Naoko Kozuki1, Joanne Katz1, Parul Christian1, Anne C C Lee2, Li Liu3, Mariangela F Silveira4, Fernando Barros4, James M Tielsch5, Christentze Schmiegelow6, Ayesha Sania7, Dominique Roberfroid8, Richard Ndyomugyenyi9, Luke C Mullany1, Aroonsri Mongkolchati10, Lieven Huybregts11, Jean Humphrey12, Wafaie Fawzi13, Abdullah H Baqui1, Linda Adair14, Vanessa M Oddo1, Robert E Black1. 1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 2. Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 3. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland3Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 4. Programa de Pós-graduacao em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil. 5. Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC. 6. Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark. 7. Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts. 8. Nutrition and Child Health Unit, Institute of Tropical Medicine, Antwerpen, Belgium. 9. Vector Control Division, Ministry of Health, Kampala, Uganda. 10. ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand. 11. Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium12Poverty, Nutrition and Health Division, International Food Policy Research Institute, Washington, DC. 12. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland13ZVITAMBO, Borrowdale, Harare, Zimbabwe. 13. Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts14Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts15Department of Epidemiology, Harvard School of Public Health, Boston, Massa. 14. University of North Carolina School of Public Health, Chapel Hill.
Abstract
IMPORTANCE: This study introduces how the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) international birth weight standards alter our previous understanding and interpretations of fetal growth restriction as represented by small for gestational age (SGA) status. OBJECTIVES: To compare the birth weight distributions of the INTERGROWTH-21st international standard to commonly used US references and examine the differences in the prevalence and neonatal mortality risk of SGA status (below the 10th percentile of a population reference). DESIGN, SETTING, AND PARTICIPANTS: We analyzed data from 16 prospective cohorts of newborns on gestational age, birth weight, and systematic mortality follow-up through 28 days from 10 low- and middle-income countries. The studies included were conducted between 1983 and 2008. The analysis was conducted in 2014. Infants were categorized as SGA using the 1991 US birth weight reference, the 1999-2000 US birth weight reference, and the new INTERGROWTH-21st standard. For each study, we compared the SGA prevalence and the risk ratio between SGA status and neonatal mortality, calculated using Poisson regression with robust error variance. MAIN OUTCOMES AND MEASURES: We examine neonatal mortality (death within the first 28 days after birth) as the main outcome measure. RESULTS: The pooled SGA prevalence was 23.7% (95% CI, 16.5%-31.0%) using the INTERGROWTH-21st standard compared with 36.0% (95% CI, 27.0%-45.0%) with the US 2000 reference. The relative decrease in prevalence was larger among infants born at 33 to less than 37 weeks' gestation compared with term infants. The pooled neonatal mortality risk did not differ significantly; the adjusted risk ratios were 2.13 (95% CI, 1.78-2.54; P < .001) for the INTERGROWTH-21st standard and 2.12 (95% CI, 1.81-2.48; P < .001) for the US 2000 reference. CONCLUSIONS AND RELEVANCE: To our knowledge, INTERGROWTH-21st is the first international newborn standard for size for gestational age for healthy fetal growth. We observed a greater-than-one-quarter reduction in SGA prevalence and no significant change in the associated neonatal mortality risk, resulting in a decrease in the percentage of neonatal death attributable to SGA. Our study sheds light on how previously published studies on SGA status may be reinterpreted with the introduction of this new birth weight standard.
IMPORTANCE: This study introduces how the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) international birth weight standards alter our previous understanding and interpretations of fetal growth restriction as represented by small for gestational age (SGA) status. OBJECTIVES: To compare the birth weight distributions of the INTERGROWTH-21st international standard to commonly used US references and examine the differences in the prevalence and neonatal mortality risk of SGA status (below the 10th percentile of a population reference). DESIGN, SETTING, AND PARTICIPANTS: We analyzed data from 16 prospective cohorts of newborns on gestational age, birth weight, and systematic mortality follow-up through 28 days from 10 low- and middle-income countries. The studies included were conducted between 1983 and 2008. The analysis was conducted in 2014. Infants were categorized as SGA using the 1991 US birth weight reference, the 1999-2000 US birth weight reference, and the new INTERGROWTH-21st standard. For each study, we compared the SGA prevalence and the risk ratio between SGA status and neonatal mortality, calculated using Poisson regression with robust error variance. MAIN OUTCOMES AND MEASURES: We examine neonatal mortality (death within the first 28 days after birth) as the main outcome measure. RESULTS: The pooled SGA prevalence was 23.7% (95% CI, 16.5%-31.0%) using the INTERGROWTH-21st standard compared with 36.0% (95% CI, 27.0%-45.0%) with the US 2000 reference. The relative decrease in prevalence was larger among infants born at 33 to less than 37 weeks' gestation compared with term infants. The pooled neonatal mortality risk did not differ significantly; the adjusted risk ratios were 2.13 (95% CI, 1.78-2.54; P < .001) for the INTERGROWTH-21st standard and 2.12 (95% CI, 1.81-2.48; P < .001) for the US 2000 reference. CONCLUSIONS AND RELEVANCE: To our knowledge, INTERGROWTH-21st is the first international newborn standard for size for gestational age for healthy fetal growth. We observed a greater-than-one-quarter reduction in SGA prevalence and no significant change in the associated neonatal mortality risk, resulting in a decrease in the percentage of neonatal death attributable to SGA. Our study sheds light on how previously published studies on SGA status may be reinterpreted with the introduction of this new birth weight standard.
Authors: Hannah J Cooper; Martha Iwamoto; Maura Lash; Erin E Conners; Marc Paladini; Sally Slavinski; Anne D Fine; Joseph Kennedy; Dominique Heinke; Andrea Ciaranello; George R Seage; Ellen H Lee Journal: Obstet Gynecol Date: 2019-12 Impact factor: 7.661
Authors: Rachel A Blake; Sangshin Park; Palmera Baltazar; Edna B Ayaso; Donna Bella S Monterde; Luz P Acosta; Remigio M Olveda; Veronica Tallo; Jennifer F Friedman Journal: PLoS One Date: 2016-07-21 Impact factor: 3.240
Authors: Elizabeth P Schlaudecker; Flor M Munoz; Azucena Bardají; Nansi S Boghossian; Asma Khalil; Hatem Mousa; Mirjana Nesin; Muhammad Imran Nisar; Vitali Pool; Hans M L Spiegel; Milagritos D Tapia; Sonali Kochhar; Steven Black Journal: Vaccine Date: 2017-12-04 Impact factor: 3.641