked prenatal care with ultrasound measurements for fetal biometry at the Shenzhen Maternity and Child Healthcare Hospital between 2012 and 2019. A fractional polynomial regression model was applied to generate Shenzhen fetal growth chart ranges for head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL). The differences between Shenzhen charts and published charts were quantified by calculating the Z-score. The impact of applying these published charts was quantified by calculating the proportions of fetuses with biometric measurements below the 3rd centile of these charts. The sensitivity and area under the receiver operating characteristic curves of published charts to predict neonatal SGA (birthweight <10th centile) were assessed. Results:. Following selection, 169,980 scans of fetal biometry contributed by 41,032 pregnancies with reliable gestational age were analyzed. When using Hadlock references (<3rd centile), the proportions of small heads and short femurs were as high as 8.9% and 6.6% in late gestation, respectively. The INTERGROWTH-21st standards matched those of our observed curves better than other charts, in particular for fat-free biometry (HC and FL). When using AC<10th centile, all of these references were poor at predicting neonatal SGA. Conclusions:. Applying long-standing Hadlock references could misclassify a large proportion of fetuses as SGA. INTERGROWTH-21st standard appears to be a safe option in China. For fat-based biometry, AC, a reference based on the Chinese population is needed. In addition, when applying published charts, particular care should be taken due to the discrepancy of measurement methods.http://journals.lww.com/10.1097/CM9.0000000000002335 |
| spellingShingle | Jianxin Zhao Ying Yuan Jing Tao Chunyi Chen Xiaoxia Wu Yimei Liao Linlin Wu Qing Zeng Yin Chen Ke Wang Xiaohong Li Zheng Liu Jiayuan Zhou Yangwen Zhou Shengli Li Jun Zhu Jing Ni Which fetal growth charts should be used? A retrospective observational study in China Chinese Medical Journal |
| title | Which fetal growth charts should be used? A retrospective observational study in China |
| title_full | Which fetal growth charts should be used? A retrospective observational study in China |
| title_fullStr | Which fetal growth charts should be used? A retrospective observational study in China |
| title_full_unstemmed | Which fetal growth charts should be used? A retrospective observational study in China |
| title_short | Which fetal growth charts should be used? A retrospective observational study in China |
| title_sort | which fetal growth charts should be used a retrospective observational study in china |
| url | http://journals.lww.com/10.1097/CM9.0000000000002335 |
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