Relationship Between Foot Length and Gestational Age in Pakistan

Abstract

Background: Preterm births have a high risk of mortality. Therefore, knowledge of the gestational age (GA) at birth is crucial to guide the appropriate management of a newborn. Common methods for estimating GA such as the last menstrual period, ultrasonography, and post-natal Ballard scoring have some limitations and are often unavailable in low-resource areas. This study aimed to determine the relationship between foot length and GA in order to develop an equation for predicting GA of the neonates born in Pakistan, a region with high rates of preterm birth and newborn mortality.Methods: We conducted a prospective study in a large obstetric hospital in Pakistan. Data for this analysis were extracted from the hospital files of eligible women by trained study midwives. Midwives were also trained in performing the Ballard examination and taking foot length using a disposable measuring tape within an hour of the birth. The GA was calculated using an android-based GA calculator, which used a report of last menstrual period, ultrasound examination, and Ballard examination. Simple and multiple linear regression were used to construct predicting equations for GA.Results: Both the foot length and GA were available for 1,542 cases. The median GA was 34.5 weeks with an interquartile range (IQR 4.7) and the median foot length was 7 cm (IQR 1.4). There was a positive linear relationship between foot length and GA (r2 81.7%, p-value < 0.001). Stratified analysis showed an r2 of 81.7% for males and 81.6% for females. The r2 for stillbirths was 84.1% and, 82.3% for live births. The r2 for macerated stillbirths was 88.6% and 90.6% for fresh stillbirths.Conclusion: In resource poor settings, the use of foot length can estimate GA in both live births and stillbirths and can easily identify preterm infants. This tool could facilitate early management of preterm births in low-resource settings.