Advertisement

Adverse pregnancy outcome and association with small for gestational age birthweight by customized and population-based percentiles

      Objective

      The objective of the study was to investigate the association between pregnancy complications and small for gestational age (SGA) birthweight, comparing SGA based on the customized growth potential with SGA based on the birthweight standard of the same population.

      Study Design

      This was a retrospective analysis of a database from a US multicenter study. Pregnancy complications included threatened preterm labor, antepartum hemorrhage, pregnancy-induced hypertension, preeclampsia, stillbirth, and early neonatal death.

      Results

      Compared with SGA by the birthweight standard, SGA by customized growth potential showed higher risk for each of the 6 adverse indicators. A third of the SGA group was small by customized centiles but not by population-based centiles, yet was strongly associated with each of the pregnancy complications studied. This subgroup of unrecognized SGA babies included 26% preterm deliveries. In contrast, a subgroup that was SGA by the population standard but not by the customized standard (17.2%), was not associated with any of the indicators of adverse outcome.

      Conclusion

      SGA defined by customized growth potential improves the differentiation between physiologically and pathologically small babies.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kady S.M.
        • Gardosi J.
        Perinatal mortality and fetal growth restriction.
        in: Arulkumaran S. Gardosi J. Best practice and research. Elsevier, 2004: 397-410
        • Gardosi J.
        • Chang A.
        • Kalyan B.
        • Sahota D.
        • Symonds E.M.
        Customised antenatal growth charts.
        Lancet. 1992; 339: 283-287
        • Gardosi J.
        • Mongelli M.
        • Wilcox M.
        • Chang A.
        An adjustable fetal weight standard.
        Ultrasound Obstet Gynecol. 1995; 6: 168-174
        • Gardosi J.
        • Francis A.
        A customized standard to assess fetal growth in a US population.
        Am J Obstet Gynecol. 2009; 201: 25.e1-25.e7
        • Wilcox M.
        • Gardosi J.
        • Mongelli M.
        • Ray C.
        • Johnson I.
        Birth weight from pregnancies dated by ultrasonography in a multicultural British population.
        BMJ. 1993; 307: 588-591
        • Malone F.D.
        • Canick J.A.
        • Ball R.H.
        • et al.
        First-trimester or second-trimester screening, or both, for Down's syndrome.
        N Engl J Med. 2005; 353: 2001-2011
        • Cole T.J.
        • Green P.J.
        Smoothing reference centile curves: the LMS method and penalized likelihood.
        Stat Med. 1992; 11: 1305-1319
        • Hadlock F.P.
        • Harrist R.B.
        • Martinez-Poyer J.
        In utero analysis of fetal growth: a sonographic weight standard.
        Radiology. 1991; 181: 129-133
        • Zeitlin J.
        • Ancel P.Y.
        • Saurel-Cubizolles M.J.
        • Papiernik E.
        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
        • Groom K.M.
        • Poppe K.K.
        • North R.A.
        • McCowan M.E.
        Small-for-gestational age infants classified by customised or population birthweight centiles: impact of gestational age at delivery.
        Am J Obstet Gynecol. 2007; 197: 239.e1-239.e5
        • de Jong C.L.D.
        • Gardosi J.
        • Dekker G.A.
        • Colenbrander G.J.
        • van Geijn H.P.
        Application of a customised birthweight standard in the assessment of perinatal outcome in a high risk population.
        BJOG. 1998; 105: 531-535
        • Clausson B.
        • Gardosi J.
        • Francis A.
        • Cnattingius S.
        Perinatal outcome in SGA births defined by customised versus population-based birthweight standards.
        BJOG. 2001; 108: 830-834
        • McCowan L.
        • Harding J.E.
        • Stewart A.W.
        Customised birthweight centiles predict SGA pregnancies with perinatal morbidity.
        BJOG. 2005; 112: 1026-1033
        • Ego A.
        • Subtil D.
        • Grange G.
        • 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
        • Bukowski R.
        • Uchida T.
        • Smith G.C.S.
        • et al.
        Individualised norms of optimal fetal growth.
        Obstet Gynecol. 2008; 111: 1065-1076
        • Alexander G.R.
        • Himes J.H.
        • Kaufman R.B.
        • Mor J.
        • Kogan M.A.
        United States national reference for fetal growth.
        Obstet Gynecol. 1996; 87: 163-168
        • Hutcheon J.A.
        • Zhang X.
        • Cnattingius S.
        • Kramer M.S.
        • Platt R.W.
        Customised birthweight percentiles: does adjusting for maternal characteristics matter?.
        BJOG. 2008; 115: 1397-1404
        • Bai J.
        • Wong F.W.
        • Bauman A.
        • Mohsin M.
        Parity and pregnancy outcomes.
        Am J Obstet Gynecol. 2002; 186: 274-278
        • Alexander G.R.
        • Kogan M.D.
        • Himes J.H.
        • Mor J.M.
        • Goldenberg R.
        Racial differences in birthweight for gestational age and infant mortality in extremely low risk US populations.
        Pediatr Perinat Epidemiol. 1999; 13: 205-217
        • Stephansson O.
        • Dickman P.W.
        • Johansson A.L.V.
        • Cnattingius S.
        The influence of socioeconomic status on stillbirth risk in Sweden.
        Int J Epidemiol. 2001; 20: 1296-1301
        • Cnattingius S.
        • Bergstrom R.
        • Lipworth L.
        • Kramer M.S.
        Prepregnancy weight and the risk of adverse pregnancy outcomes.
        N Engl J Med. 1998; 338: 147-152
        • Gardosi J.
        • Clausson B.
        • Francis A.
        The use of customised versus population-based birthweight standards in predicting perinatal mortality.
        BJOG. 2007; 114: 1301-1302
      1. 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.