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Randomized Controlled Trial
. 2013 Apr;30(4):335-41.
doi: 10.1055/s-0032-1324708. Epub 2012 Aug 14.

Population versus customized fetal growth norms and adverse outcomes in an intrapartum cohort

Maged M Costantine  1 , Yinglei Lai, Steven L Bloom, Catherine Y Spong, Michael W Varner, Dwight J Rouse, Susan M Ramin, Steve N Caritis, Alan M Peaceman, Yoram Sorokin, Anthony Sciscione, Brian M Mercer, John M Thorp, Fergal D Malone, Margaret Harper, Jay D Iams; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Collaborators, Affiliations
Randomized Controlled Trial

Population versus customized fetal growth norms and adverse outcomes in an intrapartum cohort

Maged M Costantine et al. Am J Perinatol. 2013 Apr.

Abstract

Objective: To compare population versus customized fetal growth norms in identifying neonates at risk for adverse outcomes (APO) associated with small for gestational age (SGA).

Study design: Secondary analysis of an intrapartum fetal pulse oximetry trial in nulliparous women at term. Birth weight percentiles were calculated using ethnicity- and gender-specific population norms and customized norms (Gardosi).

Results: Of the studied neonates, 508 (9.9%) and 584 (11.3%) were SGA by population (SGApop) and customized (SGAcust) norms, respectively. SGApop infants were significantly associated with a composite adverse neonatal outcome, neonatal intensive care admission, low fetal oxygen saturation, and reduced risk of cesarean delivery; both SGApop and SGAcust infants were associated with a 5-minute Apgar score < 4. The ability of customized and population birth weight percentiles in predicting APO was poor (12 of 14 APOs had area under the curve of <0.6).

Conclusion: In this intrapartum cohort, neither customized nor normalized population norms adequately identified neonates at risk of APO related to SGA.

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Conflict of interest statement

Disclosure: None of the authors have a conflict of interest

Figures

Figure 1
Figure 1
distribution of neonates classified as small for gestational age (SGA) by the population (SGApop, n=508) and the customized methods (SGAcust, n=584). The diagram also shows the subgroups that are SGA by both methods (n=397) and SGA by population or customized norms only (SGApop only, n=111 and SGAcust only, n=187)
Figure 2
Figure 2
Odds and incidence of adverse perinatal and neonatal outcomes in SGA neonates by population or customized norms categories compared with those not SGA.
See this image and copyright information in PMC

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