Prediction of Large‐for‐Gestational‐Age Neonates by Different Growth Standards

Abstract

Objective Compare the accuracy of the Hadlock, the NICHD, and the Fetal Medicine Foundation (FMF) charts to detect large‐for‐gestational‐age (LGA) and adverse neonatal outcomes (as a secondary outcome). Methods This is a secondary analysis from a prospective study that included singleton non‐anomalous gestations with growth ultrasound at 26–36 weeks. LGA was suspected with estimated fetal weight > 90th percentile by the NICHD, FMF, and Hadlock charts. LGA was diagnosed with birth weight > 90th percentile. We tested the performance of these charts to detect LGA and adverse neonatal outcomes (neonatal intensive care unit admission, Ph < 7.1, Apgar <7 at 5 minutes, seizures, and neonatal death) by calculating the area under the curve, sensitivity, specificity, positive predictive value, and negative predictive value. Results Of 1054 pregnancies, 123 neonates (12%) developed LGA. LGA was suspected in 58 (5.5%) by Hadlock, 229 (21.7%) by NICHD standard, and 231 (22%) by FMF chart. The NICHD standard (AUC: .79; 95% CI: .75–.83 vs. AUC .64; 95%CI: .6–.68; p = < .001) and FMF chart (AUC: .81 95% CI: .77–.85 vs. AUC .64; 95%CI: .6–.68; p = < .001) were more accurate than Hadlock. The FMF and NICHD had higher sensitivity (77.2 vs. 72.4 vs. 30.1%) but Hadlock had higher specificity for LGA (97.5 vs. 88.5 vs. 85.4%). All standards were poor predictors for adverse neonatal outcomes. Conclusions The NICHD and the FMF standards may increase the detection rate of LGA in comparison to the Hadlock chart. However, this may increase obstetrical interventions.

Development of a Machine Learning Model for Sonographic Assessment of Gestational Age

“…Analysis of per country performance is summarized in eTable 4 in Supplement 1, which shows that the accuracy of Hadlock-based GA estimates are close to Hadlock in the US (mean [SD], NICHD MAE, 4.79 [4.16] days; Hadlock MAE, 4.90 [4.32] days), while outperforming Hadlock significantly in the Zambia population (mean [SD], NICHD MAE, 4.96 [4.84] days; Hadlock MAE, 5.62 [5.20] days). The Intergrowth-21st formula performed significantly worse than Hadlock and NICHD across both populations as demonstrated in other studies . Our ensemble model estimate was compared against NICHD, and the result showed that the ensemble model had a lower MAE for both US (mean [SD] difference 3.58 [2.79] days; 95% CI, −1.90 to −0.70 days) and Zambia (mean [SD] difference, 3.70 [3.57] days; 95% CI, −1.80 to −0.60 days), demonstrating robustness and statistical superiority on all subgroups.…”

Outcome‐based comparison of SMFM and ISUOG definitions of fetal growth restriction

“…Use of the normogram of Alexander et al 18 to identify SGA neonates may also be considered a limitation, as it uses actual birth weight and tends to underestimate the true prevalence of neonates with suboptimal growth. However, the same charts have been utilized to assess neonatal-weight disorders in prior studies 29,30 . Finally, we did not report monitoring methods such as Doppler, cardiotocography and biophysical profiles for growth-restricted fetuses and how these tests may have impacted on the timing and outcome of delivery.…”

Prediction of large‐for‐gestational‐age infant by fetal growth charts and hemoglobin A1c level in pregnancy complicated by pregestational diabetes

“…In their low‐risk pregnant population, Duncan et al . 18 found that the FMF growth chart had the highest accuracy for detection of LGA (AUC, 0.8). Similarly, in an obese population without diabetes, Verger et al .…”

“…The NICHD growth chart was selected because of its focus on including a racially and ethnically diverse contemporary population 11 , and because prior research has suggested it has a higher screen‐positive rate for EFW ≥ 90 th percentile compared with other growth charts 17 . The FMF growth chart was selected because it may improve the ability to predict LGA compared with the Hadlock growth chart in low‐risk individuals without pregestational diabetes 18 . At the time at which the current study was conducted, our institution utilized the Brenner growth chart, and has more recently transitioned to the Hadlock growth chart.…”

“…Prior studies comparing the predictive performance of these fetal growth charts have focused primarily on fetal growth restriction and, consequently, small‐for‐gestational‐age (SGA) infants at birth 15 , 16 , 17 . A previous study assessed the predictive performance of these charts for LGA infants at birth but did not focus on pregnant individuals with pregestational diabetes 18 . Regardless of the growth chart used, sonographically estimated fetal weight (EFW) can deviate from actual BW, and more so with LGA infants 19 , 20 , 21 .…”