Intrauterine Growth Standards

  • Mira A. Wehbe
  • Lama Charafeddine
  • Khalid A. Yunis
Chapter
First Online:

Abstract

Fetal growth assessment is essential in identifying the infants’ well-being. When discussing and defining intrauterine growth and intrauterine growth standards, one has to consider definitions of growth restriction. An intrauterine growth-restricted infant (IUGR) is defined as a fetus who fails to reach her growth potential. In published literature, different cutoff points for birth weight are used to define IUGR due to the absence of population-derived percentiles. The most commonly used birth weight cutoff point is the 10th percentile although small for gestational age infants are not necessarily growth restricted. In this chapter, we examined published population-based growth charts from different areas and populations. This close inspection highlights a significant difference between different populations and within the same population, in both developed and developing countries. Authors have used different methodologies to derive specific growth standards (including various calculations and ranges of gestational age, exclusion criteria, study design, and sample size). A high rate of false-positive and false-negative diagnosis of IUGR indicates the importance of adjusting for maternal, fetal, and placental factors affecting growth. A proposed adjustment method is the use of individualized customized growth charts. These charts take into account specific population characteristics and maternal factors in order to develop fetal growth potentials for each particular pregnancy. To conclude, further research is needed to identify a refined uniform definition for IUGR in order to increase our understanding of etiologies, contributing factors, and outcomes of infants with abnormal uterine growth.

Keywords

Birth Weight Fetal Growth Growth Chart Fetal Weight Last Menstrual Period 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

AC

Abdominal circumference

ACOG

American College of Obstetricians and Gynecologists

BPD

Biparietal diameter

DNA

Deoxyribo-nucleic acid

EDC

Expected date of confinement

EFW

Estimated fetal weight

EMR

East Mediterranean region

FL

Femur length

HC

Head circumference

IUGR

Intrauterine growth restriction

LGA

Large for gestational age

LMP

Last menstrual period

NCPNN

National Collaborative Perinatal Neonatal Network

SES

Socioeconomic status

SGA

Small for gestational age

UK

United Kingdom

US

Ultrasound

WHO

World Health Organization

This is a preview of subscription content, log in to check access.

References

  1. ACOG Practice Bulletin. Intrauterine growth restriction. Int J Gynecol Obstet. 2001;72:85–96.CrossRefGoogle Scholar
  2. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan, M. A United States National reference for fetal growth. Obstet Gynecol. 1996;87:163–8.PubMedCrossRefGoogle Scholar
  3. Alshimmiri MM, Al-Saleh EA, Alsaeid K, Hammoud MS, Al-Harmi JA. Birth weight percentiles by gestational age in Kuwait. Arch Gynecol Obstet. 2004;269:111–6.PubMedCrossRefGoogle Scholar
  4. Arbuckle TE, Wilkins R, Sherman GJ. Birth weight percentiles by gestational age in Canada. Obstet Gynecol. 1993;81:39–48.PubMedGoogle Scholar
  5. Babson SG, Benda GI. Growth graphs for the clinical assessment of infants of varying gestational age. J Pediatr. 1976;89:814–20.PubMedCrossRefGoogle Scholar
  6. Beckmann CRB, Barzansky BM, Herbert WNP, Ling FW, Laube DW. Chapter 18, Fetal growth abnormalities: Intrauterine growth restriction and macrosomia. In: Beckmann CRB, Barzansky BM, Herbert WNP, Ling FW, Laube DW, Smith RP, editors. Obstetrics and gynecology. Philadelphia, PA: Lippincott Williams & Wilkins; 2009. pp. 189–94.Google Scholar
  7. Brenner WE, Edelman DA, Hendricks CH. A standard of fetal growth for the United States of America. Am J Obstet Gynecol. 1976;126:555–64.PubMedGoogle Scholar
  8. Chang TC, Robson SC, Boys RJ, Spencer JAD. Prediction of the small for gestational age infant: which ultrasonic measurement is best? Obstet Gynecol. 1992;80:1030–8.PubMedGoogle Scholar
  9. Chervenak FA, Skupski DW, Romero R, Myers MK, Smith-Levitin M, Rosenwaks Z, Thaler H. How accurate is fetal biometry in the assessment of fetal age? Am J Obstet Gynecol. 1998;178:678–87.PubMedCrossRefGoogle Scholar
  10. Chia-chin L, Irvin E. A comparison of American and Chinese intrauterine growth standards. Are American babies really smaller? Am J Epidemiol. 1972;95:418–30.Google Scholar
  11. Clausson B, Gardosi J, Francis A, Cnattingius S. Perinatal outcome in SGA births defined customized versus population based birth weight standards. Int J Obstet Gynecol. 2001;108:830–4.Google Scholar
  12. De Jong C, Gardosi J, Dekker GA, Colenbrander GJ, Van Geijn HP. Application of a customized birth weight standard in the assessment of perinatal outcome in a high risk population. Br J Obstet Gynaecol. 1998;104:531–5.Google Scholar
  13. Deter RL. Individualized growth assessment: evaluation of growth using each fetus as its own control. Semin Perinatol. 2004;28:23–32.PubMedCrossRefGoogle Scholar
  14. Drumm JE, Clinch J, MacKenzie G. The ultrasonic measurement of fetal crown-rump length as a method of assessing gestational age. Br J Obstet Gynaecol. 1976;83:417–21.PubMedCrossRefGoogle Scholar
  15. Ego A, Subtil D, Grange G, Thiebaugeorges O, Senat MV, Vayssiere C, Zeitlin J. Customized versus population-based birth weight standards for identifying growth restricted infants: French multicenter study. Am J Obstet Gynecol. 2006;194:1042–9.PubMedCrossRefGoogle Scholar
  16. Fenton TR. A new growth chart for preterm babies: Babson and Benda’s chart updated with recent data and a new format. BMC Pediatr. 2003;3:13–23.PubMedCrossRefGoogle Scholar
  17. Figueras F, Meler E, Iraola A, Eixarch E, Coll O, Figueras J, Francis A, Gratacos E, Gardosi J. Customized birth weight standards for a Spanish population. Eur J Obstet Gynecol RB. 2008;136:20–4.CrossRefGoogle Scholar
  18. Fisher DA. Intrauterine growth retardation: endocrine and receptor aspects. Semin Perinatol. 1984;8:37–41.PubMedGoogle Scholar
  19. Gardosi J. Customized fetal growth standards: rationale and clinical application. Semin Perinatol. 2004;28:33–40.PubMedCrossRefGoogle Scholar
  20. Gardosi J, Francis A. A customized standard to assess fetal growth in a US population. Am J Obstet Gynecol. 2009;201:e1–7.Google Scholar
  21. Gardosi J, Chang A, Kalyan B, Sahota D, Symonds EM. Customised antenatal growth charts. Lancet. 1992;339:283–7.PubMedCrossRefGoogle Scholar
  22. Gardosi J, Mongelli M, Wilcox M, Chang A. An adjustable fetal weight standard. Ultrasound Obstet Gynecol. 1995;6:168–74.PubMedCrossRefGoogle Scholar
  23. GROW: Gestation Related Optimal Weight; Growth Charts. Available at: Gestation Network. http://www.gestation.net (2009). Accessed 5 Sept 2009.
  24. Harkness UF, Mari G. Diagnosis and management of intrauterine growth restriction. Clin Perinatol. 2004;31:743–64.PubMedCrossRefGoogle Scholar
  25. Hemming K, Hutton JL, Bonellie S. A comparison of customized and population-based birth-weight standards: the influence of gestational age. Eur J Obstet Gynecol RB. 2009;146:41–5.CrossRefGoogle Scholar
  26. Hosain GMM, Chatterjee N, Begum A, Saha SC. Factors associated with low birth-weight in rural Bangladesh. J Trop Pediatr. 2006;52:87–91.PubMedCrossRefGoogle Scholar
  27. Klebanoff MA, Schulsinger, C, Mednick BR, Secher NJ. Preterm and small-for-gestational-age birth across generations. Am J Obstet Gynecol. 1997;176:521–6.PubMedCrossRefGoogle Scholar
  28. Kliegman RM. Chapter 13 (III), Intrauterine growth restriction. In: Martin RI, Fanaroff AA, Walsh MC, editors. Fanaroff and Martin’s neonatal-perinatal medicine: diseases of the fetus and the infant. St. Louis, MO: Elsevier Mosby; 2006.Google Scholar
  29. Kramer MS, Platt RW, Wen SW, Joseph KS, Allen A, Abrahamowicz M, Blondel B, Breart G. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics. 2001;108:E35.PubMedCrossRefGoogle Scholar
  30. Lubchenco LO, Hansman C, Boyd E. Intrauterine growth as estimated from live-born birth-weight data at 24 to 42 weeks of gestation. Pediatrics. 1963;32:793–800.PubMedGoogle Scholar
  31. Mandruzzato G, Antsaklis A, Botet F, Chervenak FA, Figueras F, Grunebaum A, Puerto B, Skupski D, Milan S. Intrauterine Restriction (IUGR). J Perinat Med. 2008;36:277–81.PubMedCrossRefGoogle Scholar
  32. Martin A, Hamilton BE, Ventura SJ, Menacker F, Park MM. Births: final data for 2000. Natl Vital Stat Rep (CDC). 2002;50:1–104.Google Scholar
  33. McCowan L, Stewart AW, Francis A, Gardosi J. A customised birthweight centile calculator developed for a New Zealand population. Aust N Z J Obstet Gynaecol. 2004;44:428–31.PubMedCrossRefGoogle Scholar
  34. Mongelli M, Gardosi J. Reduction of false-positive diagnosis of fetal growth restriction by application of customized fetal growth standards. Obstet Gynecol. 1996;88:844–8.PubMedCrossRefGoogle Scholar
  35. Mongelli M, Figueras F, Francis A, Gardosi J. A customised birthweight centile calculator developed for an Australian population. Aust N Z J Obstet Gynaecol. 2007;47:128–31.PubMedCrossRefGoogle Scholar
  36. Olowe SA. Standards of intrauterine growth for an African population at sea level. J Pediatr. 1982;99:489–95.CrossRefGoogle Scholar
  37. Ott WJ. Intrauterine Growth Retardation and preterm delivery. Am J Obstet Gynecol. 1993;168:1710–17.PubMedGoogle Scholar
  38. Paul IM, Lehman EB, Suliman AK, Hillemeier MM. Perinatal disparities for black mothers and their newborns. Matern Child Health J. 2008;12:452–60.PubMedCrossRefGoogle Scholar
  39. Pearce JM, Campbell S. A comparison of symphysis-fundal height and ultrasound as screening tests for light-for-gestational age infants. Br J Obstet Gynaecol. 1987;94:100–4.PubMedCrossRefGoogle Scholar
  40. Resnik R. One size does not fit all. Am J Obstet Gynecol. 2007;197:221–2.PubMedCrossRefGoogle Scholar
  41. Royal College of Obstetricians and Gynaecologists. The investigation and management of the small-for-gestational age fetus. Royal College of Obstetricians and Gynaecologists Green Top Guideline 2002 (#31).Google Scholar
  42. Salihu H, Lynch O, Alio A, Mbah A, Kornosky J, Marty P. Extreme maternal underweight and feto-infant morbidity outcomes: a population-based study. J Matern Fetal Neonat Med. 2009;22:428–34.CrossRefGoogle Scholar
  43. Sanderson DA, Wilcox MA, Johnson IR. The individualized birthweight ratio: a new method of identifying intrauterine growth retardation. Br J Obstet Gynaecol. 1994;101:310–4.PubMedCrossRefGoogle Scholar
  44. Standard. In Merriam-Webster Online Dictionary. http://www.merriam-webster.com/dictionary/standard (2009). Accessed 5 Sept 2009.
  45. Subhani M. Chapter 11, Intrauterin growth restriction. In: Spitzer AR, editor. Intensive care of the fetus and neonate. Philadelphia, PA: Elsevier Mosby; 2005. pp.135–48.Google Scholar
  46. Usher R, McLean F. Intrauterine growth of live-born Caucasian infants at sea level: standards obtained from measurements in 7 dimensions of infants born between 25 and 44 weeks of gestation. J Pediatr. 1969;74:901–10.PubMedCrossRefGoogle Scholar
  47. Walraven GE, Mkanje RJ, Van Roosmalen J, Van Dongen PW, Van Asten AG, Dolmans WM. Single pre-delivery symphysis-fundal height measurement as a predictor of birth weight and multiple pregnancy. Br J Obstet Gynaecol. 1995;102:525–9.PubMedCrossRefGoogle Scholar
  48. Wilcox M, Gardosi J, Mongelli M, Ray C, Johnson I. Birth weight from pregnancies dated by ultrasonography in a multicultural British population. Br Med J. 1993;307:588–91.CrossRefGoogle Scholar
  49. Winick M. Cellular changes during placental and fetal growth. Am J Obstet Gynecol. 1971;109:166–76.PubMedGoogle Scholar
  50. Wollmann HA. Intrauterine growth restriction: definition and etiology. Horm Res. 1998;49:1–6.CrossRefGoogle Scholar
  51. World Health Organization (WHO). Regional health paper. Multi-center study on low birth weight and infant mortality in India, Nepal and Sri Lanka. SEARO 1994;25.Google Scholar
  52. Yunis KA, Khawaja M, Beydoun H, Nassif Y, Khogali M, Tamim H for the National Collaborative Perinatal Neonatal Network (NCPNN). Intrauterine growth standards in a developing country: a study of singleton livebirths at 28–42 weeks’ gestation. Pediatr Perinat Epidemiol. 2007;21:387–96.CrossRefGoogle Scholar
  53. Zhang X, Platt RW, Cnattingius S, Joseph KS, Kramer MS. The use of customized versus population-based birth weight standards in predicting perinatal mortality. BJOG Int J Obstet Gynecol. 2007;114:474–7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Mira A. Wehbe
    • 1
  • Lama Charafeddine
    • 2
  • Khalid A. Yunis
    • 1
  1. 1.Department of Pediatrics, National Collaborative Perinatal Neonatal NetworkAmerican University of Beirut Medical CenterBeirutLebanon
  2. 2.Department of Pediatrics, National Collaborative Perinatal Neonatal NetworkAmerican University of Beirut Medical CenterBeirutLebanon

Personalised recommendations