Value of a single early third trimester fetal biometry for the prediction of birth weight deviations in a low risk population
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Paul A.O.M. De Reu
Abstract
Objective: To analyze the value of a single ultrasound biometry examination at the onset of the third trimester of pregnancy for the detection of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) at birth in a low risk population. The aim of this study was to develop a simple and useful method for the detection of growth deviations during pregnancy in primary care (midwife or general practitioner) practices.
Setting: A Dutch primary care midwifery practice.
Study design: In an earlier study, we developed parity and sex specific fetal growth charts of abdominal circumference (AC) and head circumference (HC) on the basis of ultrasound data of a low-risk midwifery population in the Netherlands. In the present study, we calculated sensitivity, specificity and predictive values at different cut-off points of AC and HC for the prediction of growth deviations at birth. Patients booked for perinatal care between 1 January 1993 and 31 December 2003 (n=3449) were used for the identification of cut-off points (derivation cohort) and those admitted between 1 January 2004 and 31 December 2005 (n=725) were used to evaluate the performance of these cut-offs in an independent population (validation cohort). For the determination of SGA and macrosomia at birth, we used the recently published Dutch birth weight percentiles.
Results: Most promising cut-offs were AC ≤25th percentile for the prediction of SGA (birth weight ≤10th percentile) and AC ≥75th percentile for the prediction of macrosomia (birth weight ≥90th percentile). Within the validation cohort these cut-offs performed slightly better than in the derivation cohort. For the prediction of SGA, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 53% (95% CI 49–58%), 81% (95% CI 80–83%), 26% (95% CI 23–29%), and 93% (95% CI 93–94%), respectively. The false positive rate was 74%. For the prediction of macrosomia, the values of these parameters were 64% (95% CI 59–69%), 80% (95% CI 78–81%), 23% (95% CI 20–26%), and 96% (95% CI 95–97%), respectively. Here, false positive rate was 77%. No cut-offs were found that predicted extreme birth weight deviations (≤2.3 percentile; ≥97.7 percentile) sufficiently well.
Conclusions: In a low risk population, we could predict future growth deviations with a higher sensitivity and in a significant earlier stage (at the onset of the third trimester of pregnancy) than with the use of conventional screening methods (i.e., palpation of the uterus only and fundus-symphysis measurement). Sonographic measurement of fetal abdominal circumference enables to detect more than half of cases of SGA at birth and more than two-thirds of cases of macrosomia with acceptable false-positive rates. We suggest that fetuses with biometry results below the 25th percentile or above the 75th percentile at the onset of the third trimester of pregnancy should be more intensively investigated in order to distinguish between pathology (e.g., IUGR or macrosomia) and physiology and to decide about the appropriate level of further perinatal care.
©2008 by Walter de Gruyter Berlin New York
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- Evidence supporting proteolytic cleavage of insulin-like growth factor binding protein-1 (IGFBP-1) protein in amniotic fluid
- Original articles – Fetus
- Value of a single early third trimester fetal biometry for the prediction of birth weight deviations in a low risk population
- Comparison of six sonographic signs in the prenatal diagnosis of spina bifida
- Original articles – Newborn
- Relationships between umbilical cord arterial blood pH levels at delivery and Bayley Psychomotor Development Index scores in early childhood
- Head circumference and long-term outcome in small-for-gestational age infants
- Hypocalcemia is common in the first 48 h of life in ELBW infants
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- Letter to the editor
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- Obituary Gösta Rooth
- The death of Prof. Gösta Rooth
- Erratum
- Hematological profile of Korean very low birth weight infants
- Congress Calander
- Congress Calendar
- Announcement
- Announcement
Articles in the same Issue
- Editorial
- Does globalization and change demand a different kind of perinatal research?
- Recommendations and guidelines for perinatal practice
- Intrauterine restriction (IUGR)
- Review article
- The role of antioxidant vitamins in hypertensive disorders of pregnancy
- Original articles – Obstetrics
- The fetus, not the mother, elicits maternal immunologic rejection: lessons from discordant dizygotic twin placentas
- Do risk factors for elective cesarean section differ from those of cesarean section during labor in low risk pregnancies?
- Obstetric antecedents for preterm delivery
- Post-delivery oxidative stress in women with preeclampsia or IUGR
- Evidence supporting proteolytic cleavage of insulin-like growth factor binding protein-1 (IGFBP-1) protein in amniotic fluid
- Original articles – Fetus
- Value of a single early third trimester fetal biometry for the prediction of birth weight deviations in a low risk population
- Comparison of six sonographic signs in the prenatal diagnosis of spina bifida
- Original articles – Newborn
- Relationships between umbilical cord arterial blood pH levels at delivery and Bayley Psychomotor Development Index scores in early childhood
- Head circumference and long-term outcome in small-for-gestational age infants
- Hypocalcemia is common in the first 48 h of life in ELBW infants
- Total body water in small- and appropriate- for gestational age newborns
- Below median birth weight in appropriate-for-gestational-age preterm infants as a risk factor for bronchopulmonary dysplasia
- Letter to the editor
- Congenital lupus erythematosus affecting both twins
- Obituary Gösta Rooth
- The death of Prof. Gösta Rooth
- Erratum
- Hematological profile of Korean very low birth weight infants
- Congress Calander
- Congress Calendar
- Announcement
- Announcement
