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Prediction of adverse perinatal outcome by fetal biometry: comparison of customized and populationâ based standards
dc.contributor.authorKabiri, D.
dc.contributor.authorRomero, R.
dc.contributor.authorGudicha, D. W.
dc.contributor.authorHernandez‐andrade, E.
dc.contributor.authorPacora, P.
dc.contributor.authorBenshalom‐tirosh, N.
dc.contributor.authorTirosh, D.
dc.contributor.authorYeo, L.
dc.contributor.authorErez, O.
dc.contributor.authorHassan, S. S.
dc.contributor.authorTarca, A. L.
dc.date.accessioned2020-02-05T15:08:23Z
dc.date.availableWITHHELD_13_MONTHS
dc.date.available2020-02-05T15:08:23Z
dc.date.issued2020-02
dc.identifier.citationKabiri, D.; Romero, R.; Gudicha, D. W.; Hernandez‐andrade, E. ; Pacora, P.; Benshalom‐tirosh, N. ; Tirosh, D.; Yeo, L.; Erez, O.; Hassan, S. S.; Tarca, A. L. (2020). "Prediction of adverse perinatal outcome by fetal biometry: comparison of customized and populationâ based standards." Ultrasound in Obstetrics & Gynecology 55(2): 177-188.
dc.identifier.issn0960-7692
dc.identifier.issn1469-0705
dc.identifier.urihttps://hdl.handle.net/2027.42/153734
dc.description.abstractObjectiveTo compare the predictive performance of estimated fetal weight (EFW) percentiles, according to eight growth standards, to detect fetuses at risk for adverse perinatal outcome.MethodsThis was a retrospective cohort study of 3437 Africanâ American women. Populationâ based (Hadlock, INTERGROWTHâ 21st, World Health Organization (WHO), Fetal Medicine Foundation (FMF)), ethnicityâ specific (Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)), customized (Gestationâ Related Optimal Weight (GROW)) and Africanâ American customized (Perinatology Research Branch (PRB)/NICHD) growth standards were used to calculate EFW percentiles from the last available scan prior to delivery. Prediction performance indices and relative risk (RR) were calculated for EFW <â 10th and >â 90th percentiles, according to each standard, for individual and composite adverse perinatal outcomes. Sensitivity at a fixed (10%) falseâ positive rate (FPR) and partial (FPR <â 10%) and full areas under the receiverâ operatingâ characteristics curves (AUC) were compared between the standards.ResultsTen percent (341/3437) of neonates were classified as smallâ forâ gestational age (SGA) at birth, and of these 16.4% (56/341) had at least one adverse perinatal outcome. SGA neonates had a 1.5â fold increased risk of any adverse perinatal outcome (Pâ <â 0.05). The screenâ positive rate of EFW <â 10th percentile varied from 6.8% (NICHD) to 24.4% (FMF). EFW <â 10th percentile, according to all standards, was associated with an increased risk for each of the adverse perinatal outcomes considered (Pâ <â 0.05 for all). The highest RRs associated with EFW <â 10th percentile for each adverse outcome were 5.1 (95%â CI, 2.1â 12.3) for perinatal mortality (WHO); 5.0 (95%â CI, 3.2â 7.8) for perinatal hypoglycemia (NICHD); 3.4 (95%â CI, 2.4â 4.7) for mechanical ventilation (NICHD); 2.9 (95%â CI, 1.8â 4.6) for 5â min Apgar score <â 7 (GROW); 2.7 (95%â CI, 2.0â 3.6) for neonatal intensive care unit (NICU) admission (NICHD); and 2.5 (95%â CI, 1.9â 3.1) for composite adverse perinatal outcome (NICHD). Although the RR CIs overlapped among all standards for each individual outcome, the RR of composite adverse perinatal outcome in pregnancies with EFW <â 10th percentile was higher according to the NICHD (2.46; 95%â CI, 1.9â 3.1) than the FMF (1.47; 95%â CI, 1.2â 1.8) standard. The sensitivity for composite adverse perinatal outcome varied substantially between standards, ranging from 15% for NICHD to 32% for FMF, due mostly to differences in FPR; this variation subsided when the FPR was set to the same value (10%). Analysis of AUC revealed significantly better performance for the prediction of perinatal mortality by the PRB/NICHD standard (AUCâ =â 0.70) compared with the Hadlock (AUCâ =â 0.66) and FMF (AUCâ =â 0.64) standards. Evaluation of partial AUC (FPR <â 10%) demonstrated that the INTERGROWTHâ 21st standard performed better than the Hadlock standard for the prediction of NICU admission and mechanical ventilation (Pâ <â 0.05 for both). Although fetuses with EFW >â 90th percentile were also at risk for any adverse perinatal outcome according to the INTERGROWTHâ 21st (RRâ =â 1.4; 95%â CI, 1.0â 1.9) and Hadlock (RRâ =â 1.7; 95%â CI, 1.1â 2.6) standards, many times fewer cases (2â 5â fold lower sensitivity) were detected by using EFW >â 90th percentile, rather than EFW <â 10th percentile, in screening by these standards.ConclusionsFetuses with EFW <â 10th percentile or EFW >â 90th percentile were at increased risk of adverse perinatal outcomes according to all or some of the eight growth standards, respectively. The RR of a composite adverse perinatal outcome in pregnancies with EFW <â 10th percentile was higher for the mostâ stringent (NICHD) compared with the leastâ stringent (FMF) standard. The results of the complementary analysis of AUC suggest slightly improved detection of adverse perinatal outcome by more recent populationâ based (INTERGROWTHâ 21st) and customized (PRB/NICHD) standards compared with the Hadlock and FMF standards. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.
dc.publisherJohn Wiley & Sons, Ltd.
dc.subject.otherneonatal intensive care unit admission
dc.subject.otherperinatal mortality
dc.subject.othermechanical ventilation
dc.subject.othergrowth restriction
dc.subject.otherestimated fetal weight
dc.subject.othercustomized fetal growth standards
dc.subject.otherperinatal morbidity
dc.titlePrediction of adverse perinatal outcome by fetal biometry: comparison of customized and populationâ based standards
dc.typeArticle
dc.rights.robotsIndexNoFollow
dc.subject.hlbsecondlevelObstetrics and Gynecology
dc.subject.hlbtoplevelHealth Sciences
dc.description.peerreviewedPeer Reviewed
dc.description.bitstreamurlhttps://deepblue.lib.umich.edu/bitstream/2027.42/153734/1/uog20299.pdf
dc.description.bitstreamurlhttps://deepblue.lib.umich.edu/bitstream/2027.42/153734/2/uog20299_am.pdf
dc.identifier.doi10.1002/uog.20299
dc.identifier.sourceUltrasound in Obstetrics & Gynecology
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dc.owningcollnameInterdisciplinary and Peer-Reviewed


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