Diagnostic accuracy of individual antenatal tools for prediction of small‐for‐gestational age at birth

Poljak, B, Agarwal, U, Jackson, R, Alfirevic, Z ORCID: 0000-0001-9276-518X and Sharp, AN ORCID: 0000-0003-3396-7464
(2017) Diagnostic accuracy of individual antenatal tools for prediction of small‐for‐gestational age at birth. Ultrasound in Obstetrics and Gynecology, 49 (4). 493 - 499.

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Objective To determine the accuracy of fetal and newborn growth charts for the prediction of small‐for‐gestational age (SGA ) at birth (birth weight < 10th centile). Methods This was a prospective cohort study performed within a UK specialist fetal growth clinic. A total of 105 consecutive pregnant women referred for a suspected SGA fetus were included. All pregnancies were managed according to a standard protocol using estimated fetal weight (EFW ) plotted on customized Gestation Related Optimal Weight (GROW ) charts. The last antenatal estimates of EFW (according to charts of GROW , Hadlock et al . and Mikolajczyk et al .), abdominal circumference (AC ) (according to charts of Hadlock et al ., INTERGROWTH‐21st Project and Chitty et al .) or change in AC over time (calculated according to Pregnancy Outcome Prediction (POP ) study) were compared against four birth‐weight charts (GROW , INTERGROWTH‐21st, Mikolajczyk et al . and World Health Organization (WHO)). The ability of each antenatal test to predict adverse perinatal outcome (APO ) was assessed. Results Birth weight < 10th centile was assigned in 62 (59%) neonates using the GROW chart, 57 (54%) using the Mikolajczyk et al. chart, 55 (52%) using the INTERGROWTH‐21st chart and 51 (49%) using the WHO chart. AC ‐Hadlock had the best negative likelihood ratio (range, 0.3–0.4) and sensitivity (range, 74%–82%) for predicting SGA as defined by all four postnatal birth‐weight charts. AC ‐INTERGROWTH ‐21st had the best positive likelihood ratio (range, 5.9–10.9) and specificity (94%–96%). For prediction of APO , AC ‐Hadlock and EFW ‐GROW had the best sensitivities (57% and 52%, respectively), whereas AC ‐POP had the best positive likelihood ratio (2.2) and specificity (88%). Antenatal prediction of APO increased to a sensitivity of 61% when AC ‐POP and EFW ‐GROW were combined; however, specificity was only 56%. Conclusions We have identified wide variation in the diagnostic accuracy of various antenatal tools for the prediction of both SGA and APO , dependent on the choice of chart. Suboptimal diagnostic accuracy of commonly used antenatal tests may lead to increasing medicalization without prevention of APO . Researchers should focus their attention on a combination of fetal biometry and biomarkers for better prediction of SGA and prevention of APO . Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Item Type: Article
Uncontrolled Keywords: fetal growth restriction, small‐for‐gestational age, ultrasound prediction
Depositing User: Symplectic Admin
Date Deposited: 25 Jul 2016 09:30
Last Modified: 13 Nov 2020 14:42
DOI: 10.1002/uog.17211
Related URLs:
URI: http://livrepository.liverpool.ac.uk/id/eprint/3002487