Population versus Customized Fetal Growth Norms and Adverse Outcomes in an Intrapartum Cohort

Maged M. Costantine; Yinglei Lai; Steven L. Bloom; Catherine Y. Spong; Michael W. Varner; Dwight J. Rouse; Susan M. Ramin; Steve N. Caritis; Alan M. Peaceman; Yoram Sorokin; Anthony Sciscione; Brian M. Mercer; John M. Thorp; Fergal D. Malone; Margaret Harper; Jay D. Iams; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network

doi:10.1055/s-0032-1324708

American Journal of Perinatology, Table of Contents

Am J Perinatol 2013; 30(04): 335-342
DOI: 10.1055/s-0032-1324708

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Population versus Customized Fetal Growth Norms and Adverse Outcomes in an Intrapartum Cohort

Maged M. Costantine

¹Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas

,

Yinglei Lai

²The George Washington University Biostatistics Center, Washington, District of Columbia

,

Steven L. Bloom

³Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas

,

Catherine Y. Spong

⁴The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland

,

Michael W. Varner

⁵Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah

,

Dwight J. Rouse

⁶Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

,

Susan M. Ramin

⁷Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas

,

Steve N. Caritis

⁸Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania

,

Alan M. Peaceman

⁹Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois

,

Yoram Sorokin

¹⁰Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan

,

Anthony Sciscione

¹¹Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania

,

Brian M. Mercer

¹²Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio

,

John M. Thorp

¹³Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill

,

Fergal D. Malone

¹⁴Department of Obstetrics and Gynecology, Columbia University, New York

,

Margaret Harper

¹⁵Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, North Carolina

,

Jay D. Iams

¹⁶Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio

,

for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network

› Author Affiliations

Abstract

Objective To compare population versus customized fetal growth norms in identifying neonates at risk for adverse outcomes (APO) associated with small for gestational age (SGA).

Study Design Secondary analysis of an intrapartum fetal pulse oximetry trial in nulliparous women at term. Birth weight percentiles were calculated using ethnicity- and gender-specific population norms and customized norms (Gardosi).

Results Of the studied neonates, 508 (9.9%) and 584 (11.3%) were SGA by population (SGApop) and customized (SGAcust) norms, respectively. SGApop infants were significantly associated with a composite adverse neonatal outcome, neonatal intensive care admission, low fetal oxygen saturation, and reduced risk of cesarean delivery; both SGApop and SGAcust infants were associated with a 5-minute Apgar score < 4. The ability of customized and population birth weight percentiles in predicting APO was poor (12 of 14 APOs had area under the curve of <0.6).

Conclusion In this intrapartum cohort, neither customized nor normalized population norms adequately identified neonates at risk of APO related to SGA.

Keywords

customized norm - fetal growth - small for gestational age - adverse outcomes

Full Text

References

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