Comparison of US Birth Weight References and the International Fetal and Newborn Growth Consortium for the 21st Century Standard

Naoko Kozuki; Joanne Katz; Parul Christian; Anne Cc Lee; Li Liu; Mariangela F Silveira; Fernando Barros; James M Tielsch; Christentze Schmiegelow; Ayesha Sania; Dominique Roberfroid; Richard Ndyomugyenyi; Luke C Mullany; Aroonsri Mongkolchati; Lieven Huybregts; Jean Humphrey; Wafaie Fawzi; Abdullah H Baqui; Linda Adair; Vanessa M Oddo; Robert E Black; Child Health Epidemiology Reference Group Preterm Birth–SGA Working Group

doi:10.1001/jamapediatrics.2015.1438

Comparison of US Birth Weight References and the International Fetal and Newborn Growth Consortium for the 21st Century Standard

Naoko Kozuki, Joanne Katz, Parul Christian, Anne Cc Lee, Li Liu, Mariangela F Silveira, Fernando Barros, James M Tielsch, Christentze Schmiegelow, Ayesha Sania, Dominique Roberfroid, Richard Ndyomugyenyi, Luke C Mullany, Aroonsri Mongkolchati, Lieven Huybregts, Jean Humphrey, Wafaie Fawzi, Abdullah H Baqui, Linda Adair, Vanessa M OddoRobert E Black, Child Health Epidemiology Reference Group Preterm Birth–SGA Working Group

29 Citations (Scopus)

Abstract

IMPORTANCE This study introduces how the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) international birth weight standards alter our previous understanding and interpretations of fetal growth restriction as represented by small for gestational age (SGA) status. OBJECTIVES To compare the birth weight distributions of the INTERGROWTH-21st international standard to commonly used US references and examine the differences in the prevalence and neonatal mortality risk of SGA status (below the 10th percentile of a population reference). DESIGN, SETTING, AND PARTICIPANTS We analyzed data from 16 prospective cohorts of newborns on gestational age, birth weight, and systematic mortality follow-up through 28 days from 10 low- And middle-income countries. The studies included were conducted between 1983 and 2008. The analysis was conducted in 2014. Infants were categorized as SGA using the 1991 US birth weight reference, the 1999-2000 US birth weight reference, and the new INTERGROWTH-21st standard. For each study, we compared the SGA prevalence and the risk ratio between SGA status and neonatal mortality, calculated using Poisson regression with robust error variance. MAIN OUTCOMES AND MEASURES We examine neonatal mortality (death within the first 28 days after birth) as the main outcome measure. RESULTS The pooled SGA prevalence was 23.7%(95%CI, 16.5%-31.0%) using the INTERGROWTH-21st standard compared with 36.0%(95%CI, 27.0%-45.0%) with the US 2000 reference. The relative decrease in prevalence was larger among infants born at 33 to less than 37 weeks' gestation compared with term infants. The pooled neonatal mortality risk did not differ significantly; the adjusted risk ratios were 2.13 (95%CI, 1.78-2.54; P < .001) for the INTERGROWTH-21st standard and 2.12 (95%CI, 1.81-2.48; P < .001) for the US 2000 reference. CONCLUSIONS AND RELEVANCE To our knowledge, INTERGROWTH-21st is the first international newborn standard for size for gestational age for healthy fetal growth.We observed a greater-than-one-quarter reduction in SGA prevalence and no significant change in the associated neonatal mortality risk, resulting in a decrease in the percentage of neonatal death attributable to SGA. Our study sheds light on how previously published studies on SGA status may be reinterpreted with the introduction of this new birth weight standard.

Original language	English
Article number	e151438
Journal	J A M A Pediatrics
Volume	169
Issue number	7
Number of pages	8
ISSN	2168-6203
DOIs	https://doi.org/10.1001/jamapediatrics.2015.1438
Publication status	Published - 1 Jul 2015

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Kozuki, N., Katz, J., Christian, P., Lee, A. C., Liu, L., Silveira, M. F., Barros, F., Tielsch, J. M., Schmiegelow, C., Sania, A., Roberfroid, D., Ndyomugyenyi, R., Mullany, L. C., Mongkolchati, A., Huybregts, L., Humphrey, J., Fawzi, W., Baqui, A. H., Adair, L., ... Child Health Epidemiology Reference Group Preterm Birth–SGA Working Group (2015). Comparison of US Birth Weight References and the International Fetal and Newborn Growth Consortium for the 21st Century Standard. J A M A Pediatrics, 169(7), Article e151438. https://doi.org/10.1001/jamapediatrics.2015.1438

Kozuki, N, Katz, J, Christian, P, Lee, AC, Liu, L, Silveira, MF, Barros, F, Tielsch, JM, Schmiegelow, C, Sania, A, Roberfroid, D, Ndyomugyenyi, R, Mullany, LC, Mongkolchati, A, Huybregts, L, Humphrey, J, Fawzi, W, Baqui, AH, Adair, L, Oddo, VM, Black, RE & Child Health Epidemiology Reference Group Preterm Birth–SGA Working Group 2015, 'Comparison of US Birth Weight References and the International Fetal and Newborn Growth Consortium for the 21st Century Standard', J A M A Pediatrics, vol. 169, no. 7, e151438. https://doi.org/10.1001/jamapediatrics.2015.1438

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abstract = "IMPORTANCE This study introduces how the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) international birth weight standards alter our previous understanding and interpretations of fetal growth restriction as represented by small for gestational age (SGA) status. OBJECTIVES To compare the birth weight distributions of the INTERGROWTH-21st international standard to commonly used US references and examine the differences in the prevalence and neonatal mortality risk of SGA status (below the 10th percentile of a population reference). DESIGN, SETTING, AND PARTICIPANTS We analyzed data from 16 prospective cohorts of newborns on gestational age, birth weight, and systematic mortality follow-up through 28 days from 10 low- And middle-income countries. The studies included were conducted between 1983 and 2008. The analysis was conducted in 2014. Infants were categorized as SGA using the 1991 US birth weight reference, the 1999-2000 US birth weight reference, and the new INTERGROWTH-21st standard. For each study, we compared the SGA prevalence and the risk ratio between SGA status and neonatal mortality, calculated using Poisson regression with robust error variance. MAIN OUTCOMES AND MEASURES We examine neonatal mortality (death within the first 28 days after birth) as the main outcome measure. RESULTS The pooled SGA prevalence was 23.7%(95%CI, 16.5%-31.0%) using the INTERGROWTH-21st standard compared with 36.0%(95%CI, 27.0%-45.0%) with the US 2000 reference. The relative decrease in prevalence was larger among infants born at 33 to less than 37 weeks' gestation compared with term infants. The pooled neonatal mortality risk did not differ significantly; the adjusted risk ratios were 2.13 (95%CI, 1.78-2.54; P < .001) for the INTERGROWTH-21st standard and 2.12 (95%CI, 1.81-2.48; P < .001) for the US 2000 reference. CONCLUSIONS AND RELEVANCE To our knowledge, INTERGROWTH-21st is the first international newborn standard for size for gestational age for healthy fetal growth.We observed a greater-than-one-quarter reduction in SGA prevalence and no significant change in the associated neonatal mortality risk, resulting in a decrease in the percentage of neonatal death attributable to SGA. Our study sheds light on how previously published studies on SGA status may be reinterpreted with the introduction of this new birth weight standard.",

author = "Naoko Kozuki and Joanne Katz and Parul Christian and Lee, {Anne Cc} and Li Liu and Silveira, {Mariangela F} and Fernando Barros and Tielsch, {James M} and Christentze Schmiegelow and Ayesha Sania and Dominique Roberfroid and Richard Ndyomugyenyi and Mullany, {Luke C} and Aroonsri Mongkolchati and Lieven Huybregts and Jean Humphrey and Wafaie Fawzi and Baqui, {Abdullah H} and Linda Adair and Oddo, {Vanessa M} and Black, {Robert E} and {Child Health Epidemiology Reference Group Preterm Birth–SGA Working Group}",

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doi = "10.1001/jamapediatrics.2015.1438",

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T1 - Comparison of US Birth Weight References and the International Fetal and Newborn Growth Consortium for the 21st Century Standard

AU - Kozuki, Naoko

AU - Katz, Joanne

AU - Christian, Parul

AU - Lee, Anne Cc

AU - Liu, Li

AU - Silveira, Mariangela F

AU - Barros, Fernando

AU - Tielsch, James M

AU - Schmiegelow, Christentze

AU - Sania, Ayesha

AU - Roberfroid, Dominique

AU - Ndyomugyenyi, Richard

AU - Mullany, Luke C

AU - Mongkolchati, Aroonsri

AU - Huybregts, Lieven

AU - Humphrey, Jean

AU - Fawzi, Wafaie

AU - Baqui, Abdullah H

AU - Adair, Linda

AU - Oddo, Vanessa M

AU - Black, Robert E

AU - Child Health Epidemiology Reference Group Preterm Birth–SGA Working Group

PY - 2015/7/1

Y1 - 2015/7/1

N2 - IMPORTANCE This study introduces how the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) international birth weight standards alter our previous understanding and interpretations of fetal growth restriction as represented by small for gestational age (SGA) status. OBJECTIVES To compare the birth weight distributions of the INTERGROWTH-21st international standard to commonly used US references and examine the differences in the prevalence and neonatal mortality risk of SGA status (below the 10th percentile of a population reference). DESIGN, SETTING, AND PARTICIPANTS We analyzed data from 16 prospective cohorts of newborns on gestational age, birth weight, and systematic mortality follow-up through 28 days from 10 low- And middle-income countries. The studies included were conducted between 1983 and 2008. The analysis was conducted in 2014. Infants were categorized as SGA using the 1991 US birth weight reference, the 1999-2000 US birth weight reference, and the new INTERGROWTH-21st standard. For each study, we compared the SGA prevalence and the risk ratio between SGA status and neonatal mortality, calculated using Poisson regression with robust error variance. MAIN OUTCOMES AND MEASURES We examine neonatal mortality (death within the first 28 days after birth) as the main outcome measure. RESULTS The pooled SGA prevalence was 23.7%(95%CI, 16.5%-31.0%) using the INTERGROWTH-21st standard compared with 36.0%(95%CI, 27.0%-45.0%) with the US 2000 reference. The relative decrease in prevalence was larger among infants born at 33 to less than 37 weeks' gestation compared with term infants. The pooled neonatal mortality risk did not differ significantly; the adjusted risk ratios were 2.13 (95%CI, 1.78-2.54; P < .001) for the INTERGROWTH-21st standard and 2.12 (95%CI, 1.81-2.48; P < .001) for the US 2000 reference. CONCLUSIONS AND RELEVANCE To our knowledge, INTERGROWTH-21st is the first international newborn standard for size for gestational age for healthy fetal growth.We observed a greater-than-one-quarter reduction in SGA prevalence and no significant change in the associated neonatal mortality risk, resulting in a decrease in the percentage of neonatal death attributable to SGA. Our study sheds light on how previously published studies on SGA status may be reinterpreted with the introduction of this new birth weight standard.

AB - IMPORTANCE This study introduces how the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) international birth weight standards alter our previous understanding and interpretations of fetal growth restriction as represented by small for gestational age (SGA) status. OBJECTIVES To compare the birth weight distributions of the INTERGROWTH-21st international standard to commonly used US references and examine the differences in the prevalence and neonatal mortality risk of SGA status (below the 10th percentile of a population reference). DESIGN, SETTING, AND PARTICIPANTS We analyzed data from 16 prospective cohorts of newborns on gestational age, birth weight, and systematic mortality follow-up through 28 days from 10 low- And middle-income countries. The studies included were conducted between 1983 and 2008. The analysis was conducted in 2014. Infants were categorized as SGA using the 1991 US birth weight reference, the 1999-2000 US birth weight reference, and the new INTERGROWTH-21st standard. For each study, we compared the SGA prevalence and the risk ratio between SGA status and neonatal mortality, calculated using Poisson regression with robust error variance. MAIN OUTCOMES AND MEASURES We examine neonatal mortality (death within the first 28 days after birth) as the main outcome measure. RESULTS The pooled SGA prevalence was 23.7%(95%CI, 16.5%-31.0%) using the INTERGROWTH-21st standard compared with 36.0%(95%CI, 27.0%-45.0%) with the US 2000 reference. The relative decrease in prevalence was larger among infants born at 33 to less than 37 weeks' gestation compared with term infants. The pooled neonatal mortality risk did not differ significantly; the adjusted risk ratios were 2.13 (95%CI, 1.78-2.54; P < .001) for the INTERGROWTH-21st standard and 2.12 (95%CI, 1.81-2.48; P < .001) for the US 2000 reference. CONCLUSIONS AND RELEVANCE To our knowledge, INTERGROWTH-21st is the first international newborn standard for size for gestational age for healthy fetal growth.We observed a greater-than-one-quarter reduction in SGA prevalence and no significant change in the associated neonatal mortality risk, resulting in a decrease in the percentage of neonatal death attributable to SGA. Our study sheds light on how previously published studies on SGA status may be reinterpreted with the introduction of this new birth weight standard.

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DO - 10.1001/jamapediatrics.2015.1438

M3 - Journal article

C2 - 26147059

SN - 2168-6203

VL - 169

JO - J A M A Pediatrics

JF - J A M A Pediatrics

IS - 7

M1 - e151438

ER -

Comparison of US Birth Weight References and the International Fetal and Newborn Growth Consortium for the 21st Century Standard

Abstract

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