A United States National Reference for Fetal Growth

Objective: To develop a current national fetal growth curve that can be used as a common reference point by researchers to facilitate investigations of the predictors and consequences of small and large for gestational age delivery.

Methods: Single live births to United States resident mothers in 1991 (n = 3,134,879) were used for the development of this curve, which was compared with four previously published fetal growth curves. Techniques were developed to address cases with implausible birth weight-gestational age combinations and to smooth fetal growth curves across gestational age categories.

Results: In general, the previously published fetal growth curves underestimated the 1991 United States reference curve. This underestimation is most apparent during the latter weeks of gestation, approximately 33-38 weeks.

Conclusion: Our findings indicate that the prevalence of fetal growth restriction (FGR) will vary markedly, depending on the fetal growth curve used. Furthermore, many previously published fetal growth curves no longer provide an up-to-date reference for describing the distribution of birth weight by gestational age and for determining FGR that is consistent with the most recent live birth data for the entire United States.