Comparison of first trimester dating methods for gestational age estimation and their implication on preterm birth classification in a North Indian cohort

Vijayram, Ramya; Damaraju, Nikhita; Xavier, Ashley; Desiraju, Bapu Koundinya; Thiruvengadam, Ramachandran; Misra, Sumit; Chopra, Shilpa; Khurana, Ashok; Wadhwa, Nitya; Rengaswamy, Raghunathan; Sinha, Himanshu; Bhatnagar, Shinjini

doi:10.1101/2019.12.27.19016006

Cited by 3 publications

(6 citation statements)

References 27 publications

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“…CRL was measured in 99 cases as one of the cases had an anembryonic pregnancy. CRL is the most crucial parameter in assessing the gestational age in a pregnancy [11].…”

Section: Discussionmentioning

confidence: 99%

The Role of Routine Ultrasonography in the First Trimester of Pregnancy

Saravanan

Kirubamani

2021

JPRI

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Introduction: In the early stages of pregnancy, ultrasound is an extremely specific method for examination. This article reviews how the normal development of a baby in the first trimester of pregnancy relates to ultrasound findings. Aim: To highlight the importance of routine ultrasonography in the first trimester of pregnancy in detecting and dating gestation, its viability and early detection of anomalies and complications Methods: This descriptive study involved 100 pregnant women within 12 weeks of gestation attending antenatal clinic at Saveetha Medical college, during the study period Inclusion Criteria: Pregnant women with history of amenorrhea <12 weeks of gestation. Exclusion criteria: Individuals with history of pain abdomen and bleeding per vaginum Results: A total of 99 pregnancies were intrauterine of which 1 was anembryonic and 2 had early pregnancy failure, 15 pregnancies were redated. One ectopic and one fibroid complicating pregnancy were aslo found. Conclusion: Ultrasonography is an effective method to detect and date pregnancy, identify nonviable pregnancies, fetal abnormalities and early trimester complications. Hence it is ideal to use it routinely as screening tool during the first trimester of pregnancy.

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“…CRL was measured in 99 cases as one of the cases had an anembryonic pregnancy. CRL is the most crucial parameter in assessing the gestational age in a pregnancy [11].…”

Section: Discussionmentioning

confidence: 99%

The Role of Routine Ultrasonography in the First Trimester of Pregnancy

Saravanan

Kirubamani

2021

JPRI

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“…In five studies, confidence intervals did not cross the null effect. These findings were robust since a sensitivity analysis removing the duplicity of proportions of prematurity [30,37] showed a risk difference of 0.02 (95%CI: 0.01 to 0.03), I 2 98%, p < 0.001, Additional file 2.…”

Section: Risk Difference Between Two Proportionsmentioning

confidence: 76%

“…However, it presented a 95% CI reaching the null value. Among the ten studies in this group, four showed evidence of significant risk differences in favor of LMP [14,21,22,33], and two studies found differences in favor of USG, but not significant [31,37]. Most of the studies in this subgroup presented high proportions of prematurity as compared to those in the HIC group.…”

Section: Investigation Of Subgroup Analyses Incomementioning

confidence: 86%

“…Regarding the cohort studies, three of them reached 9/10 stars [21,24,27]. The other studies are cross-sectional, with a maximum score of 7/9 stars in only two articles [32,37]. The quality of the results refers to the independent or blind assessment of the prematurity proportions by the two references, the clarity in obtaining the date of birth, and the connection to the data of the beginning of pregnancy.…”

Section: Quality Analysis Of Included Articlesmentioning

confidence: 99%

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Influence of different methods for calculating gestational age at birth on prematurity and small for gestational age proportions: a systematic review with meta-analysis

Vitral

Romanelli

Leonel

et al. 2023

BMC Pregnancy Childbirth

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Background Recognizing premature newborns and small-for-gestational-age (SGA) is essential for providing care and supporting public policies. This systematic review aims to identify the influence of the last menstrual period (LMP) compared to ultrasonography (USG) before 24 weeks of gestation references on prematurity and SGA proportions at birth. Methods Systematic review with meta-analysis followed the recommendations of the PRISMA Statement. PubMed, BVS, LILACS, Scopus-Elsevier, Embase-Elsevier, and Web-of-Science were searched (10–30-2022). The research question was: (P) newborns, (E) USG for estimating GA, (C) LMP for estimating GA, and (O) prematurity and SGA rates for both methods. Independent reviewers screened the articles and extracted the absolute number of preterm and SGA infants, reference standards, design, countries, and bias. Prematurity was birth before 37 weeks of gestation, and SGA was the birth weight below the p10 on the growth curve. The quality of the studies was assessed using the New-Castle-Ottawa Scale. The difference between proportions estimated the size effect in a meta-analysis of prevalence. Results Among the 642 articles, 20 were included for data extraction and synthesis. The prematurity proportions ranged from 1.8 to 33.6% by USG and varied from 3.4 to 16.5% by the LMP. The pooled risk difference of prematurity proportions revealed an overestimation of the preterm birth of 2% in favor of LMP, with low certainty: 0.02 (95%CI: 0.01 to 0.03); I2 97%). Subgroup analysis of USG biometry (eight articles) showed homogeneity for a null risk difference between prematurity proportions when crown-rump length was the reference: 0.00 (95%CI: -0.001 to 0.000; I2: 0%); for biparietal diameter, risk difference was 0.00 (95%CI: -0.001 to 0.000; I2: 41%). Only one report showed the SGA proportions of 32% by the USG and 38% by the LMP. Conclusions LMP-based GA, compared to a USG reference, has little or no effect on prematurity proportions considering the high heterogeneity among studies. Few data (one study) remained unclear the influence of such references on SGA proportions. Results reinforced the importance of qualified GA to mitigate the impact on perinatal statistics. Trial registration Registration number PROSPERO: CRD42020184646.

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“…Gestational age for participants at their second and third-trimester visits was computed using the GA estimated during their first trimester dating scan. In our previous work (15), we had developed a CRL based first-trimester dating model (Garbhini-GA1) and showed it to be performing as well as the Hadlock’s and INTERGROWTH-21st first trimester dating models. We used the Garbhini-GA1 model to obtain the first trimester dating for our study participants.…”

Section: Methodsmentioning

confidence: 99%

Development of second and third-trimester population-specific machine learning pregnancy dating model (Garbhini-GA2) derived from the GARBH-Ini cohort in north India

Damaraju

Xavier

Vijayram

et al. 2021

Preprint

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Background: The prevalence of preterm birth (PTB) is high in lower and middle-income countries (LMIC) such as India. In LMIC, since a large proportion seeks antenatal care for the first time beyond 14-weeks of pregnancy, accurate estimation of gestational age (GA) using measures derived from ultrasonography scans in the second and third trimesters is of paramount importance. Different models have been developed globally to estimate GA, and currently, LMIC uses Hadlock's formula derived from data based on a North American cohort. This study aimed to develop a population-specific model using data from GARBH-Ini, a multidimensional and ongoing pregnancy cohort established in a district hospital in North India for studying PTB. Methods: Data obtained by longitudinal ultrasonography across all trimesters of pregnancy was used to develop and validate GA models for second and third trimesters. The first trimester GA estimated by ultrasonography was considered the Gold Standard. The second and third trimester GA model named, Garbhini-GA2 is a multivariate random forest model using five ultrasonographic parameters routinely measured during this period. Garbhini-GA2 model was compared to Hadlock and INTERGROWTH-21st models in the TEST set by estimating root mean-squared error, bias and PTB rate. Findings: Garbhini-GA2 reduced the GA estimation error by 23-45% compared to the published models. Furthermore, the PTB rate estimated using Garbhini-GA2 was more accurate when compared to published formulae that overestimated the rate by 1.5-2.0 times. Interpretation: The Garbhini-GA2 model developed is the first of its kind developed solely using Indian population data. The higher accuracy of GA estimation by Garbhini-GA2 emphasises the need to apply population-specific GA formulae to improve antenatal care and better PTB rate estimates.

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Comparison of first trimester dating methods for gestational age estimation and their implication on preterm birth classification in a North Indian cohort

Cited by 3 publications

References 27 publications

The Role of Routine Ultrasonography in the First Trimester of Pregnancy

The Role of Routine Ultrasonography in the First Trimester of Pregnancy

Influence of different methods for calculating gestational age at birth on prematurity and small for gestational age proportions: a systematic review with meta-analysis

Development of second and third-trimester population-specific machine learning pregnancy dating model (Garbhini-GA2) derived from the GARBH-Ini cohort in north India

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