TY - JOUR
T1 - International versus national growth charts for identifying small and large-for-gestational age newborns
T2 - A population-based study in 15 European countries
AU - Hocquette, Alice
AU - Durox, Mélanie
AU - Wood, Rachael
AU - Klungsøyr, Kari
AU - Szamotulska, Katarzyna
AU - Berrut, Sylvan
AU - Rihs, Tonia
AU - Kyprianou, Theopisti
AU - Sakkeus, Luule
AU - Lecomte, Aline
AU - Zile, Irisa
AU - Alexander, Sophie
AU - Klimont, Jeannette
AU - Barros, Henrique
AU - Gatt, Miriam
AU - Isakova, Jelena
AU - Blondel, Béatrice
AU - Gissler, Mika
AU - Zeitlin, Jennifer
N1 - Funding Information:
The Euro-Peristat network receives funding from the European Commission as part of the InfAct (Information for Action) Joint Action (Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) Grant n° 801,553). This work was conducted as part of the ConcePTION project which has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 821,520. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation program and EFPIA. Alice HOCQUETTE was supported by a PhD grant from EHESP. While the research leading to these Results was conducted as part of the ConcePTION consortium, this paper only reflects the personal views of the stated authors.
Publisher Copyright:
© 2021 The Authors
PY - 2021/9
Y1 - 2021/9
N2 - Background: To inform the on-going debate about the use of universal prescriptive versus national intrauterine growth charts, we compared perinatal mortality for small and large-for-gestational-age (SGA/LGA) infants according to international and national charts in Europe. Methods: We classified singleton births from 33 to 42 weeks of gestation in 2010 and 2014 from 15 countries (N = 1,475,457) as SGA (birthweight <10th percentile) and LGA (>90th percentile) using the international Intergrowth-21st newborn standards and national charts based on the customised charts methodology. We computed sex-adjusted odds ratios (aOR) for stillbirth, neonatal and extended perinatal mortality by this classification using multilevel models. Findings: SGA and LGA prevalence using national charts were near 10% in all countries, but varied according to international charts with a north to south gradient (3.0% to 10.1% and 24.9% to 8.0%, respectively). Compared with appropriate for gestational age (AGA) infants by both charts, risk of perinatal mortality was increased for SGA by both charts (aOR[95% confidence interval (CI)]=6.1 [5.6–6.7]) and infants reclassified by international charts from SGA to AGA (2.7 [2.3–3.1]), but decreased for those reclassified from AGA to LGA (0.6 [0.4–0.7]). Results were similar for stillbirth and neonatal death. Interpretation: Using international instead of national charts in Europe could lead to growth restricted infants being reclassified as having normal growth, while infants with low risks of mortality could be reclassified as having excessive growth. Funding: InfAct Joint Action, CHAFEA Grant n°801,553 and EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking ConcePTION grant n°821,520. AH received a PhD grant from EHESP.
AB - Background: To inform the on-going debate about the use of universal prescriptive versus national intrauterine growth charts, we compared perinatal mortality for small and large-for-gestational-age (SGA/LGA) infants according to international and national charts in Europe. Methods: We classified singleton births from 33 to 42 weeks of gestation in 2010 and 2014 from 15 countries (N = 1,475,457) as SGA (birthweight <10th percentile) and LGA (>90th percentile) using the international Intergrowth-21st newborn standards and national charts based on the customised charts methodology. We computed sex-adjusted odds ratios (aOR) for stillbirth, neonatal and extended perinatal mortality by this classification using multilevel models. Findings: SGA and LGA prevalence using national charts were near 10% in all countries, but varied according to international charts with a north to south gradient (3.0% to 10.1% and 24.9% to 8.0%, respectively). Compared with appropriate for gestational age (AGA) infants by both charts, risk of perinatal mortality was increased for SGA by both charts (aOR[95% confidence interval (CI)]=6.1 [5.6–6.7]) and infants reclassified by international charts from SGA to AGA (2.7 [2.3–3.1]), but decreased for those reclassified from AGA to LGA (0.6 [0.4–0.7]). Results were similar for stillbirth and neonatal death. Interpretation: Using international instead of national charts in Europe could lead to growth restricted infants being reclassified as having normal growth, while infants with low risks of mortality could be reclassified as having excessive growth. Funding: InfAct Joint Action, CHAFEA Grant n°801,553 and EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking ConcePTION grant n°821,520. AH received a PhD grant from EHESP.
KW - fetal growth
KW - fetal growth charts
KW - large for gestational age
KW - small for gestational age
UR - http://www.scopus.com/inward/record.url?scp=85120357835&partnerID=8YFLogxK
UR - https://www.ncbi.nlm.nih.gov/pubmed/34557855
U2 - 10.1016/j.lanepe.2021.100167
DO - 10.1016/j.lanepe.2021.100167
M3 - Article
C2 - 34557855
SN - 2666-7762
VL - 8
JO - The Lancet Regional Health - Europe
JF - The Lancet Regional Health - Europe
M1 - 100167
ER -