Skip to main content
SpringerLink
Log in

Intrauterine Growth Standards

  • Chapter
  • First Online:
Handbook of Growth and Growth Monitoring in Health and Disease

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.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 429.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 549.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 549.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

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

References

  • ACOG Practice Bulletin. Intrauterine growth restriction. Int J Gynecol Obstet. 2001;72:85–96.

    Article  Google Scholar 

  • Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan, M. A United States National reference for fetal growth. Obstet Gynecol. 1996;87:163–8.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Arbuckle TE, Wilkins R, Sherman GJ. Birth weight percentiles by gestational age in Canada. Obstet Gynecol. 1993;81:39–48.

    PubMed  CAS  Google Scholar 

  • Babson SG, Benda GI. Growth graphs for the clinical assessment of infants of varying gestational age. J Pediatr. 1976;89:814–20.

    Article  PubMed  CAS  Google Scholar 

  • 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 

  • 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.

    PubMed  CAS  Google Scholar 

  • 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.

    PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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 

  • 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.

    CAS  Google Scholar 

  • 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 

  • Deter RL. Individualized growth assessment: evaluation of growth using each fetus as its own control. Semin Perinatol. 2004;28:23–32.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • Fisher DA. Intrauterine growth retardation: endocrine and receptor aspects. Semin Perinatol. 1984;8:37–41.

    PubMed  CAS  Google Scholar 

  • Gardosi J. Customized fetal growth standards: rationale and clinical application. Semin Perinatol. 2004;28:33–40.

    Article  PubMed  Google Scholar 

  • 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 

  • Gardosi J, Chang A, Kalyan B, Sahota D, Symonds EM. Customised antenatal growth charts. Lancet. 1992;339:283–7.

    Article  PubMed  CAS  Google Scholar 

  • Gardosi J, Mongelli M, Wilcox M, Chang A. An adjustable fetal weight standard. Ultrasound Obstet Gynecol. 1995;6:168–74.

    Article  PubMed  CAS  Google Scholar 

  • GROW: Gestation Related Optimal Weight; Growth Charts. Available at: Gestation Network. http://www.gestation.net (2009). Accessed 5 Sept 2009.

  • Harkness UF, Mari G. Diagnosis and management of intrauterine growth restriction. Clin Perinatol. 2004;31:743–64.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Hosain GMM, Chatterjee N, Begum A, Saha SC. Factors associated with low birth-weight in rural Bangladesh. J Trop Pediatr. 2006;52:87–91.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Olowe SA. Standards of intrauterine growth for an African population at sea level. J Pediatr. 1982;99:489–95.

    Article  Google Scholar 

  • Ott WJ. Intrauterine Growth Retardation and preterm delivery. Am J Obstet Gynecol. 1993;168:1710–17.

    PubMed  CAS  Google Scholar 

  • Paul IM, Lehman EB, Suliman AK, Hillemeier MM. Perinatal disparities for black mothers and their newborns. Matern Child Health J. 2008;12:452–60.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Resnik R. One size does not fit all. Am J Obstet Gynecol. 2007;197:221–2.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Standard. In Merriam-Webster Online Dictionary. http://www.merriam-webster.com/dictionary/standard (2009). Accessed 5 Sept 2009.

  • 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 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • Winick M. Cellular changes during placental and fetal growth. Am J Obstet Gynecol. 1971;109:166–76.

    PubMed  CAS  Google Scholar 

  • Wollmann HA. Intrauterine growth restriction: definition and etiology. Horm Res. 1998;49:1–6.

    Article  CAS  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, National Collaborative Perinatal Neonatal Network, American University of Beirut Medical Center, Beirut, Lebanon

    Mira A. Wehbe & Khalid A. Yunis

  2. Department of Pediatrics, National Collaborative Perinatal Neonatal Network, American University of Beirut Medical Center, Beirut, Lebanon

    Lama Charafeddine

Authors
  1. Mira A. Wehbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lama Charafeddine
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Khalid A. Yunis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Khalid A. Yunis .

Editor information

Editors and Affiliations

  1. Dept. Nutrition & Dietetics, King's College, Stamford St. 150, London, SE1 9NH, United Kingdom

    Victor R. Preedy

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Wehbe, M.A., Charafeddine, L., Yunis, K.A. (2012). Intrauterine Growth Standards. In: Preedy, V. (eds) Handbook of Growth and Growth Monitoring in Health and Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1795-9_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-1795-9_6

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-1794-2

  • Online ISBN: 978-1-4419-1795-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation