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. 2021 Jul 15:8:100167.
doi: 10.1016/j.lanepe.2021.100167. eCollection 2021 Sep.

International versus national growth charts for identifying small and large-for-gestational age newborns: A population-based study in 15 European countries

Alice Hocquette  1 , Mélanie Durox  1 , Rachael Wood  2 , Kari Klungsøyr  3 , Katarzyna Szamotulska  4 , Sylvan Berrut  5 , Tonia Rihs  5 , Theopisti Kyprianou  6 , Luule Sakkeus  7 , Aline Lecomte  8 , Irisa Zile  9 , Sophie Alexander  10 , Jeannette Klimont  11 , Henrique Barros  12 , Miriam Gatt  13 , Jelena Isakova  14 , Béatrice Blondel  1 , Mika Gissler  15 , Jennifer Zeitlin  1
Affiliations

International versus national growth charts for identifying small and large-for-gestational age newborns: A population-based study in 15 European countries

Alice Hocquette et al. Lancet Reg Health Eur. .

Abstract

Background: To inform the on-going debate about the use of universal prescriptive versus national intrauterine growth charts, we compared perinatal mortality for small and large-for-gestational-age (SGA/LGA) infants according to international and national charts in Europe.

Methods: We classified singleton births from 33 to 42 weeks of gestation in 2010 and 2014 from 15 countries (N = 1,475,457) as SGA (birthweight <10th percentile) and LGA (>90th percentile) using the international Intergrowth-21st newborn standards and national charts based on the customised charts methodology. We computed sex-adjusted odds ratios (aOR) for stillbirth, neonatal and extended perinatal mortality by this classification using multilevel models.

Findings: SGA and LGA prevalence using national charts were near 10% in all countries, but varied according to international charts with a north to south gradient (3.0% to 10.1% and 24.9% to 8.0%, respectively). Compared with appropriate for gestational age (AGA) infants by both charts, risk of perinatal mortality was increased for SGA by both charts (aOR[95% confidence interval (CI)]=6.1 [5.6-6.7]) and infants reclassified by international charts from SGA to AGA (2.7 [2.3-3.1]), but decreased for those reclassified from AGA to LGA (0.6 [0.4-0.7]). Results were similar for stillbirth and neonatal death.

Interpretation: Using international instead of national charts in Europe could lead to growth restricted infants being reclassified as having normal growth, while infants with low risks of mortality could be reclassified as having excessive growth.

Funding: InfAct Joint Action, CHAFEA Grant n°801,553 and EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking ConcePTION grant n°821,520. AH received a PhD grant from EHESP.

Keywords: fetal growth; fetal growth charts; large for gestational age; small for gestational age.

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Conflict of interest statement

No conflict of interest to disclose.

Figures

Fig. 1a
Fig. 1a
Difference in prevalence of SGA between international and national birthweight charts This map shows the geographic pattern of differences in SGA prevalence depending on the use of international compared to national birthweight charts, with the lightest blue color denoting countries where differences between the charts are most pronounced. Differences are largest in the north of Europe where international charts give lower SGA prevalence than the national charts.
Fig. 1b
Fig. 1b
Difference in prevalence of LGA between international and national birthweight charts This map shows the geographic pattern of differences in LGA prevalence depending on use of international compared to national birthweight charts, with the lightest blue color denoting countries where the differences between the charts are most pronounced. Differences are largest in the north of Europe, where international charts give higher LGA prevalence than the national charts.
See this image and copyright information in PMC

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