Which fetal growth charts should be used?A retrospective observational study in China

Background:The fetal growth charts in widest use in China were published by Hadlock>35 years ago and were established on data from several hundred of American pregnant women.After that,>100 fetal growth charts were published around the world.We attempted to assess the impact of applying the long-standing Hadlock charts and other charts in a Chinese population and to compare their ability to predict newborn small for gestational age(SGA).Methods:For this retrospective observational study,we reviewed all pregnant women(n=106,455)who booked prenatal care with ultrasound measurements for fetal biometry at the Shenzhen Maternity and Child Healthcare Hospital between 2012 and 2019.A fractional polynomial regression model was applied to generate Shenzhen fetal growth chart ranges for head circumference(HC),biparietal diameter(BPD),abdominal circumference(AC),and femur length(FL).The differences between Shenzhen charts and published charts were quantified by calculating the Z-score.The impact of applying these published charts was quantifed by calculating the proportions of fetuses with biometric measurements below the 3rd centile of these charts.The sensitivity and area under the receiver operating characteristic curves of published charts to predict neonatal SGA(birthweight<10th centile)were assessed..Results:Following selection,169,980 scans of fetal biometry contributed by 41,032 pregnancies with reliable gestational age were analyzed.When using Hadlock references(<3rd centile),the proportions of small heads and short femurs were as high as 8.9%and 6.6%in late gestation,respectively.The INTERGROWTH-21st standards matched those of our observed curves better than other charts,in particular for fat-free biometry(HC and FL).When using AC<10th centile,all of these references were poor at predicting neonatal SGA.Conclusions:Applying long-standing Hadlock references could misclassify a large proportion of fetuses as SGA.INTERGROWTH-21st standard appears to be a safe option in China.For fat-based biometry,AC,a reference based on the Chinese population is needed.In addition,when applying published charts,particular care should be taken due to the discrepancy of measurement methods.

Neuroimaging brain growth charts:A road to mental health

Mental disorders are common health concerns and contribute to a heavy global burden on our modern society.It is challenging to identify and treat them timely.Neuroimaging evidence suggests the incidence of various psychiatric and behavioral disorders is closely related to the atypical development of brain structure and function.The identification and understanding of atypical brain development provide chances for clinicians to detect mental disorders earlier,perhaps even prior to onset,and treat them more precisely.An invaluable and necessary method in identifying and monitoring atypical brain development are growth charts of typically developing individuals in the population.The brain growth charts can offer a series of standard references on typical neurodevelopment,representing an important resource for the scientific and medical communities.In the present paper,we review the relationship between mental disorders and atypical brain development from a perspective of normative brain development by surveying the recent progress in the development of brain growth charts,including four aspects on growth chart utility:1)cohorts,2)measures,3)mechanisms,and 4)clinical translations.In doing so,we seek to clarify the challenges and opportunities in charting brain growth,and to promote the application of brain growth charts in clinical practice.

Comparison of updated birth weight,length and head circumference charts by gestational age in China with the INTERGROWTH-21 st NCSS charts:a population-based study

Background INTERGROWTH-21 st Newborn Cross-Sectional Study(NCSS)charts were established and recommended for global application.However,whether one international reference is appropriate for all populations is still unclear.We aim to compare the updated Chinese birth size charts by gestational age with INTERGROWTH-21st NCSS charts.Methods A cross-sectional survey was carried out,and the birth weight,length and head circumference of 24,375 infants born after uncomplicated pregnancies at gestational age ranging from 24+0 to 42+6 weeks were measured in 13 cities in China from 2015 to 2018.Growth charts were constructed.The measurements of all these infants were evaluated by the methods of calculating their Z scores using the INTERGROWTH-21 st standards.The prevalence of small for gestational age(SGA)and large for gestational age(LGA)based on birth weight was analyzed using Chinese charts and INTERGROWTH-21st charts.Results The mean Z scores were 0.10 for birth weight,0.35 for length and-0.02 for head circumference.Compared to the INTERGROWTH-21st charts,the Chinese birth weight percentile curves were higher except for the 90th percentile at 29-37 weeks gestational age,and the length percentile curves were higher after 33 weeks gestational age,while the 10th percentile of the head circumference was lower and the other percentiles were similar.The prevalence of SGA was 10.1%[95%confidence interval(CI)=9.7%-10.5%]using the Chinese birth weight chart and 6.5%(95%CI=6.2%-6.8%)using the INTERGROWTH-21 st birth weight chart.The prevalence of LGA was 9.9%(95%CI=9.5%-10.2%)and 8.2%(95%CI=7.9%-8.6%)using the Chinese and INTERGROWTH-21st birth weight charts,respectively.Conclusions Chinese birth size charts based on infants born after uncomplicated pregnancies were different from the INTER-GROWTH-21st charts.Differences in the classification of newborns by the two charts should receive attention,and whether the application of INTERGROWTH-21st in Chinese newborns will lead to misclassification needs to be validated in future clinical practice.

Chinese Fetal Growth:A Multicenter Cohort Study Based on Fetal Ultrasound Measurements

Objective:To build a reference fetal growth chart for the Chinese population based on fetal ultrasound measurements.Methods:This was a multicenter,population-based retrospective cohort study.Longitudinal ultrasound measurement data were collected from 24 hospitals in 18 provinces of China from 1st September through 31st October of 2019.The estimated fetal weight(EFW)was calculated based on head circumference,abdominal circumference,and femur length using Hadlock formula 3.Fetal growth curves were estimated using a two-level linear regression model with cubic splines.All participants were divided into two groups:the northern group(n=5829)and the southern group(n=3246)based on the geographical division of China and male fetus group(n=4775)and female fetus group(n=4300)based on fetal gender.The EFW was compared by fetal gender and geographical group.All statistical models were adjusted for maternal sociodemographic characteristics.Results:A total of 9075 participants with 31,700 ultrasound measurement records were included in this study.Male fetuses demonstrated significantly larger EFW compared to female ones starting at 16 weeks of gestation and extending to delivery(global testP<0.01).The overall geographic difference in EFW was significant(global testP=0.03),and week-specific comparisons showed that the northern group had a greater EFW starting at 15 weeks of gestation and extending to 29 weeks of gestation,although this difference did not extend to the time of delivery.TheZ-score of EFW confirmed that our Chinese fetal growth charts differed from previously published standards.Conclusion:This study provides EFW and ultrasound biometric reference measurements for Chinese fetuses and reveals differences from other fetal growth charts.The chart is worth promoting in more regions of China but should be tested prudently before use.

Charting brain growth in tandem with brain templates at school age

Brain growth charts and age-normed brain templates are essential resources for researchers to eventually contribute to the care of individuals with atypical developmental trajectories.The present work generates age-normed brain templates for children and adolescents at one-year intervals and the corresponding growth charts to investigate the influences of age and ethnicity using a common pediatric neuroimaging protocol.Two accelerated longitudinal cohorts with the identical experimental design were implemented in the United States and China.Anatomical magnetic resonance imaging(MRI)of typically developing school-age children(TDC)was obtained up to three times at nominal intervals of1.25 years.The protocol generated and compared population-and age-specific brain templates and growth charts,respectively.A total of 674 Chinese pediatric MRI scans were obtained from 457 Chinese TDC and 190 American pediatric MRI scans were obtained from 133 American TDC.Population-and age-specific brain templates were used to quantify warp cost,the differences between individual brains and brain templates.Volumetric growth charts for labeled brain network areas were generated.Shape analyses of cost functions supported the necessity of age-specific and ethnicitymatched brain templates,which was confirmed by growth chart analyses.These analyses revealed volumetric growth differences between the two ethnicities primarily in lateral frontal and parietal areas,regions which are most variable across individuals in regard to their structure and function.Age-and ethnicity-specific brain templates facilitate establishing unbiased pediatric brain growth charts,indicating the necessity of the brain charts and brain templates generated in tandem.These templates and growth charts as well as related codes have been made freely available to the public for open neuroscience(https://github.com/zuoxinian/CCS/tree/master/H3/Growth Charts).

Establishing Chinese Fetal Growth Standards: Why and How

Choosing a fetal growth standard or reference is crucial when defining normal and abnormal fetal growth.We reviewed the recently published standards and compared them with a customized fetal growth chart based on a nationwide population in China.There were substantial discrepancies in the fetal growth pattern,suggesting that these standards may not be applicable to Chinese fetuses.Developing a Chinese-specific standard may better meet our clinical requirements.We also discuss the steps to establish a Chinese fetal growth standard and the potential challenges,including regional disparities and accuracy of sonographic estimated fetal weight.Standardized ultrasound measurement protocol and the introduction of new ultrasonography technology may be helpful in developing a more precise standard than existing ones for the Chinese population.