Individualized norms of optimal fetal growth: Fetal growth potential

Radek Bukowski, Tatsuo Uchida, Gordon C S Smith, Fergal D. Malone, Robert H. Ball, David A. Nyberg, Christine H. Comstock, Gary Hankins, Richard L. Berkowitz, Susan J. Gross, Lorraine Dugoff, Sabrina D. Craigo, Ilan E. Timor, Stephen R. Carr, Honor M. Wolfe, Mary E. D'Alton

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

OBJECTIVE: To demonstrate that individualized optimal fetal growth norms, accounting for physiologic and pathologic determinants of fetal growth, better identify normal and abnormal outcomes of pregnancy than existing methods. METHODS: In a prospective cohort of 38,033 singleton pregnancies, we identified 9,818 women with a completely normal outcome of pregnancy and characterized the physiologic factors affecting birth weight using multivariable regression. We used those physiologic factors to individually predict optimal growth trajectory and its variation, growth potential, for each fetus in the entire cohort. By comparing actual birth weight with growth potential, population, ultrasound, and customized norms, we calculated for each fetus achieved percentiles, by each norm. We then compared proportions of pregnancies classified as normally grown, between 10th and 90th percentile, or aberrantly grown, outside this interval, by growth potential and traditional norms, in 14,229 complicated pregnancies, 1,518 pregnancies with diabetes or hypertensive disorders, and 1,347 pregnancies with neonatal complications. RESULTS: Nineteen physiologic factors, associated with maternal characteristics and early placental function, were identified. Growth potential norms correctly classified significantly more pregnancies than population, ultrasound, or customized norms in complicated pregnancies (26.4% compared with 18.3%, 18.7%, 22.8%, respectively, all P<.05), pregnancies with diabetes or hypertensive disorders (37.3% compared with 23.0%, 28.0%, 34.0%, respectively, all P<.05) and neonatal complications (33.3% compared with 19.7%, 24.9%, 29.8%, respectively, all P<.05). CONCLUSION: Growth potential norms based on the physiologic determinants of birth weight are a better discriminator of aberrations of fetal growth than traditional norms.

Original languageEnglish (US)
Pages (from-to)1065-1076
Number of pages12
JournalObstetrics and Gynecology
Volume111
Issue number5
DOIs
StatePublished - May 2008
Externally publishedYes

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Fetal Development
Pregnancy
Birth Weight
Growth
Pregnancy Outcome
Fetus
Population Growth
Mothers
Population

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Bukowski, R., Uchida, T., Smith, G. C. S., Malone, F. D., Ball, R. H., Nyberg, D. A., ... D'Alton, M. E. (2008). Individualized norms of optimal fetal growth: Fetal growth potential. Obstetrics and Gynecology, 111(5), 1065-1076. https://doi.org/10.1097/AOG.0b013e3181704e48

Individualized norms of optimal fetal growth : Fetal growth potential. / Bukowski, Radek; Uchida, Tatsuo; Smith, Gordon C S; Malone, Fergal D.; Ball, Robert H.; Nyberg, David A.; Comstock, Christine H.; Hankins, Gary; Berkowitz, Richard L.; Gross, Susan J.; Dugoff, Lorraine; Craigo, Sabrina D.; Timor, Ilan E.; Carr, Stephen R.; Wolfe, Honor M.; D'Alton, Mary E.

In: Obstetrics and Gynecology, Vol. 111, No. 5, 05.2008, p. 1065-1076.

Research output: Contribution to journalArticle

Bukowski, R, Uchida, T, Smith, GCS, Malone, FD, Ball, RH, Nyberg, DA, Comstock, CH, Hankins, G, Berkowitz, RL, Gross, SJ, Dugoff, L, Craigo, SD, Timor, IE, Carr, SR, Wolfe, HM & D'Alton, ME 2008, 'Individualized norms of optimal fetal growth: Fetal growth potential', Obstetrics and Gynecology, vol. 111, no. 5, pp. 1065-1076. https://doi.org/10.1097/AOG.0b013e3181704e48
Bukowski R, Uchida T, Smith GCS, Malone FD, Ball RH, Nyberg DA et al. Individualized norms of optimal fetal growth: Fetal growth potential. Obstetrics and Gynecology. 2008 May;111(5):1065-1076. https://doi.org/10.1097/AOG.0b013e3181704e48
Bukowski, Radek ; Uchida, Tatsuo ; Smith, Gordon C S ; Malone, Fergal D. ; Ball, Robert H. ; Nyberg, David A. ; Comstock, Christine H. ; Hankins, Gary ; Berkowitz, Richard L. ; Gross, Susan J. ; Dugoff, Lorraine ; Craigo, Sabrina D. ; Timor, Ilan E. ; Carr, Stephen R. ; Wolfe, Honor M. ; D'Alton, Mary E. / Individualized norms of optimal fetal growth : Fetal growth potential. In: Obstetrics and Gynecology. 2008 ; Vol. 111, No. 5. pp. 1065-1076.
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AU - Bukowski, Radek

AU - Uchida, Tatsuo

AU - Smith, Gordon C S

AU - Malone, Fergal D.

AU - Ball, Robert H.

AU - Nyberg, David A.

AU - Comstock, Christine H.

AU - Hankins, Gary

AU - Berkowitz, Richard L.

AU - Gross, Susan J.

AU - Dugoff, Lorraine

AU - Craigo, Sabrina D.

AU - Timor, Ilan E.

AU - Carr, Stephen R.

AU - Wolfe, Honor M.

AU - D'Alton, Mary E.

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N2 - OBJECTIVE: To demonstrate that individualized optimal fetal growth norms, accounting for physiologic and pathologic determinants of fetal growth, better identify normal and abnormal outcomes of pregnancy than existing methods. METHODS: In a prospective cohort of 38,033 singleton pregnancies, we identified 9,818 women with a completely normal outcome of pregnancy and characterized the physiologic factors affecting birth weight using multivariable regression. We used those physiologic factors to individually predict optimal growth trajectory and its variation, growth potential, for each fetus in the entire cohort. By comparing actual birth weight with growth potential, population, ultrasound, and customized norms, we calculated for each fetus achieved percentiles, by each norm. We then compared proportions of pregnancies classified as normally grown, between 10th and 90th percentile, or aberrantly grown, outside this interval, by growth potential and traditional norms, in 14,229 complicated pregnancies, 1,518 pregnancies with diabetes or hypertensive disorders, and 1,347 pregnancies with neonatal complications. RESULTS: Nineteen physiologic factors, associated with maternal characteristics and early placental function, were identified. Growth potential norms correctly classified significantly more pregnancies than population, ultrasound, or customized norms in complicated pregnancies (26.4% compared with 18.3%, 18.7%, 22.8%, respectively, all P<.05), pregnancies with diabetes or hypertensive disorders (37.3% compared with 23.0%, 28.0%, 34.0%, respectively, all P<.05) and neonatal complications (33.3% compared with 19.7%, 24.9%, 29.8%, respectively, all P<.05). CONCLUSION: Growth potential norms based on the physiologic determinants of birth weight are a better discriminator of aberrations of fetal growth than traditional norms.

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