Identification of the optimal growth charts for use in a preterm population: An Australian state-wide retrospective cohort study

Autoři: Natasha L. Pritchard aff001;  Richard J. Hiscock aff001;  Elizabeth Lockie aff001;  Michael Permezel aff001;  Monica F. G. McGauren aff002;  Amber L. Kennedy aff001;  Brittany Green aff001;  Susan P. Walker aff001;  Anthea C. Lindquist aff001
Působiště autorů: Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia aff001;  Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia aff002;  Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia aff003
Vyšlo v časopise: Identification of the optimal growth charts for use in a preterm population: An Australian state-wide retrospective cohort study. PLoS Med 16(10): e32767. doi:10.1371/journal.pmed.1002923
Kategorie: Research Article
doi: 10.1371/journal.pmed.1002923



Preterm infants are a group at high risk of having experienced placental insufficiency. It is unclear which growth charts perform best in identifying infants at increased risk of stillbirth and other adverse perinatal outcomes. We compared 2 birthweight charts (population centiles and INTERGROWTH-21st birthweight centiles) and 3 fetal growth charts (INTERGROWTH-21st fetal growth charts, World Health Organization fetal growth charts, and Gestation Related Optimal Weight [GROW] customised growth charts) to identify which chart performed best in identifying infants at increased risk of adverse perinatal outcome in a preterm population.

Methods and findings

We conducted a retrospective cohort study of all preterm infants born at 24.0 to 36.9 weeks gestation in Victoria, Australia, from 2005 to 2015 (28,968 records available for analysis). All above growth charts were applied to the population. Proportions classified as <5th centile and <10th centile by each chart were compared, as were proportions of stillborn infants considered small for gestational age (SGA, <10th centile) by each chart. We then compared the relative performance of non-overlapping SGA cohorts by each chart to our low-risk reference population (infants born appropriate size for gestational age [>10th and <90th centile] by all intrauterine charts [AGAall]) for the following perinatal outcomes: stillbirth, perinatal mortality (stillbirth or neonatal death), Apgar <4 or <7 at 5 minutes, neonatal intensive care unit admissions, suspicion of poor fetal growth leading to expedited delivery, and cesarean section. All intrauterine charts classified a greater proportion of infants as <5th or <10th centile than birthweight charts. The magnitude of the difference between birthweight and fetal charts was greater at more preterm gestations. Of the fetal charts, GROW customised charts classified the greatest number of infants as SGA (22.3%) and the greatest number of stillborn infants as SGA (57%). INTERGROWTH classified almost no additional infants as SGA that were not already considered SGA on GROW or WHO charts; however, those infants classified as SGA by INTERGROWTH had the greatest risk of both stillbirth and total perinatal mortality. GROW customised charts classified a larger proportion of infants as SGA, and these infants were still at increased risk of mortality and adverse perinatal outcomes compared to the AGAall population. Consistent with similar studies in this field, our study was limited in comparing growth charts by the degree of overlap, with many infants classified as SGA by multiple charts. We attempted to overcome this by examining and comparing sub-populations classified as SGA by only 1 growth chart.


In this study, fetal charts classified greater proportions of preterm and stillborn infants as SGA, which more accurately reflected true fetal growth restriction. Of the intrauterine charts, INTERGROWTH classified the smallest number of preterm infants as SGA, although it identified a particularly high-risk cohort, and GROW customised charts classified the greatest number at increased risk of perinatal mortality.

Klíčová slova:

Ethnicities – Charts – Infants – Labor and delivery – Morbidity – Neonatal care – Neonates – Stillbirths


1. Miller SL, Huppi PS, Mallard C. The consequences of fetal growth restriction on brain structure and neurodevelopmental outcome. J Physiol. 2016;594(4):807–23. doi: 10.1113/JP271402 26607046

2. Chan PYL, Morris JM, Leslie GI, Kelly PJ, Gallery EDM. The long-term effects of prematurity and intrauterine growth restriction on cardiovascular, renal, and metabolic function. Int J Pediatr. 2010;2010:280402. doi: 10.1155/2010/280402 21197428

3. Kady SM, Gardosi J. Perinatal mortality and fetal growth restriction. Best Pract Res Clin Obstet Gynaecol. 2004;18(3):397–410. doi: 10.1016/j.bpobgyn.2004.02.009 15183135

4. Garite TJ, Clark R, Thorp JA. Intrauterine growth restriction increases morbidity and mortality among premature neonates. Am J Obstet Gynecol. 2004;191(2):481–7. doi: 10.1016/j.ajog.2004.01.036 15343225

5. Goldenberg RL, Culhane JF, Iams JD, Romero R. Preterm birth 1: epidemiology and causes of preterm birth. Lancet. 2008;371(9606):75–84. doi: 10.1016/S0140-6736(08)60074-4 18177778

6. Saigal S, Doyle LW. Preterm birth 3: an overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet. 2008;371(9608):261–9. doi: 10.1016/S0140-6736(08)60136-1 18207020

7. Harding JE, Derraik JGB, Berry MJ, Jaquiery AL, Alsweiler JM, Cormack BE, et al. Optimum feeding and growth in preterm neonates. J Dev Orig Health Dis. 2013;4(3):215–22. doi: 10.1017/S2040174412000736 25054840

8. Matinolli HM, Hovi P, Levalahti E, Kaserva N, Silveira PP, Hemio K, et al. Neonatal nutrition predicts energy balance in young adults born preterm at very low birth weight. Nutrients. 2017;9(12):E1282. doi: 10.3390/nu9121282 29186804

9. Yeung MY. Postnatal growth, neurodevelopment and altered adiposity after preterm birth—from a clinical nutrition perspective. Acta Paediatr. 2007;95(8):909–17. doi: 10.1080/08035250600724507 16882561

10. Roggero P, Gianni ML, Liotto N, Taroni F, Morniroli D, Mosca F. Small for gestational age preterm infants: nutritional strategies and quality of growth after discharge. J Matern Fetal Neonatal Med. 2011;24(Suppl 1):144–6. doi: 10.3109/14767058.2011.607657 21888510

11. Bukowski R, Gahn D, Denning J, Saade G. Impairment of growth in fetuses destined to deliver preterm. Am J Obstet Gynecol. 2001;185(2):463–7. doi: 10.1067/mob.2001.115865 11518910

12. Zeitlin J, Ancel PY, Saurel-Cubizolles MJ, Papiernik E. The relationship between intrauterine growth restriction and preterm delivery: an empirical approach using data from a European case-control study. BJOG. 2005;107(6):750–8. doi: 10.1111/j.1471-0528.2000.tb13336.x

13. Burkhardt T, Schäffer L, Zimmermann R, Kurmanavicius J. Newborn weight charts underestimate the incidence of low birthweight in preterm infants. Am J Obstet Gynecol. 2008;199(2):139.e1–6. doi: 10.1016/j.ajog.2008.01.011 18395687

14. Chauhan SP, Beydoun H, Chang E, Sandlin AT, Dahlke JD, Igwe E, et al. Prenatal detection of fetal growth restriction in newborns classified as small for gestational age: correlates and risk of neonatal morbidity. Am J Perinatol. 2014;31(3):187–94. doi: 10.1055/s-0033-1343771 23592315

15. Kabiri D, Romero R, Gudicha DW, Hernandez-Andrade E, Pacora P, Benshalom–Tirosh N, et al. Prediction of adverse perinatal outcomes by fetal biometry: a comparison of customized and population-based standards. Ultrasound Obstet Gynecol. 2019 Apr 22. doi: 10.1002/uog.20299 31006913

16. Zaw W, Gagnon R, da Silva O. The risks of adverse neonatal outcome among preterm small for gestational age infants according to neonatal versus fetal growth standards. Pediatrics. 2003;111(6 Pt 1):1273–7.

17. Villar J, Cheikh Ismail L, Staines Urias E, Giuliani F, Ohuma EO, Victora CG, et al. The satisfactory growth and development at 2 years of age of the INTERGROWTH-21(st) Fetal Growth Standards cohort support its appropriateness for constructing international standards. Am J Obstet Gynecol. 2018;218(2s):S841–54.e2. doi: 10.1016/j.ajog.2017.11.564 29273309

18. Kiserud T, Piaggio G, Carroli G, Widmer M, Carvalho J, Neerup Jensen L, et al. The World Health Organization fetal growth charts: a multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight. PLoS Med. 2017;14(1):e1002220. doi: 10.1371/journal.pmed.1002220 28118360

19. Gardosi J, Clausson B, Francis A. The value of customised centiles in assessing perinatal mortality risk associated with parity and maternal size. BJOG: an international journal of obstetrics and gynaecology. 2009;116(10):1356–63. doi: 10.1111/j.1471-0528.2009.02245.x 19538413

20. Gardosi J, Figueras F, Clausson B, Francis A. The customised growth potential: an international research tool to study the epidemiology of fetal growth. Paediatr Perinat Epidemiol. 2011;25(1):2–10. doi: 10.1111/j.1365-3016.2010.01166.x 21133964

21. Mongelli M, Figueras F, Francis A, Gardosi J. A customized birthweight centile calculator developed for an Australian population. Aust N Z J Obst Gynaecol. 2007;47(2):128–31. doi: 10.1111/j.1479-828X.2007.00698.x 17355302

22. Gardosi J, Francis A. Adverse pregnancy outcome and association with small for gestational age birthweight by customized and population-based percentiles. Am J Obstet Gynecol. 2009;201(1):28.e1–8. doi: 10.1016/j.ajog.2009.04.034 19576372

23. Lockie E, McCarthy EA, Hui L, Churilov L, Walker SP. Feasibility of using self-reported ethnicity in pregnancy according to the gestation-related optimal weight classification: a cross-sectional study. BJOG. 2018;125(6):704–9. doi: 10.1111/1471-0528.14825 28708265

24. Dobbins TA, Sullivan EA, Roberts CL, Simpson JM. Australian national birthweight percentiles by sex and gestational age, 1998–2007. Med J Aust. 2012;197(5):291–4. doi: 10.5694/mja11.11331 22938128

25. Villar J, Ismail LC, Victora CG, Ohuma EO, Bertino E, Altman DG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014;384(9946):857–68. doi: 10.1016/S0140-6736(14)60932-6 25209487

26. Villar J, Giuliani F, Fenton TR, Ohuma EO, Ismail LC, Kennedy SH. INTERGROWTH-21st very preterm size at birth reference charts. Lancet. 2016;387(10021):844–5. doi: 10.1016/S0140-6736(16)00384-6 26898853

27. Stirnemann J, Villar J, Salomon LJ, Ohuma E, Ruyan P, Altman DG, et al. International estimated fetal weight standards of the INTERGROWTH-21(st) Project. Ultrasound Obstet Gynecol. 2017;49(4):478–86. doi: 10.1002/uog.17347 27804212

28. Gardosi J, Mul T, Mongelli M, Fagan D. Analysis of birthweight and gestational age in anteparturn stillbirths. BJOG. 1998;105(5):524–30. doi: 10.1111/j.1471-0528.1998.tb10153.x 9637122

29. Boghossian NS, Geraci M, Edwards EM, Horbar JD. Neonatal and fetal growth charts to identify preterm infants <30 weeks gestation at risk of adverse outcomes. Am J Obstet Gynecol. 2018;219(2):195.e1–14. doi: 10.1016/j.ajog.2018.05.002 29750954

30. Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. BMJ. 2013;346:f108. doi: 10.1136/bmj.f108 23349424

31. Yao R, Ananth CV, Park BY, Pereira L, Plante LA. Obesity and the risk of stillbirth: a population-based cohort study. Am J Obstet Gynecol. 2014;210(5):457.e1–9. doi: 10.1016/j.ajog.2014.01.044 24674712

32. Yao R, Park BY, Caughey AB. The effects of maternal obesity on perinatal outcomes among those born small for gestational age. J Matern Fetal Neonatal Med. 2017;30(12):1417–22. doi: 10.1080/14767058.2016.1216098 27450769

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PLOS Medicine

2019 Číslo 10

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