Performance of the Intergrowth-21st and WHO fetal growth charts for the detection of small-for-gestational age neonates in Latin America

Abstract

To evaluate the performance of INTERGROWTH-21st and WHO fetal growth charts to identify small-for-gestational-age (SGA) and fetal growth restriction (FGR) neonates as well as their specific risks for adverse neonatal outcomes.Multicenter cross-sectional study including 67,968 live births from ten maternity units across four Latin American countries. According to each standard, neonates were classified as SGA and FGR (birth weight <10th and <3rd centiles, respectively). The relative risk (RR) and diagnostic performance for a low Apgar score and low ponderal index were calculated for each standard.WHO charts identified more neonates as SGA than INTERGROWTH-21st (13.9% vs. 7%, respectively). Neonates classified as FGRs by both standards had the highest RR for a low Apgar (RR: 5.57; 95% CI: 3.99-7.78), followed by those SGA by both curves (RR: 3.27; 95% CI: 2.52-4.24), while SGAs identified by WHO alone did not have an additional risk (RR: 0.87; 95% CI: 0.55-1.39). Furthermore, the diagnostic odds ratio for a low Apgar was higher when INTERGROWTH-21st was used.In a population from Latin America, the WHO charts seem to identify more SGA neonates, but the diagnostic performance of the INTERGROWTH-21st charts for low Apgar score and low ponderal index is better.This article is protected by copyright. All rights reserved.