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Impact of Selection of Growth Chart in the Diagnosis of Suboptimal Fetal Growth and Neonatal Birthweight and Correlation with Adverse Neonatal Outcomes in a Third Trimester South Indian Antenatal Cohort; A Prospective Cross-Sectional Study

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Journal of Fetal Medicine

Abstract

Objectives: To compare fetal and neonatal growth charts pertaining to different models (population-specific, universal reference, universal standard and fully customised) in detecting suboptimal fetal growth in the third trimester. Methods: This was a prospective observational study conducted at two fetal medicine centers. After applying the inclusion criteria [singleton pregnancies between 28 and 40 weeks, verified dates and estimated fetal weight (EFW) ≤ 25th centile as per the Hadlock chart], 292 women were consecutively recruited. Four fetal growth charts (Hadlock, Intergrowth, fully customised GROW, Sonocare) and three neonatal charts (Fenton, Intergrowth and fully customised GROW) were used in the study. The EFW and birthweight centiles were categorized into three groups: < 3.0, 3.1–10th and > 10th centiles. The charts were evaluated by their ability to detect pregnancies with uteroplacental insufficiency and/or development of adverse neonatal outcomes in the third trimester. Results: Significant difference was noted between the fetuses/neonates assigned as < 3rd centile (Hadlock-9.3%, Sonocare-4.8%, Intergrowth- 6.8% and the fully customised GROW- 6.5%) and the neonatal charts (Fenton-18.5%, Intergrowth- 20.2% and fully customised GROW- 13.4%). At a cut-off of 3rd centile, the GROW chart had the highest sensitivity (84.2%) followed by Intergrowth (78.9%), Hadlock (70.37%) and Sonocare (64.29%). Similarly, for a cut-off of < 10th, the sensitivity was GROW 70.27%, Sonocare 64%, Intergrowth 60.8% and Hadlock 50%. Amongst the neonatal charts, fully customised GROW chart had the greatest detection rate (< 3rd = 74.36%, < 10th = 70.27%). However, there was no significant difference between the charts in the detection of pregnancies with suboptimal fetal growth associated with uteroplacental insufficiency and/or adverse neonatal outcomes. Conclusion: Despite substantial discrepancy between the growth charts in diagnosing fetal smallness, adding multivessel Doppler negates significant differences between them in diagnosing suboptimal fetal growth associated with uteroplacental insufficiency and adverse neonatal outcomes.

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Authors and Affiliations

  1. Consultant in Maternal-Fetal Medicine, ARMC AEGIS hospital, Bypass road, Perinthalmana, Malappuram, Kerala, 679322, India

    Seneesh Kumar Vikraman & Aditi Dubey

  2. Fetal Medicine, Consultant in Maternal-Fetal Medicine, Nahas Hospital, Malappuram, Kerala, India

    Rinshi Abid Elayedatt

  3. Fellow in Fetal Medicine, ARMC AEGIS hospital, Perinthalmana, Kerala, India

    Aditi Dubey

  4. Fetal Medicine, ARMC, Salem, Tamil Nadu, India

    Nithya Elango

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  1. Seneesh Kumar Vikraman
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Correspondence to Seneesh Kumar Vikraman.

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Vikraman, S.K., Elayedatt, R.A., Dubey, A. et al. Impact of Selection of Growth Chart in the Diagnosis of Suboptimal Fetal Growth and Neonatal Birthweight and Correlation with Adverse Neonatal Outcomes in a Third Trimester South Indian Antenatal Cohort; A Prospective Cross-Sectional Study. J. Fetal Med. 8, 177–184 (2021). https://doi.org/10.1007/s40556-021-00312-8

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