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Fetal growth velocity standards from the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project.

Ohuma, EO; Villar, J; Feng, Y; Xiao, L; Salomon, L; Barros, FC; Cheikh Ismail, L; Stones, W; Jaffer, Y; Oberto, M; et al. Ohuma, EO; Villar, J; Feng, Y; Xiao, L; Salomon, L; Barros, FC; Cheikh Ismail, L; Stones, W; Jaffer, Y; Oberto, M; Noble, JA; Gravett, MG; Wu, Q; Victora, CG; Lambert, A; Di Nicola, P; Purwar, M; Bhutta, ZA; Kennedy, SH; Papageorghiou, AT; International Fetal and Newborn Growth Consortium for the 21st C (2021) Fetal growth velocity standards from the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. Am J Obstet Gynecol, 224 (2). 208.e1-208.e18. ISSN 1097-6868 https://doi.org/10.1016/j.ajog.2020.07.054
SGUL Authors: Papageorghiou, Aris

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Abstract

BACKGROUND: Human growth is susceptible to damage from insults, particularly during periods of rapid growth. Identifying those periods and the normative limits that are compatible with adequate growth and development are the first key steps toward preventing impaired growth. OBJECTIVE: This study aimed to construct international fetal growth velocity increment and conditional velocity standards from 14 to 40 weeks' gestation based on the same cohort that contributed to the INTERGROWTH-21st Fetal Growth Standards. STUDY DESIGN: This study was a prospective, longitudinal study of 4321 low-risk pregnancies from 8 geographically diverse populations in the INTERGROWTH-21st Project with rigorous standardization of all study procedures, equipment, and measurements that were performed by trained ultrasonographers. Gestational age was accurately determined clinically and confirmed by ultrasound measurement of crown-rump length at <14 weeks' gestation. Thereafter, the ultrasonographers, who were masked to the values, measured the fetal head circumference, biparietal diameter, occipitofrontal diameter, abdominal circumference, and femur length in triplicate every 5 weeks (within 1 week either side) using identical ultrasound equipment at each site (4-7 scans per pregnancy). Velocity increments across a range of intervals between measures were modeled using fractional polynomial regression. RESULTS: Peak velocity was observed at a similar gestational age: 16 and 17 weeks' gestation for head circumference (12.2 mm/wk), and 16 weeks' gestation for abdominal circumference (11.8 mm/wk) and femur length (3.2 mm/wk). However, velocity growth slowed down rapidly for head circumference, biparietal diameter, occipitofrontal diameter, and femur length, with an almost linear reduction toward term that was more marked for femur length. Conversely, abdominal circumference velocity remained relatively steady throughout pregnancy. The change in velocity with gestational age was more evident for head circumference, biparietal diameter, occipitofrontal diameter, and femur length than for abdominal circumference when the change was expressed as a percentage of fetal size at 40 weeks' gestation. We have also shown how to obtain accurate conditional fetal velocity based on our previous methodological work. CONCLUSION: The fetal skeleton and abdomen have different velocity growth patterns during intrauterine life. Accordingly, we have produced international Fetal Growth Velocity Increment Standards to complement the INTERGROWTH-21st Fetal Growth Standards so as to monitor fetal well-being comprehensively worldwide. Fetal growth velocity curves may be valuable if one wants to study the pathophysiology of fetal growth. We provide an application that can be used easily in clinical practice to evaluate changes in fetal size as conditional velocity for a more refined assessment of fetal growth than is possible at present (https://lxiao5.shinyapps.io/fetal_growth/). The application is freely available with the other INTERGROWTH-21st tools at https://intergrowth21.tghn.org/standards-tools/.

Item Type: Article
Additional Information: © 2020 The Authors. Published by Elsevier Inc. This is anopen access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Keywords: correlation models, fetal growth, fetal growth velocity, fetal velocity standards, longitudinal study, International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st Project), 1114 Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE )
Journal or Publication Title: Am J Obstet Gynecol
ISSN: 1097-6868
Language: eng
Dates:
DateEvent
February 2021Published
5 August 2020Published Online
29 July 2020Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 32768431
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/112271
Publisher's version: https://doi.org/10.1016/j.ajog.2020.07.054

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