Nathan R Blue1, William A Grobman2, Jacob C Larkin3, Christina M Scifres4, Hyagriv N Simhan3, Judith H Chung5, George R Saade6, David M Haas4, Ronald Wapner7, Uma M Reddy8, Brian Mercer9, Samuel I Parry10, Robert M Silver1. 1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah. 2. Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois. 3. Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 4. Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana. 5. Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California. 6. Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas. 7. Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York. 8. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut. 9. Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio. 10. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
OBJECTIVE: The aim of study is to compare the performance of ultrasonographic customized and population fetal growth standards for prediction adverse perinatal outcomes. STUDY DESIGN: This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be, in which l data were collected at visits throughout pregnancy and after delivery. Percentiles were assigned to estimated fetal weights (EFWs) measured at 22 to 29 weeks using the Hadlock population standard and a customized standard (www.gestation.net). Areas under the curve were compared for the prediction of composite and severe composite perinatal morbidity using EFW percentile. RESULTS: Among 8,701 eligible study participants, the population standard diagnosed more fetuses with fetal growth restriction (FGR) than the customized standard (5.5 vs. 3.5%, p < 0.001). Neither standard performed better than chance to predict composite perinatal morbidity. Although the customized performed better than the population standard to predict severe perinatal morbidity (areas under the curve: 0.56 vs. 0.54, p = 0.003), both were poor. Fetuses considered FGR by the population standard but normal by the customized standard had morbidity rates similar to fetuses considered normally grown by both standards.The population standard diagnosed FGR among black women and Hispanic women at nearly double the rate it did among white women (p < 0.001 for both comparisons), even though morbidity was not different across racial/ethnic groups. The customized standard diagnosed FGR at similar rates across groups. Using the population standard, 77% of FGR cases were diagnosed among female fetuses even though morbidity among females was lower (p < 0.001). The customized model diagnosed FGR at similar rates in male and female fetuses. CONCLUSION: At 22 to 29 weeks' gestation, EFW percentile alone poorly predicts perinatal morbidity whether using customized or population fetal growth standards. The population standard diagnoses FGR at increased rates in subgroups not at increased risk of morbidity and at lower rates in subgroups at increased risk of morbidity, whereas the customized standard does not. Thieme. All rights reserved.
OBJECTIVE: The aim of study is to compare the performance of ultrasonographic customized and population fetal growth standards for prediction adverse perinatal outcomes. STUDY DESIGN: This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be, in which l data were collected at visits throughout pregnancy and after delivery. Percentiles were assigned to estimated fetal weights (EFWs) measured at 22 to 29 weeks using the Hadlock population standard and a customized standard (www.gestation.net). Areas under the curve were compared for the prediction of composite and severe composite perinatal morbidity using EFW percentile. RESULTS: Among 8,701 eligible study participants, the population standard diagnosed more fetuses with fetal growth restriction (FGR) than the customized standard (5.5 vs. 3.5%, p < 0.001). Neither standard performed better than chance to predict composite perinatal morbidity. Although the customized performed better than the population standard to predict severe perinatal morbidity (areas under the curve: 0.56 vs. 0.54, p = 0.003), both were poor. Fetuses considered FGR by the population standard but normal by the customized standard had morbidity rates similar to fetuses considered normally grown by both standards.The population standard diagnosed FGR among black women and Hispanic women at nearly double the rate it did among white women (p < 0.001 for both comparisons), even though morbidity was not different across racial/ethnic groups. The customized standard diagnosed FGR at similar rates across groups. Using the population standard, 77% of FGR cases were diagnosed among female fetuses even though morbidity among females was lower (p < 0.001). The customized model diagnosed FGR at similar rates in male and female fetuses. CONCLUSION: At 22 to 29 weeks' gestation, EFW percentile alone poorly predicts perinatal morbidity whether using customized or population fetal growth standards. The population standard diagnoses FGR at increased rates in subgroups not at increased risk of morbidity and at lower rates in subgroups at increased risk of morbidity, whereas the customized standard does not. Thieme. All rights reserved.
Authors: David M Haas; Corette B Parker; Deborah A Wing; Samuel Parry; William A Grobman; Brian M Mercer; Hyagriv N Simhan; Matthew K Hoffman; Robert M Silver; Pathik Wadhwa; Jay D Iams; Matthew A Koch; Steve N Caritis; Ronald J Wapner; M Sean Esplin; Michal A Elovitz; Tatiana Foroud; Alan M Peaceman; George R Saade; Marian Willinger; Uma M Reddy Journal: Am J Obstet Gynecol Date: 2015-01-31 Impact factor: 8.661
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Authors: Nathan R Blue; Lisa Mele; William A Grobman; Jennifer L Bailit; Ronald J Wapner; John M Thorp; Steve N Caritis; Mona Prasad; Alan T N Tita; George R Saade; Dwight J Rouse; Sean C Blackwell Journal: Am J Obstet Gynecol MFM Date: 2022-02-18