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. 2019 Aug 30;38(19):3527-3539.
doi: 10.1002/sim.8000. Epub 2018 Oct 23.

Design and other methodological considerations for the construction of human fetal and neonatal size and growth charts

Eric O Ohuma  1   2 , Douglas G Altman  2 ; International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st Project)
Affiliations

Design and other methodological considerations for the construction of human fetal and neonatal size and growth charts

Eric O Ohuma et al. Stat Med. .

Abstract

This paper discusses the features of study design and methodological considerations for constructing reference centile charts for attained size, growth, and velocity charts with a focus on human growth charts used during pregnancy. Recent systematic reviews of pregnancy dating, fetal size, and newborn size charts showed that many studies aimed at constructing charts are still conducted poorly. Important design features such as inclusion and exclusion criteria, ultrasound quality control measures, sample size determination, anthropometric evaluation, gestational age estimation, assessment of outliers, and chart presentation are seldom well addressed, considered, or reported. Many of these charts are in clinical use today and directly affect the identification of at-risk newborns that require treatment and nutritional strategies. This paper therefore reiterates some of the concepts previously identified as important for growth studies, focusing on considerations and concepts related to study design, sample size, and methodological considerations with an aim of obtaining valid reference or standard centile charts. We discuss some of the key issues and provide more details and practical examples based on our experiences from the INTERGROWTH-21st Project. We discuss the statistical methodology and analyses for cross-sectional studies and longitudinal studies in a separate article in this issue.

Keywords: design; fetal; growth charts; methodological considerations; neonatal.

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Conflict of interest statement

The authors declare that they have no competing interests.

EOO wrote the manuscript with contributions from DGA. DGA read and approved earlier versions of the manuscript.

EOO is a Senior Medical Statistician and DGA is a Professor of Statistics in Medicine.

Comment in

References

    1. Tanner JM. Foetus into Man: Physical Growth From Conception to Maturity. 2nd ed. Ware, UK: Castlemead Publications; 1989.
    1. Larsson A, Palm M, Hansson LO, Axelsson O. Reference values for clinical chemistry tests during normal pregnancy. BJOG Int J Obstet Gynaecol. 2008;115(7):874‐881. - PubMed
    1. Klajnbard A, Szecsi PB, Colov NP, et al. Laboratory reference intervals during pregnancy, delivery and the early postpartum period. Clin Chem Lab Med. 2010;48(2):237‐248. - PubMed
    1. Milman N, Bergholt T, Byg KE, Eriksen L, Hvas AM. Reference intervals for haematological variables during normal pregnancy and postpartum in 434 healthy Danish women. Eur J Haematol. 2007;79(1):39‐46. - PubMed
    1. Papageorghiou AT, Ohuma EO, Altman DG, et al. International standards for fetal growth based on serial ultrasound measurements: the fetal growth longitudinal study of the INTERGROWTH‐21st project. Lancet. 2014;384(9946):869‐879. - PubMed

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