International gestational age-specific centiles for umbilical artery Doppler indices: A longitudinal prospective cohort study of the INTERGROWTH-21st Project
<p><strong>Background:</strong><br /> Reference values for umbilical artery Doppler indices are used clinically to assess fetal well-being. However, many studies that have produced reference charts have important methodologic limitations, and these result in significant heter...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Elsevier
2020
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| _version_ | 1797074102172778496 |
|---|---|
| author | Drukker, L Staines-Urias, E Villar, J Barros, FC Carvalho, M Munim, S McGready, R Nosten, F Berkley, JA Norris, SA Uauy, R Kennedy, SH Papageorghiou, AT |
| author_facet | Drukker, L Staines-Urias, E Villar, J Barros, FC Carvalho, M Munim, S McGready, R Nosten, F Berkley, JA Norris, SA Uauy, R Kennedy, SH Papageorghiou, AT |
| author_sort | Drukker, L |
| collection | OXFORD |
| description | <p><strong>Background:</strong><br />
Reference values for umbilical artery Doppler indices are used clinically to assess fetal well-being. However, many studies that have produced reference charts have important methodologic limitations, and these result in significant heterogeneity of reported reference ranges.</p><br />
<p><strong>Objectives:</strong><br />
To produce international gestational age-specific centiles for umbilical artery Doppler indices based on longitudinal data and the same rigorous methodology used in the original Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project.</p><br />
<p><strong>Study Design:</strong><br />
In Phase II of the INTERGROWTH-21st Project (the INTERBIO-21st Study), we prospectively continued enrolling pregnant women according to the same protocol from 3 of the original populations in Pelotas (Brazil), Nairobi (Kenya), and Oxford (United Kingdom) that had participated in the Fetal Growth Longitudinal Study. Women with a singleton pregnancy were recruited at <14 weeks’ gestation, confirmed by ultrasound measurement of crown–rump length, and then underwent standardized ultrasound every 5±1 weeks until delivery. From 22 weeks of gestation umbilical artery indices (pulsatility index, resistance index, and systolic/diastolic ratio) were measured in a blinded fashion, using identical equipment and a rigorously standardized protocol. Newborn size at birth was assessed using the international INTERGROWTH-21st Standards, and infants had detailed assessment of growth, nutrition, morbidity, and motor development at 1 and 2 years of age. The appropriateness of pooling data from the 3 study sites was assessed using variance component analysis and standardized site differences. Umbilical artery indices were modeled as functions of the gestational age using an exponential, normal distribution with second-degree fractional polynomial smoothing; goodness of fit for the overall models was assessed.</p><br />
<p><strong>Results:</strong><br />
Of the women enrolled at the 3 sites, 1629 were eligible for this study; 431 (27%) met the entry criteria for the construction of normative centiles, similar to the proportion seen in the original fetal growth longitudinal study. They contributed a total of 1243 Doppler measures to the analysis; 74% had 3 measures or more. The healthy low-risk status of the population was confirmed by the low rates of preterm birth (4.9%) and preeclampsia (0.7%). There were no neonatal deaths and satisfactory growth, health, and motor development of the infants at 1 and 2 years of age were documented. Only a very small proportion (2.8%–6.5%) of the variance of Doppler indices was due to between-site differences; in addition, standardized site difference estimates were marginally outside this threshold in only 1 of 27 comparisons, and this supported the decision to pool data from the 3 study sites. All 3 Doppler indices decreased with advancing gestational age. The 3rd, 5th 10th, 50th, 90th, 95th, and 97th centiles according to gestational age for each of the 3 indices are provided, as well as equations to allow calculation of any value as a centile and z scores. The mean pulsatility index according to gestational age = 1.02944 + 77.7456*(gestational age)–2 – 0.000004455*gestational age3.</p><br />
<p><strong>Conclusion:</strong><br />
We present here international gestational age-specific normative centiles for umbilical artery Doppler indices produced by studying healthy, low-risk pregnant women living in environments with minimal constraints on fetal growth. The centiles complement the existing INTERGROWTH-21st Standards for assessment of fetal well-being.</p> |
| first_indexed | 2024-03-06T23:31:28Z |
| format | Journal article |
| id | oxford-uuid:6c2a8379-bc7b-4ffa-b782-54ebf282e865 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T23:31:28Z |
| publishDate | 2020 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:6c2a8379-bc7b-4ffa-b782-54ebf282e8652022-03-26T19:09:04ZInternational gestational age-specific centiles for umbilical artery Doppler indices: A longitudinal prospective cohort study of the INTERGROWTH-21st ProjectJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:6c2a8379-bc7b-4ffa-b782-54ebf282e865EnglishSymplectic ElementsElsevier2020Drukker, LStaines-Urias, EVillar, JBarros, FCCarvalho, MMunim, SMcGready, RNosten, FBerkley, JANorris, SAUauy, RKennedy, SHPapageorghiou, AT<p><strong>Background:</strong><br /> Reference values for umbilical artery Doppler indices are used clinically to assess fetal well-being. However, many studies that have produced reference charts have important methodologic limitations, and these result in significant heterogeneity of reported reference ranges.</p><br /> <p><strong>Objectives:</strong><br /> To produce international gestational age-specific centiles for umbilical artery Doppler indices based on longitudinal data and the same rigorous methodology used in the original Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project.</p><br /> <p><strong>Study Design:</strong><br /> In Phase II of the INTERGROWTH-21st Project (the INTERBIO-21st Study), we prospectively continued enrolling pregnant women according to the same protocol from 3 of the original populations in Pelotas (Brazil), Nairobi (Kenya), and Oxford (United Kingdom) that had participated in the Fetal Growth Longitudinal Study. Women with a singleton pregnancy were recruited at <14 weeks’ gestation, confirmed by ultrasound measurement of crown–rump length, and then underwent standardized ultrasound every 5±1 weeks until delivery. From 22 weeks of gestation umbilical artery indices (pulsatility index, resistance index, and systolic/diastolic ratio) were measured in a blinded fashion, using identical equipment and a rigorously standardized protocol. Newborn size at birth was assessed using the international INTERGROWTH-21st Standards, and infants had detailed assessment of growth, nutrition, morbidity, and motor development at 1 and 2 years of age. The appropriateness of pooling data from the 3 study sites was assessed using variance component analysis and standardized site differences. Umbilical artery indices were modeled as functions of the gestational age using an exponential, normal distribution with second-degree fractional polynomial smoothing; goodness of fit for the overall models was assessed.</p><br /> <p><strong>Results:</strong><br /> Of the women enrolled at the 3 sites, 1629 were eligible for this study; 431 (27%) met the entry criteria for the construction of normative centiles, similar to the proportion seen in the original fetal growth longitudinal study. They contributed a total of 1243 Doppler measures to the analysis; 74% had 3 measures or more. The healthy low-risk status of the population was confirmed by the low rates of preterm birth (4.9%) and preeclampsia (0.7%). There were no neonatal deaths and satisfactory growth, health, and motor development of the infants at 1 and 2 years of age were documented. Only a very small proportion (2.8%–6.5%) of the variance of Doppler indices was due to between-site differences; in addition, standardized site difference estimates were marginally outside this threshold in only 1 of 27 comparisons, and this supported the decision to pool data from the 3 study sites. All 3 Doppler indices decreased with advancing gestational age. The 3rd, 5th 10th, 50th, 90th, 95th, and 97th centiles according to gestational age for each of the 3 indices are provided, as well as equations to allow calculation of any value as a centile and z scores. The mean pulsatility index according to gestational age = 1.02944 + 77.7456*(gestational age)–2 – 0.000004455*gestational age3.</p><br /> <p><strong>Conclusion:</strong><br /> We present here international gestational age-specific normative centiles for umbilical artery Doppler indices produced by studying healthy, low-risk pregnant women living in environments with minimal constraints on fetal growth. The centiles complement the existing INTERGROWTH-21st Standards for assessment of fetal well-being.</p> |
| spellingShingle | Drukker, L Staines-Urias, E Villar, J Barros, FC Carvalho, M Munim, S McGready, R Nosten, F Berkley, JA Norris, SA Uauy, R Kennedy, SH Papageorghiou, AT International gestational age-specific centiles for umbilical artery Doppler indices: A longitudinal prospective cohort study of the INTERGROWTH-21st Project |
| title | International gestational age-specific centiles for umbilical artery Doppler indices: A longitudinal prospective cohort study of the INTERGROWTH-21st Project |
| title_full | International gestational age-specific centiles for umbilical artery Doppler indices: A longitudinal prospective cohort study of the INTERGROWTH-21st Project |
| title_fullStr | International gestational age-specific centiles for umbilical artery Doppler indices: A longitudinal prospective cohort study of the INTERGROWTH-21st Project |
| title_full_unstemmed | International gestational age-specific centiles for umbilical artery Doppler indices: A longitudinal prospective cohort study of the INTERGROWTH-21st Project |
| title_short | International gestational age-specific centiles for umbilical artery Doppler indices: A longitudinal prospective cohort study of the INTERGROWTH-21st Project |
| title_sort | international gestational age specific centiles for umbilical artery doppler indices a longitudinal prospective cohort study of the intergrowth 21st project |
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