Comparison of Five Growth Charts for Identifying Small-Sized Fetuses and Their Predictive Value for Adverse Neonatal Outcomes

Abstract

Purpose

The main goal of fetal growth monitoring is to identify fetuses at increased risk of morbidity and mortality. This study compares 5 commonly used growth charts (Hadlock, FMF, NICHD, INTERGROWTH-21^st, WHO) to assess their ability to identify pregnancies below the 10^th percentile and predict adverse neonatal outcomes.

Materials and Methods

We retrospectively analyzed 572 singleton pregnancies with an estimated fetal weight (EFW) <10^th percentile according to Hadlock, excluding multiple pregnancies or cases with maternal comorbidities. Maternal and neonatal data were collected, and EFW and birthweight percentiles were recalculated using the different growth charts. Statistical analyses assessed the association between these charts and adverse neonatal outcomes.

Results

The WHO chart classified the fewest pregnancies below the 10^th percentile and showed significant differences in composite adverse outcomes between the groups (p < 0.05). Despite a lack of statistical significance, the WHO chart had better prediction for NICU admission compared to others. At the 3^rd percentile cutoff, all charts showed similar results for NICU admission and adverse outcomes (p < 0.01). For severe adverse outcomes, only the WHO and FMF charts showed significant differences (p = 0.043, p = 0.029).

Conclusion

The WHO chart showed superior performance at the 10^th percentile cutoff, while all charts were comparable at the 3^rd percentile. Notably, the WHO and FMF charts significantly differentiated between patients with severe composite adverse outcomes at the 3^rd percentile to improve the accuracy of diagnosing and predicting neonatal outcomes in small-sized fetuses.

Zusammenfassung

Ziel

Das Hauptziel der fetalen Wachstumsüberwachung ist es, Föten mit erhöhtem Risiko für Morbidität und Mortalität zu identifizieren. Diese Studie vergleicht 5 häufig verwendete Wachstumstabellen (Hadlock, FMF, NICHD, INTERGROWTH-21^st, WHO), um deren Fähigkeit zu bewerten, Schwangerschaften unter dem 10. Perzentil zu identifizieren und adverse neonatale Ergebnisse vorherzusagen.

Material und Methoden

Wir analysierten retrospektiv 572 Einlingsschwangerschaften mit geschätztem fetalen Gewicht (EFW) <10. Perzentil gemäß Hadlock. Maternale und neonatale Daten wurden gesammelt, und die EFW- sowie die Perzentile des Geburtsgewichts wurden mit den verschiedenen Wachstumstabellen neu berechnet. Statistische Analysen untersuchten die Assoziation zwischen diesen Tabellen und negativen neonatale Ergebnissen.

Ergebnisse

Die WHO-Tabelle kategorisierte die wenigsten Schwangerschaften unter dem 10. Perzentil und zeigte signifikante Unterschiede bei den negativen Ergebnissen (p < 0,05). Obwohl statistisch nicht signifikant, zeigte die WHO-Tabelle eine bessere Vorhersagekraft für die Aufnahme auf die Intensivstation im Vergleich zu den anderen Tabellen. Beim 3. Perzentil-Grenzwert zeigten alle Tabellen ähnliche Ergebnisse für negative Ergebnisse (p < 0,01). Für schwere negative Ergebnisse zeigten nur die WHO- und FMF-Tabellen signifikante Unterschiede (p = 0,043, p = 0,029).

Schlussfolgerungen

Die WHO-Tabelle zeigte die beste Leistung bei der 10. Perzentil-Grenze, während alle Tabellen bei der 3. Perzentil-Grenze vergleichbar waren. Besonders die WHO- und FMF-Tabellen unterschieden signifikant zwischen Patienten mit schweren negativen Ergebnissen bei der 3. Perzentil-Grenze.

Keywords

birth weight percentile - ultrasonography - fetal biometry - estimated fetal weight

Publication History

Received: 02 January 2025

Accepted after revision: 21 May 2025

Article published online:
15 August 2025

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