A research article published in PLOS Medicine contributes to the evidence base regarding the use of population charts for detection of fetal growth disorders and how best to determine risk of complications.
In the article, Stamatina Iliodromiti from the University of Glasgow, UK, and colleagues found birth weight ?25th or ?85th centile to be associated with greater risk of adverse outcomes compared with birth weight within these cutoffs, suggesting an expansion of the definition of 'fetus at risk' beyond the ?10th or ?90th centile range that is commonly used to trigger surveillance of fetal well-being and/or delivery. In this study, the researchers used routinely collected data from 979,912 term singleton pregnancies over a 19-year period in Scotland and externally validated the findings in an independent UK cohort including 10,515 pregnancies. They further estimated that by offering delivery to women outside of the 25th to 85th centile (rather than the traditionally used 10th and 90th centiles), an additional 1143 deliveries would be required to prevent one fatal event (422 additional deliveries at or below 25th centile; and 721 additional deliveries at or above the 85th centile).
In a linked Guest Editorial, Sarah Stock from the University of Edinburgh and Jenny Myers from the University of Manchester, UK acknowledge that these two research articles "support the concept that robustly developed population growth standards are appropriate for the diagnosis of fetal growth disorders, but that thresholds of risk that are relevant to local populations should be considered." They continue: "Whatever method is used, the benefits of detecting fetal growth disorders can only be realized if we can effectively reduce risk of complications."
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Research Article
Funding:
SI is funded by a UK Medical Research Council skills development fellowship (MR/N015177/1). DAL works in a Unit that receives funding from the University of Bristol and the UK Medical Research Council (MC_UU_12013/5); she is a National Institute of Health Research (NIHR) Senior Investigator (NF-SI-0611-10196). This work is also supported by the NIHR through the University of Bristol NIHR Biomedical Research Centre (BRC) and the University of Cambridge BRC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests:
I have read the journal's policy and the authors of this manuscript have the following competing interests: GCSS receives/has received research support from GE, Roche and GSK. GCSS has been paid to attend advisory boards by GSK and Roche. GCSS has acted as a paid consultant to GSK. GCSS has received support to attend a scientific meeting from Chiesi. GCSS is named inventor in a patent submitted by GSK (UK) for novel application of an existing GSK compound for the prevention of preterm birth (PCT/EP2014/062602). GCSS has acted as an expert witness. GCSS is a member of a Data Safety Monitoring Committee for a trial of an RSV vaccine in pregnancy, being run by GSK. Please note: none of these directly relate to the paper, but GCSS states them for full disclosure. GCSS is a member of the Editorial Board of PLOS Medicine. In addition to grant funding that is acknowledged in the paper and that was relevant to the conduct of the study reported in the paper, DAL's institution has received funds from public, charity, and industry funders from grants on which DAL is the Principal application (UK Medical Research Council, UK Economic and Social Research Council, UK National Institute of Health Research, Wellcome Trust, British Heart Foundation, Roche Diagnostics, Ferring Pharmaceuticals, and Medtronic PLC). These funders had no impact on any aspect of the work presented in this paper.
Citation:
Iliodromiti S, Mackay DF, Smith GCS, Pell JP, Sattar N, Lawlor DA, et al. (2017) Customised and Noncustomised Birth Weight Centiles and Prediction of Stillbirth and Infant Mortality and Morbidity: A Cohort Study of 979,912 Term Singleton Pregnancies in Scotland. PLoS Med 14(1): e1002228. doi:10.1371/journal.pmed.1002228
Author Affiliations:
School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom Department of Obstetrics and Gynaecology, University of Cambridge, Rosie Hospital, Cambridge, United Kingdom NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002228
Editorial
Funding:
The authors received no funding for this work.
Competing Interests:
The authors have declared that no competing interests exist.
Citation:
Stock SJ, Myers J (2017) Defining Abnormal Fetal Growth and Perinatal Risk: Population or Customized Standards? PLoS Med14(1): e1002229. doi:10.1371/journal. pmed.1002229
Author Affiliations:
Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Institute, Edinburgh, United Kingdom School of Women's and Infant's Health, University of Western Australia, Crawley, Western Australia, Australia Maternal & Fetal Health Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002229
Journal
PLoS Medicine