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Obstetrics & Gynecology 2008;111:1065-1076
© 2008 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Individualized Norms of Optimal Fetal Growth

Fetal Growth Potential

Radek Bukowski, MD, PhD1, Tatsuo Uchida, MS1, Gordon C. S. Smith, MD, PhD2, Fergal D. Malone, MD3, Robert H. Ball, MD4, David A. Nyberg, MD5, Christine H. Comstock, MD6, Gary D. V. Hankins, MD1, Richard L. Berkowitz, MD7, Susan J. Gross, MD8, Lorraine Dugoff, MD9, Sabrina D. Craigo, MD10, Ilan E. Timor, MD11, Stephen R. Carr, MD12, Honor M. Wolfe, MD13, Mary E. D’Alton, MD7 for the First and Second Trimester Evaluation of Risk (FASTER) Research Consortium

From the 1Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas; 2Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, United Kingdom; 3Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland; 4University of Utah and Intermountain HealthCare, Salt Lake City, Utah; 5Swedish Medical Center, Seattle, Washington; 6William Beaumont Hospital, Royal Oak, Michigan; 7Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York; 8Albert Einstein College of Medicine, Bronx, New York; 9University of Colorado Health Sciences Center, Denver, Colorado; 10Tufts University School of Medicine, Boston, Massachusetts; 11New York University School of Medicine, New York, New York; 12Brown University School of Medicine, Providence, Rhode Island; and 13University of North Carolina Medical Center, Chapel Hill, North Carolina.

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.

LEVEL OF EVIDENCE: II






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