Comparison of Fetal Growth Patterns from Western India with Intergrowth-21st

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2024 Oct 14

PMID 39401220

Authors

Arun Kinare

Priscilla Joshi

Kamini Dangat

Sanjay Gupte

Manish Tipnis

Garima Singh

Karuna Randhir

Shweta Madiwale

Hemlata Pisal

Girija Wagh

Sanjay Lalwani

Sadhana Joshi

Caroline Fall

Harshpal Singh Sachdev

Affiliations

Soon will be listed here.

Abstract

Objective: To generate longitudinal fetal growth data in an Indian population and compare it with Intergrowth-21st.

Material And Methods: Fetal biometry data was collected in a prospective longitudinal observational study (REVAMP: Research Exploring Various Aspects and Mechanisms in Preeclampsia) from 2017 to 2022. Fetal crown-rump length (CRL) was measured at 11-14 weeks gestation, and biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) at 18-22 and 32-35 weeks, and converted into Z-scores using the Intergrowth standard. Generalized Additive Models for Location, Scale and Shape (GAMLSS) models were used to construct fetal growth centile curves compared against Intergrowth centiles.

Results: Out of 1096 singleton pregnancies in REVAMP, this analysis included 655 'healthy' pregnancies (uncomplicated by pre-eclampsia, diabetes, pre-term delivery or low birth weight) and a sub-set of 106 'low-risk' pregnancies defined using Intergrowth criteria. The 'healthy' study subjects showed lower mean CRL Z-score [-0.45 SD (95% CI:-0.54,-0.37)] at 11-14 weeks, and BPD Z-score [-1.2 SD (-1.28,-1.11) and -1.17 SD (-1.23,-1.1)] at 18-22 and 32-35 weeks respectively. Mean HC Z-score was comparable to the Intergrowth standard at 18-22 weeks [-0.08 SD (-0.16, 0.02)] but smaller at 32-35 weeks [-0.25 SD (-0.32,-0.19)]. Mean AC Z-score was lower at 18-22 weeks [-0.32 SD (-0.41,-0.23)] but comparable at 32-35 weeks [0.004 SD (-0.07, 0.07)]. FL was comparable to or larger than the Intergrowth standard at both time points [0.05 SD (-0.05, 0.14); 0.82 SD (0.75, 0.89), respectively]. These findings were similar, though measurements were slightly larger, in the 'low-risk' sample.

Conclusions: This data from healthy and low-risk pregnant women in urban western India indicates that some fetal dimensions and growth trajectories differ significantly from the Intergrowth-21st. Our data suggest the need for a larger representative study to define a population-specific fetal growth reference for India, for identification of fetal growth restriction.

References

Aggarwal N, Sharma G . Fetal ultrasound parameters: Reference values for a local perspective. Indian J Radiol Imaging. 2020; 30(2):149-155. PMC: 7546290. DOI: 10.4103/ijri.IJRI_287_19. View

Stirnemann J, Villar J, Salomon L, Ohuma E, Ruyan P, Altman D . International estimated fetal weight standards of the INTERGROWTH-21 Project. Ultrasound Obstet Gynecol. 2016; 49(4):478-486. PMC: 5516164. DOI: 10.1002/uog.17347. View

Gluckman P, Hanson M, Cooper C, Thornburg K . Effect of in utero and early-life conditions on adult health and disease. N Engl J Med. 2008; 359(1):61-73. PMC: 3923653. DOI: 10.1056/NEJMra0708473. View

Buck Louis G, Grewal J, Albert P, Sciscione A, Wing D, Grobman W . Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies. Am J Obstet Gynecol. 2015; 213(4):449.e1-449.e41. PMC: 4584427. DOI: 10.1016/j.ajog.2015.08.032. View

Lewandowska M . Maternal Obesity and Risk of Low Birth Weight, Fetal Growth Restriction, and Macrosomia: Multiple Analyses. Nutrients. 2021; 13(4). PMC: 8067544. DOI: 10.3390/nu13041213. View

Roro M, Deressa W, Lindtjorn B . Intrauterine growth patterns in rural Ethiopia compared with WHO and INTERGROWTH-21st growth standards: A community-based longitudinal study. PLoS One. 2020; 14(12):e0226881. PMC: 6938373. DOI: 10.1371/journal.pone.0226881. View

Vesel L, Nimako K, Jones R, Munson M, Little S, Njogu H . Implementing the INTERGROWTH-21st gestational dating and fetal and newborn growth standards in peri-urban Nairobi, Kenya: Provider experiences, uptake and clinical decision-making. PLoS One. 2019; 14(3):e0213388. PMC: 6407840. DOI: 10.1371/journal.pone.0213388. View

Colella M, Frerot A, Rideau Batista Novais A, Baud O . Neonatal and Long-Term Consequences of Fetal Growth Restriction. Curr Pediatr Rev. 2018; 14(4):212-218. PMC: 6416241. DOI: 10.2174/1573396314666180712114531. View

Papageorghiou A, Kennedy S, Salomon L, Altman D, Ohuma E, Stones W . The INTERGROWTH-21 fetal growth standards: toward the global integration of pregnancy and pediatric care. Am J Obstet Gynecol. 2018; 218(2S):S630-S640. DOI: 10.1016/j.ajog.2018.01.011. View

10.

Mathai M, Thomas S, Peedicayil A, Regi A, Jasper P, Joseph R . Growth pattern of the Indian fetus. Int J Gynaecol Obstet. 1995; 48(1):21-4. DOI: 10.1016/0020-7292(94)02237-2. View

11.

Pierdant G, Ittermann T, Freyer-Adam J, Siewert-Markus U, Grabe H, Dorr M . Maternal socioeconomic and lifestyle factors and life dissatisfaction associated with a small for gestational age infant. The Survey of Neonates in Pomerania (SNiP). Arch Gynecol Obstet. 2022; 307(4):1243-1254. PMC: 10023753. DOI: 10.1007/s00404-022-06598-x. View

12.

Ruvolo K, Filly R, Callen P . Evaluation of fetal femur length for prediction of gestational age in a racially mixed obstetric population. J Ultrasound Med. 1987; 6(8):417-9. DOI: 10.7863/jum.1987.6.8.417. View

13.

Wadhwani N, Sundrani D, Wagh G, Mehendale S, Tipnis M, Joshi P . The REVAMP study: research exploring various aspects and mechanisms in preeclampsia: study protocol. BMC Pregnancy Childbirth. 2019; 19(1):308. PMC: 6708134. DOI: 10.1186/s12884-019-2450-0. View

14.

Ferdous F, Rashid M, Ma E, Raqib R, Hamada H, Wagatsuma Y . Fetal growth restriction in rural Bangladesh: a prospective study. Trop Med Health. 2018; 46:3. PMC: 5801896. DOI: 10.1186/s41182-018-0083-z. View

15.

Tinelli A, Bochicchio M, Vaira L, Malvasi A . Ultrasonographic fetal growth charts: an informatic approach by quantitative analysis of the impact of ethnicity on diagnoses based on a preliminary report on Salentinian population. Biomed Res Int. 2014; 2014:386124. PMC: 4083209. DOI: 10.1155/2014/386124. View

16.

Verlijsdonk J, Winkens B, Boers K, Scherjon S, Roumen F . Suspected versus non-suspected small-for-gestational age fetuses at term: perinatal outcomes. J Matern Fetal Neonatal Med. 2011; 25(7):938-43. DOI: 10.3109/14767058.2011.600793. View

17.

Policiano C, Fonseca A, Mendes J, Clode N, Graca L . Small-for-gestational-age babies of low-risk term pregnancies: does antenatal detection matter?. J Matern Fetal Neonatal Med. 2017; 31(11):1426-1430. DOI: 10.1080/14767058.2017.1317741. View

18.

Parilla B, McCulloch C, Sulo S, Curran L, McSherry D . Patterns of fetal growth in an Asian Indian cohort in the USA. Int J Gynaecol Obstet. 2015; 131(2):178-82. DOI: 10.1016/j.ijgo.2015.05.014. View

19.

Villar J, Papageorghiou A, Pang R, Ohuma E, Ismail L, Barros F . The likeness of fetal growth and newborn size across non-isolated populations in the INTERGROWTH-21st Project: the Fetal Growth Longitudinal Study and Newborn Cross-Sectional Study. Lancet Diabetes Endocrinol. 2014; 2(10):781-92. DOI: 10.1016/S2213-8587(14)70121-4. View

20.

Rossen L, Schoendorf K . Trends in racial and ethnic disparities in infant mortality rates in the United States, 1989-2006. Am J Public Health. 2013; 104(8):1549-56. PMC: 4103228. DOI: 10.2105/AJPH.2013.301272. View