Fetal weight estimation by ultrasound: development of Indian population-based models

Abstract

OBJECTIVE:To examine body size and fat measurements of babies born in rural India and compare them with white Caucasian babies born in an industrialised country. DESIGN: Community-based observational study in rural India, and comparison with data from an earlier study in the UK, measured using similar methods. SUBJECTS: A total of 631 term babies born in six rural villages, near the city of Pune, Maharashtra, India, and 338 term babies born in the Princess Anne Hospital, Southampton, UK. MEASUREMENTS: Maternal weight and height, and neonatal weight, length, head, mid-upper-arm and abdominal circumferences, subscapular and triceps skinfold thicknesses, and placental weight. RESULTS: The Indian mothers were younger, lighter, shorter and had a lower mean body mass index (BMI) (mean age, weight, height and BMI: 21.4 y, 44.6 kg, 1.52 m, and 18.2 kg/m 2 ) than Southampton mothers (26.8 y, 63.6 kg, 1.63 m and 23.4 kg/m 2 ). They gave birth to lighter babies (mean birthweight: 2.7 kg compared with 3.5 kg). Compared to Southampton babies, the Indian babies were small in all body measurements, the smallest being abdominal circumference (s.d. score: À2.38; 95% CI: À2.48 to À2.29) and mid-arm circumference (s.d. score: À1.82; 95% CI: À1.89 to À1.75), while the most preserved measurement was the subscapular skinfold thickness (s.d. score: À0.53; 95% CI: À0.61 to À0.46). Skinfolds were relatively preserved in the lightest babies (below the 10th percentile of birthweight) in both populations. CONCLUSIONS: Small Indian babies have small abdominal viscera and low muscle mass, but preserve body fat during their intrauterine development. This body composition may persist postnatally and predispose to an insulin-resistant state.

Sonographic Estimated Fetal Weight Within an Indian Cohort: Is the Hadlock Four Regression Model Appropriate or Does It Merit Adjustments?

“…The study concluded that the models performed better compared to other prevalent methods in an Indian context, including the Hadlock-4. 38 That study had a percentage error of approximately 6% 38 compared to a higher 9.1% in the present study. However, the sample size was lower than in the present study and the percentage error calculated was irrespective of GA.…”

“…The sample size used was 139 which was a smaller sample size that was used in present study. Hiwale et al, 38 proposed 2 new models for an Indian population derived from a sample size of 137 and validated with 36 patients. The study concluded that the models performed better compared to other prevalent methods in an Indian context, including the Hadlock-4.…”

“…Moreover, most of the studies done in this context have opted for an interval of a week between EFW estimation and birth. 20,31,33,34,37,38 The range of EFW obtained by most biometry based EFW calculation methods including Hadlock-4 and the proposed modification is wide (15 percent on either side of the mean). There is a need for further studies to narrow down the range and increase precision.…”

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“…Biological variation and inadequate imaging have an impact on the sonographic estimation accuracy of the EFW, regardless of the applied formula. In addition, the accuracy of the sonographic estimation declines with birth weight [13,14] and is frequently overestimated in pregnancies thought to be large for gestational age (LGA) and undervalued in pregnancies thought to have fetal growth restriction (FGR) [12].…”

Analysis of factors influencing accuracy of ultrasound-based fetal weight estimation

“…Therefore, the secondary objective of the study was to examine impact of a formula/model selection on the fetal weight estimation accuracy. For this purpose, two Indian population-based models, Hiwale-1 and Hiwale-2,[ 17 ] were compared with the Hadlock-4 model,[ 18 ] which is based on a population from the United States of America.…”