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Customized birthweight standards accurately predict perinatal morbidity
  1. Francesc Figueras (ffiguera{at}clinic.ub.es)
  1. Hospital Clinic & West Midlands Perinatal Institute, United Kingdom
    1. Josep Figueras (jfiguer{at}clinic.ub.es)
    1. Hospital Clinic, Spain
      1. Eva Meler (evitameler{at}hotmail.com)
      1. Hospital Clinic, Spain
        1. Elisenda Eixarch (sendaeix{at}yahoo.es)
        1. Hospital Clinic, Spain
          1. Oriol Coll (ocoll{at}clinic.ub.es)
          1. Hospital Clinic, Spain
            1. Eduard Gratacos (egratacos{at}clinic.ub.es)
            1. Hospital Clinic, Spain
              1. Jason Gardosi (gardosi{at}pi.nhs.uk)
              1. West Midlands Perinatal Institute, United Kingdom
                1. Xavier Carbonell (xcarbonell{at}clinic.ub.es)
                1. Hospital Clinic, Spain

                  Abstract

                  Objective: Fetal growth restriction is associated with adverse perinatal outcome but is often not recognised antenatally, and low birthweight centiles based on population norms are used as a proxy instead. We investigated the association between neonatal morbidity and fetal growth status at birth, as determined by customised birthweight centiles, and compared them with currently used centiles based on population standards.

                  Design: Cohort study.

                  Setting: Referral hospital, Barcelona, Spain.

                  Patients: A cohort of 13,661 non-malformed singleton deliveries.

                  Interventions: Both population-based and customized standards for birthweight were applied to the study cohort. Customised weight centiles were calculated by adjusting for maternal height, booking weight, parity, ethnic origin, gestational age at delivery and fetal gender.

                  Main outcome measures: Newborn morbidity and perinatal death.

                  Results: The association between smallness for gestational age (SGA) and perinatal morbidity was stronger when birthweight limits were customised, and resulted in an additional 4.1% of neonates being classified as SGA. Compared with non-SGA neonates, this newly identified group had an increased risk of perinatal mortality (OR 3.2; 95% CI 1.7-6.2), neurological morbidity (OR 3.2; 95%CI 1.7-6.1) and non- neurological morbidity (OR 8; 95%CI 4.8-13.6).

                  Conclusion: Customized standards improve the prediction of adverse neonatal outcome. The association between SGA and adverse outcome is independent of the gestational age at delivery.

                  • birthweight
                  • fetal growth restriction
                  • neonatal morbidity

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