The World Health Organization fetal growth charts: concept, findings, interpretation, and application.

Objectives: To compare fetal and neonatal growth charts pertaining to different models (population-specific, universal reference, universal standard and fully customised) in detecting suboptimal fetal growth in the third trimester. Methods: This was a prospective observational study conducted at two fetal medicine centers. After applying the inclusion criteria [singleton pregnancies between 28 and 40 weeks, verified dates and estimated fetal weight (EFW) ≤ 25th centile as per the Hadlock chart], 292 women were consecutively recruited. Four fetal growth charts (Hadlock, Intergrowth, fully customised GROW, Sonocare) and three neonatal charts (Fenton, Intergrowth and fully customised GROW) were used in the study. The EFW and birthweight centiles were categorized into three groups: < 3.0, 3.1–10th and > 10th centiles. The charts were evaluated by their ability to detect pregnancies with uteroplacental insufficiency and/or development of adverse neonatal outcomes in the third trimester. Results: Significant difference was noted between the fetuses/neonates assigned as < 3rd centile (Hadlock-9.3%, Sonocare-4.8%, Intergrowth- 6.8% and the fully customised GROW- 6.5%) and the neonatal charts (Fenton-18.5%, Intergrowth- 20.2% and fully customised GROW- 13.4%). At a cut-off of 3rd centile, the GROW chart had the highest sensitivity (84.2%) followed by Intergrowth (78.9%), Hadlock (70.37%) and Sonocare (64.29%). Similarly, for a cut-off of < 10th, the sensitivity was GROW 70.27%, Sonocare 64%, Intergrowth 60.8% and Hadlock 50%. Amongst the neonatal charts, fully customised GROW chart had the greatest detection rate (< 3rd = 74.36%, < 10th = 70.27%). However, there was no significant difference between the charts in the detection of pregnancies with suboptimal fetal growth associated with uteroplacental insufficiency and/or adverse neonatal outcomes. Conclusion: Despite substantial discrepancy between the growth charts in diagnosing fetal smallness, adding multivessel Doppler negates significant differences between them in diagnosing suboptimal fetal growth associated with uteroplacental insufficiency and adverse neonatal outcomes.

Diagnosis and management of fetal growth restriction: the ISUOG guideline and comparison with the SMFM guideline.

According to the classification system used, 15-60% of stillbirths remain unexplained, despite undergoing recommended autopsy examination, with variable attribution of fetal growth restriction (FGR) as a cause of death. Distinguishing small-for-gestational age (SGA) from pathological FGR is a challenge at postmortem examination. This study uses data from a large, well-characterized series of intrauterine death autopsies to investigate the effects of secondary changes such as fetal maceration, intrauterine retention and postmortem interval on body weight. Autopsy findings from intrauterine death investigations (2005-2013 inclusive, from Great Ormond Street Hospital and St George's Hospital, London) were collated into a research database. Growth charts published by the World Health Organization were used to determine normal expected weight centiles for fetuses born ≥ 24 weeks' gestation, and the effects of intrauterine retention (maceration) and postmortem interval were calculated. There were 1064 intrauterine deaths, including 533 stillbirths ≥ 24 weeks' gestation with a recorded birth weight. Of these, 192 (36%) had an unadjusted birth weight below the 10th centile and were defined as SGA. The majority (86%) of stillborn SGA fetuses demonstrated some degree of maceration, indicating a significant period of intrauterine retention after death. A significantly greater proportion of macerated fetuses were present in the SGA population compared with the non-SGA population (P = 0.01). There was a significant relationship between increasing intrauterine retention interval and both more severe maceration and reduction in birth weight (P < 0.0001 for both), with an average artifactual reduction in birth weight of around -0.8 SD of expected weight. There was an average 12% reduction in fetal weight between delivery and autopsy and, as postmortem interval increased, fetal weight loss increased (P = 0.0001). Based on birth weight alone, 36% of stillbirths are classified as SGA. However, fetuses lose weight in utero with increasing intrauterine retention and continue to lose weight between delivery and autopsy, resulting in erroneous overestimation of FGR. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Appropriate assessment of fetal growth is essential for safe clinical care. There have been many recent strategies to improve the detection of aberrant fetal growth patterns, one of which has been to optimize fetal growth centile charts. Over recent years there has been ongoing debates regarding the optimal growth chart for clinical usage. Controversy can arise where growth charts have demonstrated wide variance in the proportion of fetuses classified within the extremities of growth. Standards for growth charts need to be evidenced based and validated against pregnancy outcomes to demonstrate clinical utility and widespread usage. They should be supplied by high quality methodological reasoning and ideally evidenced through large prospective multicentre studies. Given the variable terminology to classify growth centile charts, including the variety of charts available, a complete understanding by healthcare professional can be troublesome to achieve. This practical guide aims to provide clarity on this diverse subject.

Objectives: Different retrospective growth charts for twin pregnancies debates whether twin growth is similar to singletons. Recently, the fetal medicine foundation (FMF) published a retrospective fetal growth chart that indicated similar growth charts for twins and singleton if only term delivery of both twins without major malformation are included. A national Denish growth chart confirmed these finding. We constructed prospective growth chart of estimated fetal weight (EFW) throughout pregnancy of monochorionic diamniotic (MCDA) and dichorionic (DC) twins using a multi-center, multi-national cohort. Study Design: Pregnancies with two live fetuses at 11-13 wks’ gestation were enrolled. Gestational age was determined from crown-rump length of the larger twin in the first trimester. EFW charts were made from fetal growth at 11-13, 20-22, 24-26, 28-30, 32-34, and 36-37 wks’ gestation using Hadlock-4 formula made of biparietal diameter, head and abdominal circumference, and femur length. Chorionicity specific charts were built for 376 DC and 158 MCDA live twins who were born at term, without malformations. Centers included were from Montreal, Canada, Bonn and Tubingen, Germany, Barcelona, Spain, Rome, Italy, and Zerifin, Israel. ANOVA was used to compare ethnic and centers charts and functional fit to were compared our charts to retrospective EFW charts of the FMF. Results: Growth was slower in MCDA compared with DC twins starting from 21st wks’ gestation and increased with advancing gestation. Our charts were similar but marginally slower than the FMF ones. Smaller EFW were in Barcelona and Rome compared to the larger in Bonn and Tubingen, and fetuses of white women were larger than those of other ethnicities Conclusions: We developed a prospective growth chart for pregnancies with two live DC and MCDA twins born at term without malformations that are consistent with those of the FMF, with small differences between countries and ethnicities.

Giants in Obstetrics and Gynecology Series: Philippe Jeanty, MD, PhD, a pioneer in the study of fetal anatomy, biometry, growth, and congenital anomalies

To establish new standards fetal biometry and growth curves for Indian population. 11567 patients were included in the present study to measure BPD(Biparital diameter), HC (Head circumference), AC (Abdominal circumference), FL (Femur length) and EFW (expected fetal weight). Statistical analysis has been performed using MS excel 2010. Data analysed as recommended by Altman, Chitty and Royton. For each measurement, polynomial regression models were fitted separately to estimate the mean and standard deviation (SD) as functions of gestational age. The SD was modelled via the absolute residuals from the regression to estimate the mean. We have developed fetal biometry for Indian population that can be utilised for clinical practice or fetal size and fetal grow Centile Trendline Equation BPD 1sty = -0.0013x3 + 0.0083x2 + 3.383x + 11.9620.9997, 5thy = -0.0014x3 + 0.0114x2 + 3.3853x + 12.9750.9998, 50thy = -0.0013x3 + 0.0094x2 + 3.4777x + 15.5430.9998, 95thy = -0.0014x3 + 0.013x2 + 3.5186x + 18.0160.9999, 99thy = -0.0014x3 + 0.0106x2 + 3.5725x + 19.1240.9998. Centile Trendline Equation AC 90thy = -0.0046x3 + 0.1042x2 + 11.047x + 54.697 50thy = -0.0037x3 + 0.0711x2 + 10.93x + 48.511 10thy = -0.0027x3 + 0.038x2 + 10.812x + 42.325, 5thy = -0.0026x3 + 0.0326x2 + 10.755x + 40.787, 3rdy = -0.0023x3 + 0.0225x2 + 10.757x + 39.426, 1sty = -0.002x3 + 0.0109x2 + 10.715x + 37.251. Centile Trendline Equation for HC R-squared: 1sty = -0.0049x3 - 0.0029x2 + 13.39x + 45.230.9999,5thy = -0.0048x3 - 0.01x2 + 13.584x + 48.3310.999,950thy = -0.0039x3 - 0.057x2 + 14.444x + 54.3260.9998. Centile Trendline Equation FL 1sty = -0.0006x3 - 0.0089x2 + 3.0605x + 1.6256 5thy = -0.0006x3 - 0.0088x2 + 3.0746x + 2.5481 10thy = -0.0007x3 - 0.0062x2 + 3.0599x + 3.1166 50thy = -0.0007x3 - 0.003x2 + 3.0591x + 4.934. For better diagnosis of fetal growth related problems, we have developed fetal biometry and growth curves for the Indian population to prevent over-diagnosis of intrauterine growth retardation, under diagnosis of fetal macrosomia and correct prediction of fetal age in Indian population. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Fetal intra-uterine growth charts are generally based on last menstrual period (LMP) data. Such charts may not really be applicable to infants whose gestational age is ultrasonically determined in early pregnancy. 1369 consecutive singleton pregnancies were studied. All fetuses had their gestational age estimated both by ultrasonic measurement of fetal crown-rump length and from registered last menstrual period data. All infants were weighed at birth as a part of the routine care. The age determination according to the two methods differed in 664 out of 1369 cases and in 516 of these 664 cases the age according to LMP was higher than according to CRL--a highly significant difference (p less than 0.001). Mean values for birth weight were found to be larger when correlated to age in terms of CRL determinations than when related to age as calculated from LMP data. Birth weight also showed a significant increase between 40 and 42 weeks when age was determined ultrasonically. This was not the case when age determination was based on LMP data. The explanation of this fact is that age is overestimated in late pregnancy when calculated from LMP data. These facts ought to be considered when future fetal growth charts are constructed.

The aim was to investigate whether placental growth and hence pregnancy outcome could be altered by switching adolescent dams from a high to a moderate nutrient intake, and vice-versa, at the end of the first trimester. Embryos recovered from adult ewes inseminated by a single sire were transferred in singleton to peripubertal adolescents. After transfer, adolescent ewes were offered a high (H, n = 33) or moderate (M, n = 32) level of a diet calculated to promote rapid or moderate maternal growth rates, respectively. At Day 50 of gestation, half the ewes had their dietary intakes switched, yielding 4 treatment groups: HH, MM, HM, and MH. A subset of ewes were killed at Day 104 of gestation to determine maternal body composition in relation to growth of the products of conception. Maternal body composition measurements revealed that the higher live weight in the high-intake dams was predominantly due to an increase in body fat deposition, with a less pronounced increase in body protein. At Day 104, HH and MH groups (high intake during second trimester) compared with MM and HM groups (moderate intake during second trimester) had a lower (p < 0.002) total fetal cotyledon weight; but fetal weight, conformation, and individual organ weights were not significantly influenced by maternal dietary intake. In ewes delivering live young at term, a high plane of nutrition from the end of the first trimester (HH and MH groups) compared with moderate levels (MM and HM groups) was associated with a reduction in gestation length (p < 0.009), total placental weight (p < 0.002), total fetal cotyledon weight (p < 0.001), and mean fetal cotyledon weight per placenta (p < 0.001). Fetal cotyledon number was dependent on maternal dietary intake during the first trimester only and was lower (p < 0.007) in HH and HM ewes compared to MM and MH ewes. The inhibition of fetal cotyledon growth in HH and MH groups was associated with a major decrease (p < 0.001) in lamb birth weight at term relative to the MM and HM groups. Thus, reducing maternal dietary intake from a high to a moderate level at the end of the first trimester stimulates placental growth and enhances pregnancy outcome, and increasing maternal dietary intake at this time point has a deleterious effect on placental development and fetal growth.

Can ultrasound fetal biometry predict fetal hyperinsulinaemia at delivery in pregnancy complicated by maternal diabetes?

The possibility that maternal unilateral ovariectomy, which is said to enhance fetal growth, might also ameliorate the harmful of undernutrition was investigated. Maternal undernutrition throughout pregnancy and unilateral ovariectomy on day 13 of pregnancy were investigated separately and in combination in primigravid rats with respect to male and female placental and fetal growth. Undernutrition increased the number of fetal resorptions in the 3rd week of pregnancy and depressed placental and fetal weights in both sexes, although there was some relative sparing of fetal brain weight. Unilateral ovariectomy of well-nourished mothers on day 13 of pregnancy caused significant increments in placental weight, and fetal body and brain weight in both sexes, but not in fetal length. None of these effects were observed in underfed mothers; that is, unilateral ovariectomy was ineffective in ameliorating the consequences for the fetus of maternal undernutrition. In none of the groups was there a significant relationship between fetal body weight and the number of fetuses, although in the undernourished litters significant negative correlations between fetal body weight and total number of placentae (normal and supernumerary) were found.

Third trimester fetal lung volume, thoracic circumference, and early infant lung function.

Consensus and controversies of international guidelines for the diagnosis, surveillance, and management of fetal growth restriction: an updated comparison.

Enhancing placental insulin-like growth factor (IGF) availability appears to be an attractive strategy for improving outcomes in fetal growth restriction (FGR). Our approach was the novel use of [Leu27]IGF-II, a human IGF-II analog that binds the IGF-II clearance receptor IGF-IIR in fetal growth-restricted (FGR) mice. We hypothesized that the impact of [Leu27]IGF-II infusion in C57BL/6J (wild-type) and endothelial nitric oxide synthase knockout (eNOS−/−; FGR) mice would be to enhance fetal growth and investigated this from mid- to late gestation; 1 mg·kg−1·day−1 [Leu27]IGF-II was delivered via a subcutaneous miniosmotic pump from E12.5 to E18.5. Fetal and placental weights recorded at E18.5 were used to generate frequency distribution curves; fetuses <5th centile were deemed growth restricted. Placentas were harvested for immunohistochemical analysis of the IGF system, and maternal serum was collected for measurement of exogenously administered IGF-II. In WT pregnancies, [Leu27]IGF-II treatment halved the number of FGR fetuses, reduced fetal(P = 0.028) and placental weight variations (P = 0.0032), and increased the numbers of pups close to the mean fetal weight (131 vs. 112 pups within 1 SD). Mixed-model analysis confirmed litter size to be negatively correlated with fetal and placental weight and showed that [Leu27]IGF-II preferentially improved fetal weight in the largest litters, as defined by number. Unidirectional 14CMeAIB transfer per gram placenta (System A amino acid transporter activity) was inversely correlated with fetal weight in [Leu27]IGF-II-treated WT animals (P < 0.01). In eNOS−/− mice, [Leu27]IGF-II reduced the number of FGR fetuses(1 vs. 5 in the untreated group). The observed reduction in FGR pup numbers in both C57 and eNOS−/− litters suggests the use of this analog as a means of standardizing and rescuing fetal growth, preferentially in the smallest offspring.

BackgroundLittle is known about whether patterns of early growth are associated with altered respiratory and immune development. This study relates prenatal and infant growth patterns to wheeze and atopy at...