INTERGROWTH-21st v. local South African growth standards (Theron-Thompson) for identification of small-for-gestational-age fetuses in stillbirths: A closer look at variation across pregnancy

Lavin, Tina; Nedkoff, Lee; Preen, David B.; Theron, Gerhard; Pattinson, Robert Clive

doi:10.7196/samj.2019.v109i7.13485

Cited by 6 publications

(8 citation statements)

References 20 publications

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“…The findings from this meta-analysis support prior studies showing that an international reference may overestimate SGA in a high-risk population with increased exposure to multiple causes of poor fetal growth, including infections like malaria and poor nutrition [ 20 , 49 ] while underestimating it in low-risk populations [ 50 ]. Several other studies [ 22 , 23 , 50 , 51 ] found differences between local and global references. The results of this and previous studies [ 20 – 23 , 49 – 51 ] strengthen the importance of having a reference chart derived from a local population, thereby accounting for geographical and ethnic differences.…”

Section: Discussionmentioning

confidence: 95%

“…Several other studies [ 22 , 23 , 50 , 51 ] found differences between local and global references. The results of this and previous studies [ 20 – 23 , 49 – 51 ] strengthen the importance of having a reference chart derived from a local population, thereby accounting for geographical and ethnic differences. The FIGO position paper supports this approach [ 17 ].…”

Section: Discussionmentioning

confidence: 95%

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The choice of reference chart affects the strength of the association between malaria in pregnancy and small for gestational age: an individual participant data meta-analysis comparing the Intergrowth-21 with a Tanzanian birthweight chart

Mtove

Minja

Abdul

et al. 2022

Malar J

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Background The prevalence of small for gestational age (SGA) may vary depending on the chosen weight-for-gestational-age reference chart. An individual participant data meta-analysis was conducted to assess the implications of using a local reference (STOPPAM) instead of a universal reference (Intergrowth-21) on the association between malaria in pregnancy and SGA. Methods Individual participant data of 6,236 newborns were pooled from seven conveniently identified studies conducted in Tanzania and Malawi from 2003–2018 with data on malaria in pregnancy, birthweight, and ultrasound estimated gestational age. Mixed-effects regression models were used to compare the association between malaria in pregnancy and SGA when using the STOPPAM and the Intergrowth-21 references, respectively. Results The 10th percentile for birthweights-for-gestational age was lower for STOPPAM than for Intergrowth-21, leading to a prevalence of SGASTOPPAM of 14.2% and SGAIG21 of 18.0%, p < 0.001. The association between malaria in pregnancy and SGA was stronger for STOPPAM (adjusted odds ratio (aOR) 1.30 [1.09–1.56], p < 0.01) than for Intergrowth-21 (aOR 1.19 [1.00–1.40], p = 0.04), particularly among paucigravidae (SGASTOPPAM aOR 1.36 [1.09–1.71], p < 0.01 vs SGAIG21 aOR 1.21 [0.97–1.50], p = 0.08). Conclusions The prevalence of SGA may be overestimated and the impact of malaria in pregnancy underestimated when using Intergrowth-21. Comparing local reference charts to global references when assessing and interpreting the impact of malaria in pregnancy may be appropriate.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 95%

The choice of reference chart affects the strength of the association between malaria in pregnancy and small for gestational age: an individual participant data meta-analysis comparing the Intergrowth-21 with a Tanzanian birthweight chart

Mtove

Minja

Abdul

et al. 2022

Malar J

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“…En contraposición, existen otros estudios que informan un buen rendimiento de IG-21. Lavin comparó las clasificaciones de fetos mortinatos PEG con la curva de referencia local en Sur Africa y la curva IG-21 (11). Encontró que la prevalencia de PEG fue similar: 32.2 % con IG-21 vs. 31.1 % con la local.…”

Section: Curvas Estandarizadas O De Prescripciónunclassified

Controversias en la elección de curvas de crecimiento para evaluar los recién nacidos colombianos.

Pomar¹

2021

Pediatria.

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Las curvas de crecimiento permiten comparar el patrón de crecimiento de cada niño(a), con aquel que se considera apropiado para su grupo etario. En los recién nacidos, una correcta clasificación del crecimiento ponderal hace posible tratar y prevenir oportunamente la morbimortalidad infantil asociada a desviaciones en el crecimiento. Actualmente existen múltiples tipos de curvas (estandarizadas, de referencia local o internacional, personalizadas) y no se tiene certeza sobre cuál de ellas evalúa mejor el crecimiento de los recién nacidos. La evidencia indica que se debe conocer el patrón de crecimiento de cada país o región antes de adoptar cualquier tipo de curva. En Colombia se tienen pocos estudios sobre curvas locales y se han adoptado curvas internacionales sin haberlas validado para nuestra población. Es fundamental generar curvas propias y conocer los pasos necesarios para adoptar una curva internacional, porque: 1) Las curvas internacionales pueden llevar a errores de clasificación, debido a problemas de representatividad. 2) Como consecuencia, se necesita conocer el patrón de crecimiento local para saber si la curva internacional se ajusta a nuestra población, y finalmente, 3) Si se desea adoptar una curva de crecimiento, es indispensable evaluar la metodología empleada para su creación, comparar los patrones de crecimiento de la curva seleccionada y la curva local y conocer el contexto clínico en el que se aplicará la curva. Estos aspectos, permitirán elegir un instrumento adecuado con el que se puedan tomar medidas de prevención o terapéuticas acertadas.

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“…Although the newly created normative/prescriptive Intergrowth 21 st Project and World Health Organization (WHO) birth weight-for-gestational age standards [1][2][3][4] represent a conceptual departure from previous descriptive, population-based references [5][6][7][8][9][10][11] and offer several theoretical advantages, studies comparing existing references and the new standards have not succeeded in establishing a preferred method for identifying SGA and LGA infants. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] One study, 22 which contrasted the Intergrowth standard with population-based references from 15 European countries, showed that infants classified as AGA by the Intergrowth standard and SGA by the 15 national references had a 2.7-fold higher risk of perinatal death (compared with infants deemed AGA by both). Conversely, infants categorized as LGA by the Intergrowth standard but AGA by the national references were at significantly reduced risk of perinatal death.…”

Section: Introductionmentioning

confidence: 99%

The clinical performance and population health impact of birth weight-for-gestational age indices with regard to adverse neonatal outcomes in term infants

John

Joseph

Fahey

et al. 2022

Preprint

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Background Despite the recent creation of several birth weight-for-gestational age references and standards, none has proven superior. We identified birth weight-for-gestational age cut-offs, and corresponding United States population-based, Intergrowth 21 st and World Health Organization centiles associated with higher risks of adverse neonatal outcomes, and evaluated their ability to predict serious neonatal morbidity and neonatal mortality (SNMM). Methods and findings The study population comprised singleton live births at 37-41 weeks’ gestation in the United States, 2003-2017. Birth weight-specific SNMM, which included 5-minute Apgar score<4, neonatal seizures, assisted ventilation and neonatal death, was modeled by gestational week using penalized B-splines. We estimated the birth weights at which SNMM odds was minimized (and higher by 10%, 50% and 100%), and identified the corresponding population, Intergrowth 21 st and World Health Organization (WHO) centiles. We then evaluated the individual- and population-level performance of these cut-offs for predicting SNMM. The study included 40,179,663 live births at 37-41 weeks’ gestation and 991,486 SNMM cases. Among female singletons at 39 weeks’ gestation, SNMM odds was lowest at 3,203 g birth weight (population, Intergrowth and WHO centiles 40, 52 and 46, respectively), and 10% higher at 2,835 g and 3,685 g (population centiles 11 th and 82 nd , Intergrowth centiles 17 th and 88 th and WHO centiles 15 th and 85 th ). SNMM odds were 50% higher at 2,495 g and 4,224 g and 100% higher at 2,268 g and 4,593 g. Birth weight cut-offs were poor predictors of SNMM. For example, the birth weight cut-off associated with 10% higher odds of SNMM among female singletons at 39 weeks’ gestation resulted in a sensitivity of 12.5%, specificity of 89.4% and population attributable fraction of 2.1%, while the cut-off associated with 50% higher odds resulted in a sensitivity of 2.9%, specificity of 98.4% and population attributable fraction of 1.3%. Conclusions Birth weight-for-gestational age cut-offs and centiles perform poorly when used to predict adverse neonatal outcomes in individual infants, and the population impact associated with these cut-offs is also small.

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INTERGROWTH-21st v. local South African growth standards (Theron-Thompson) for identification of small-for-gestational-age fetuses in stillbirths: A closer look at variation across pregnancy

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 6 publications

References 20 publications

The choice of reference chart affects the strength of the association between malaria in pregnancy and small for gestational age: an individual participant data meta-analysis comparing the Intergrowth-21 with a Tanzanian birthweight chart

The choice of reference chart affects the strength of the association between malaria in pregnancy and small for gestational age: an individual participant data meta-analysis comparing the Intergrowth-21 with a Tanzanian birthweight chart

Controversias en la elección de curvas de crecimiento para evaluar los recién nacidos colombianos.

The clinical performance and population health impact of birth weight-for-gestational age indices with regard to adverse neonatal outcomes in term infants

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