Am J Perinatol
DOI: 10.1055/a-2298-5245
Original Article

Comparing Fetal Ultrasound Biometric Measurements to Neonatal Anthropometry at the Extremes of Birthweight

1   Division of Population Health Research, Division of Intramural Research, Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
Mary L. Hediger
1   Division of Population Health Research, Division of Intramural Research, Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
Zhen Chen
2   Division of Population Health Research, Division of Intramural Research, Biostatistics and Bioinformatics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
Jagteshwar Grewal
3   Division of Population Health Research, Division of Intramural Research, Office of the Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
Roger Newman
4   Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
William A. Grobman
5   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
John Owen
6   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
Katherine L. Grantz
1   Division of Population Health Research, Division of Intramural Research, Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
› Author Affiliations
Funding This research was supported by the Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (contract numbers: HHSN275200800013C; HHSN275200800002I; HHSN27500006; HHSN275200800003IC; HHSN275200800014C; HHSN275200800012C; HHSN275200800028C; HHSN275201000009C). J.L.G., Z.C., J.G., and K.L.G. have contributed to this work as part of their official duties as employees of the United States Federal Government.


Objective Error in birthweight prediction by sonographic estimated fetal weight (EFW) has clinical implications, such as avoidable cesarean or misclassification of fetal risk in labor. We aimed to evaluate optimal timing of ultrasound and which fetal measurements contribute to error in fetal ultrasound estimations of birth size at the extremes of birthweight.

Study Design We compared differences in head circumference (HC), abdominal circumference (AC), femur length, and EFW between ultrasound and corresponding birth measurements within 14 (n = 1,290) and 7 (n = 617) days of birth for small- (SGA, <10th percentile), appropriate- (AGA, 10th–90th), and large-for-gestational age (LGA, >90th) newborns.

Results Average differences between EFW and birthweight for SGA neonates were: −40.2 g (confidence interval [CI]: −82.1, 1.6) at 14 days versus 13.6 g (CI: −52.4, 79.7) at 7 days; for AGA, −122.4 g (−139.6, −105.1) at 14 days versus −27.2 g (−50.4, −4.0) at 7 days; and for LGA, −242.8 g (−306.5, −179.1) at 14 days versus −72.1 g (−152.0, 7.9) at 7 days. Differences between fetal and neonatal HC were larger at 14 versus 7 days, and similar to patterns for EFW and birthweight, differences were the largest for LGA at both intervals. In contrast, differences between fetal and neonatal AC were larger at 7 versus 14 days, suggesting larger error in AC estimation closer to birth.

Conclusion Using a standardized ultrasound protocol, SGA neonates had ultrasound measurements closer to actual birth measurements compared with AGA or LGA neonates. LGA neonates had the largest differences between fetal and neonatal size, with measurements 14 days from delivery showing 3- to 4-fold greater differences from birthweight. Differences in EFW and birthweight may not be explained by a single fetal measurement; whether estimation may be improved by incorporation of other knowable factors should be evaluated in future research.

Key Points

  • Ultrasound measurements may be inadequate to predict neonatal size at birth.

  • Birthweight estimation error is higher for neonates >90th percentile.

  • There is higher error in AC closer to birth.

Supplementary Material

Publication History

Received: 26 December 2023

Accepted: 24 March 2024

Accepted Manuscript online:
03 April 2024

Article published online:
10 May 2024

© 2024. Thieme. All rights reserved.

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