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Comparative Study
. 2022 Feb 19;22(1):136.
doi: 10.1186/s12884-022-04450-3.

INTERGROWTH-21st versus a customized method for the prediction of neonatal nutritional status in hypertensive disorders of pregnancy

Juan Jesús Fernández-Alba #  1   2 , Maria Castillo Lara #  3 , Raquel Sánchez Mera  1 , Sara Aragón Baizán  1 , Carmen González Macías  1 , Rocio Quintero Prado  1 , Angel Vilar Sánchez  1 , Jose Manuel Jimenez Heras  2 , Luis Javier Moreno Corral  4 , Francesc Figueras  5
Affiliations
Comparative Study

INTERGROWTH-21st versus a customized method for the prediction of neonatal nutritional status in hypertensive disorders of pregnancy

Juan Jesús Fernández-Alba et al. BMC Pregnancy Childbirth. .

Abstract

Background: Hypertensive disorders of pregnancy (HDP) generate complications and are one of the principal causes of maternal, foetal, and neonatal mortality worldwide. It has been observed that in pregnancies with HDP, the incidence of foetuses small for their gestational age (SGA) is twice as high as that in noncomplicated pregnancies. In women with HDP, the identification of foetuses (SGA) is substantially important, as management and follow-up are determined by this information.

Objective: The objective of this study was to evaluate whether the INTERGROWTH-21st method or customized birthweight references better identify newborns with an abnormal nutritional status resulting from HDP.

Method: A comparative analysis study was designed with two diagnostic methods for the prediction of neonatal nutritional status in pregnancies with HDP. The performance of both methods in identifying neonatal malnutrition (defined by a neonatal body mass index < 10th centile or a ponderal index < 10th centile) was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratio, Youden's index and probability ratios.

Results: The study included 226 pregnant women diagnosed with HDP. The customized method identified 45 foetuses as small for gestational age (19.9%), while the INTERGROWTH-21st method identified 27 newborns with SGA (11.9%). The difference between proportions was statistically significant (p < 0.01). Using body mass index (< 10th centile) as a measure of nutritional status, newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH-21st (RR: 4.87 (95% CI: 1.86-12.77) vs. 3.75 (95% CI: 1.49-9.43)) (DOR: 5.56 (95% CI: 1.82-16.98) vs. 4.84 (95% CI: 1.51-15.54)) Even when using Ponderal index (< 10th centile), newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH-21st (RR 2.37 (95% CI: 1.11-5.05) vs. 1.68 (95% CI: 0.70-4.03))(DOR 2.62 (95% CI: 1.00-6.87) vs. 1.90 (95% CI: 0.61-5.92)).

Conclusion: In pregnant women with HDP, the predictive ability of the customized foetal growth curves to identify neonatal malnutrition appears to surpass that of INTERGROWTH-21st.

Keywords: Foetal growth; Foetal malnutrition; Gestational hypertension; Hypertensive disorders of pregnancy; Small for gestational age (SGA).

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Venn diagram showing the RRs of being classified as SGA by the customized, INTERGROWTH-21st or both methods
Fig. 2
Fig. 2
The diagnostic odds ratio (DOR) of INTERGROWTH-21st and the customized method in the prediction of neonatal malnutrition using PI and BMI < 10th centile as references
See this image and copyright information in PMC

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