This is very unlikely: recent research has revealed a range of interactions between the developmental environment and genetic and epigenetic processes [9]. Country differences in EFW percentiles and overall EFW percentiles are presented in S4 Table. Third Trimester. Thirty-one women had a miscarriage, and three fetuses had intrauterine death. We believe that the present WHO fetal growth charts can be used internationally, particularly where no local data exist. Fetal anomalies detected during pregnancy or at birth were noted and verified postnatally. Since the other existing multinational study, the Fetal Growth Longitudinal Study of the Intergrowth-21st Project, did not publish EFW but rather AC, which is a major determinant for EFW, we also compiled 10th and 90th percentiles for AC from relevant studies [18,19,30,32–34] (Table 17). Lippincott Williams & Williams, 2010. The sonographers participating in the study received specific training for the study and were certified as proficient under the supervision of a qualified instructor, according to a standard protocol. Some support for this concept was drawn from previous studies [13,14]. There was asymmetric distribution of growth of EFW: a slightly wider distribution among the lower percentiles during early weeks shifted to a notably expanded distribution of the higher percentiles in late pregnancy. Furthermore, the study shows that intrauterine growth is influenced by fetal sex and by maternal age, height, weight, and parity, although these influences explain only partially the differences in growth between countries. However, once they are in use, it will be prudent to test the performance of the charts in a particular setting in case adjustments, customization, or replacement with population-specific high-quality reference intervals is needed. All data (clinical, anthropometric, nutritional, and fetal biometry measurements plus 2-D/3-D images) were stored in a central server compliant with good clinical practice. Try not to worry if your results are abnormal. You should have the results in a few days. Another strength of the present WHO study is the use of quantile regression to establish the reference intervals. Sugar in urine could indicate gestational diabetes. The study protocol was published previously [20], so here we present a condensed account of the methods. Maternal complications, fetal malformations, and neonatal conditions by country. Number of women recruited to the study by country, with withdrawals and discontinuations. correction, 24 Mar 2017: Copyright: © 2017 Kiserud et al. The estimated birthweight according to neonatal sex and gestational age is shown in Table 4. However, the reported referrals were few and were found not to influence the statistics. Carroli G, S2 Table. Gestational age at birth varied between countries from a median of 38 wk 4 d in India to 40 wk 3 d in Norway (p < 0.001 for differences among countries) (Table 3). To check fetal growth. Fetuses diagnosed with any anomaly were managed according to local clinical guidelines. Influence of country on fetal growth expressed as the ultrasound measure femur length. Output from quantile multivariate regression showing Wald chi-square tests for gestational age; country; the interaction of gestational age and country; sex of the fetus; and maternal characteristics. Remember: This test can't diagnose birth defects. Variation in fetal growth within and between populations should therefore not be ignored. last menstrual period;TI, The primary motivation for this study, the fetal component of the WHO Multicentre Growth Reference Study [11], was the need for clinical reference intervals applicable internationally, including for areas of the world where perinatal morbidity and mortality are high, hence the multinational design. Quantile regression fits a function to each chosen quantile using linear programming and has the advantage of not imposing any distributional assumptions. It follows that whenever the WHO growth charts, or any reference intervals, are applied to a population, their performance should be checked or tested in order to ensure appropriate use. When adjusted for gestational age at birth, the differences were still significant for all the percentiles (p = 0.0018 for the 5th percentile and p < 0.001 for the 10th, 25th, 50th, 75th, 90th, and 95th percentiles). The occurrence of Apgar score < 7 at 5 min was similar in all countries, i.e., 0%–2.2%. The cerebellum was not included in the section. At times, the nuchal translucency test may add on ultrasound markers, such as measuring a baby's nasal bone. Second Trimester Screening. Quantile regression is now a well-established technique [26,27], and statistical software is available to fit quantile regression models. The choice of participating centers was based on their proficient use of ultrasound by experienced sonographers. How is an ultrasound scan done? All mothers recruited were followed up until the end of the study, apart from those withdrawing consent. Unfortunately, inequality between countries persists, with 98% of neonatal deaths occurring in low- and middle-income countries [3]. Statistika Consultoria, São Paulo, Brazil, Affiliation The Norway team would like to acknowledge the local coordinating physician Synnøve Lian Johnsen; midwives Ine Hildershavn Moen, Guro Kyte Børsheim, and Jeanette Aasland; and dietitians Gro Trae and Hilde Mollestad Tveit. Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University, Copenhagen, Denmark, Affiliation here. Statistics for participating women’s characteristics, their daily caloric intake, and ethnicity are presented in Table 2. No, Is the Subject Area "Fetuses" applicable to this article? Data changes were documented by a complete audit trail record kept automatically by the web system (recording when, by whom, and why data were changed). The distribution of EFW starts with a slight asymmetry to the left (i.e., lower percentiles) in early pregnancy and ends with a very noticeable right asymmetry (i.e., higher percentiles) in later pregnancy. 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