Determining Gestational Age for Public Health Care Users in Brazil: Comparison of Methods and Algorithm Creation

Overview

Journal BMC Res Notes

Publisher Biomed Central

Specialties Biology
General Medicine

Date 2013 Feb 14

PMID 23402277

Citations 22

Authors

Ana Paula Esteves Pereira

Marcos Augusto Bastos Dias

Maria Helena Bastos

Silvana Granado Nogueira da Gama

Maria do Carmo Leal

Affiliations

Soon will be listed here.

Abstract

Background: A valid, accurate method for determining gestational age (GA) is crucial in classifying early and late prematurity, and it is a relevant issue in perinatology. This study aimed at assessing the validity of different measures for approximating GA, and it provides an insight into the development of algorithms that can be adopted in places with similar characteristics to Brazil. A follow-up study was carried out in two cities in southeast Brazil. Participants were interviewed in the first trimester of pregnancy and in the postpartum period, with a final sample of 1483 participants after exclusions. The distribution of GA estimates at birth using ultrasound (US) at 21-28 weeks, US at 29+ weeks, last menstrual period (LMP), and the Capurro method were compared with GA estimates at birth using the reference US (at 7-20 weeks of gestation). Kappa, sensitivity, and specificity tests were calculated for preterm (<37 weeks of gestation) and post-term (>=42 weeks) birth rates. The difference in days in the GA estimates between the reference US and the LMP and between the reference US and the Capurro method were evaluated in terms of maternal and infant characteristics, respectively.

Results: For prematurity, US at 21-28 weeks had the highest sensitivity (0.84) and the Capurro method the highest specificity (0.97). For postmaturity, US at 21-28 weeks and the Capurro method had a very high sensitivity (0.98). All methods of GA estimation had a very low specificity (≤0.50) for postmaturity. GA estimates at birth with the algorithm and the reference US produced very similar results, with a preterm birth rate of 12.5%.

Conclusions: In countries such as Brazil, where there is less accurate information about the LMP and lower coverage of early obstetric US examinations, we recommend the development of algorithms that enable the use of available information using methodological strategies to reduce the chance of errors with GA. Thus, this study calls into attention the care needed when comparing preterm birth rates of different localities if they are calculated using different methods.

Citing Articles

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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 G, Romanelli R, Leonel T, Gaspar J, Aguiar R, Reis Z BMC Pregnancy Childbirth. 2023; 23(1):106.

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References

Andersen H, Johnson Jr T, Barclay M, Flora Jr J . Gestational age assessment. I. analysis of individual clinical observations. Am J Obstet Gynecol. 1981; 139(2):173-7. View

Taipale P, Hiilesmaa V . Predicting delivery date by ultrasound and last menstrual period in early gestation. Obstet Gynecol. 2001; 97(2):189-94. DOI: 10.1016/s0029-7844(00)01131-5. View

Olsen I, Groveman S, Lawson M, Clark R, Zemel B . New intrauterine growth curves based on United States data. Pediatrics. 2010; 125(2):e214-24. DOI: 10.1542/peds.2009-0913. View

Mongelli M, Gardosi J . Birth weight, prematurity and accuracy of gestational age. Int J Gynaecol Obstet. 1997; 56(3):251-6. DOI: 10.1016/s0020-7292(96)02835-4. View

Savitz D, Terry Jr J, Dole N, Thorp Jr J, Siega-Riz A, Herring A . Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination. Am J Obstet Gynecol. 2002; 187(6):1660-6. DOI: 10.1067/mob.2002.127601. View

Capurro H, Konichezky S, Fonseca D, Caldeyro-Barcia R . A simplified method for diagnosis of gestational age in the newborn infant. J Pediatr. 1978; 93(1):120-2. DOI: 10.1016/s0022-3476(78)80621-0. View

Wegienka G, Baird D . A comparison of recalled date of last menstrual period with prospectively recorded dates. J Womens Health (Larchmt). 2005; 14(3):248-52. DOI: 10.1089/jwh.2005.14.248. View

Whitworth M, Bricker L, Neilson J, Dowswell T . Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev. 2010; (4):CD007058. PMC: 4084925. DOI: 10.1002/14651858.CD007058.pub2. View

Wingate M, Alexander G, Buekens P, Vahratian A . Comparison of gestational age classifications: date of last menstrual period vs. clinical estimate. Ann Epidemiol. 2007; 17(6):425-30. DOI: 10.1016/j.annepidem.2007.01.035. View

10.

Hoffman C, Messer L, Mendola P, Savitz D, Herring A, Hartmann K . Comparison of gestational age at birth based on last menstrual period and ultrasound during the first trimester. Paediatr Perinat Epidemiol. 2008; 22(6):587-96. DOI: 10.1111/j.1365-3016.2008.00965.x. View

11.

Berg A . Menstrual cycle length and the calculation of gestational age. Am J Epidemiol. 1991; 133(6):585-9. DOI: 10.1093/oxfordjournals.aje.a115930. View

12.

Gardosi J, Geirsson R . Routine ultrasound is the method of choice for dating pregnancy. Br J Obstet Gynaecol. 1998; 105(9):933-6. DOI: 10.1111/j.1471-0528.1998.tb10253.x. View

13.

Peralta C, Barini R . [Obstetric ultrasound between the 11th and 14th weeks: beyond the screening for chromosomal abnormalities]. Rev Bras Ginecol Obstet. 2011; 33(1):49-57. DOI: 10.1590/s0100-72032011000100008. View

14.

Landis J, Koch G . The measurement of observer agreement for categorical data. Biometrics. 1977; 33(1):159-74. View

15.

Alexander G, Tompkins M, Petersen D, Hulsey T, Mor J . Discordance between LMP-based and clinically estimated gestational age: implications for research, programs, and policy. Public Health Rep. 1995; 110(4):395-402. PMC: 1382148. View

16.

Dietz P, England L, Callaghan W, Pearl M, Wier M, Kharrazi M . A comparison of LMP-based and ultrasound-based estimates of gestational age using linked California livebirth and prenatal screening records. Paediatr Perinat Epidemiol. 2007; 21 Suppl 2:62-71. DOI: 10.1111/j.1365-3016.2007.00862.x. View

17.

Callaghan W, Dietz P . Differences in birth weight for gestational age distributions according to the measures used to assign gestational age. Am J Epidemiol. 2010; 171(7):826-36. DOI: 10.1093/aje/kwp468. View

18.

Kramer M, McLean F, Boyd M, Usher R . The validity of gestational age estimation by menstrual dating in term, preterm, and postterm gestations. JAMA. 1988; 260(22):3306-8. View

19.

Waller D, Spears W, Gu Y, Cunningham G . Assessing number-specific error in the recall of onset of last menstrual period. Paediatr Perinat Epidemiol. 2000; 14(3):263-7. DOI: 10.1046/j.1365-3016.2000.00275.x. View

20.

Doubilet P, Benson C . Improved prediction of gestational age in the late third trimester. J Ultrasound Med. 1993; 12(11):647-53. DOI: 10.7863/jum.1993.12.11.647. View