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Cited by 532Pregnancy and preeclampsia studiesBirth, Development, and HealthMaternal and Neonatal Healthcare

Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies

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Buck Louis, Germaine M., Grewal, Jagteshwar, Albert, Paul S., Sciscione, Anthony, Wing, Deborah A., Grobman, William A., Newman, Roger B., Wapner, Ronald +11 more·2015·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2015.08.032PMC PMC4584427
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Abstract

Objective Fetal growth is associated with long-term health yet no appropriate standards exist for the early identification of under- or over-grown fetuses. We sought to develop contemporary fetal growth standards for four self-identified U.S. racial/ethnic groups. Study Design We recruited for prospective follow-up 2,334 healthy women with low-risk, singleton pregnancies from 12 community and perinatal centers between July 2009 and January 2013. The cohort comprised: 614 (26%) non-Hispanic Whites, 611 (26%) non-Hispanic Blacks, 649 (28%) Hispanics, and 460 (20%) Asians. Women were screened at 8w0d to 13w6d for maternal health status associated with presumably normal fetal growth (aged 18–40 years; body mass index 19.0–29.9 kg/m2; healthy lifestyles and living conditions; low-risk medical and obstetrical history); 92% of recruited women completed the protocol. Women were randomized among four ultrasonology schedules for longitudinal fetal measurement using the Voluson E8 GE Healthcare. In-person interviews and anthropometric assessments were conducted at each visit; medical records were abstracted. The fetuses of 1,737 (74%) women continued to be low-risk (uncomplicated pregnancy, absent anomalies) at birth, and their measurements were included in the standards. Racial/ethnic-specific fetal growth curves were estimated using linear mixed models with cubic splines. Estimated fetal weight and biometric parameter percentiles (5th, 50th, 95th) were determined for each gestational week and comparisons made by race/ethnicity, with and without adjustment for maternal and socio-demographic factors. Results Estimated fetal weight differed significantly by race/ethnicity after 20 weeks. Specifically at 39 weeks, the 5th, 50th, and 95th percentiles were 2790, 3505, and 4402 grams for White, 2633, 3336, and 4226 grams for Hispanic, 2621, 3270, and 4078 grams for Asian, and 2622, 3260, and 4053 grams for Black women (adjusted global p<0.001). For individual parameters, racial/ethnic differences by order of detection were: humerus and femur lengths (10 weeks), abdominal circumference (16 weeks), head circumference (21 weeks), and biparietal diameter (27 weeks). The study-derived standard based solely on the White group erroneously classifies as much as 15% of non-White fetuses as growth-restricted (estimated fetal weight < 5th percentile). Conclusions Significant differences in fetal growth were found among the four groups. Racial/ethnic-specific standards improve the precision in evaluating fetal growth.

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Authors
Buck Louis, G. M., Grewal, J., Albert, P. S., Sciscione, A., Wing, D. A., Grobman, W. A., Newman, R. B., Wapner, R., D’Alton, M. E., Skupski, D., Nageotte, M. P., Ranzini, A. C., Owen, J., Chien, E. K., Craigo, S., Hediger, M. L., Kim, S., Zhang, C., & Grantz, K. L.
Affiliations
  • National Institutes of Health (US)
  • Christiana Care Health System (US)
  • University of California, Irvine (US)
  • Northwestern University (US)
  • Medical University of South Carolina (US)
  • Columbia University Irving Medical Center (US)
  • New York Hospital Queens (US)
  • MemorialCare Long Beach Medical Center (US)
  • Saint Peter's University Hospital (US)
  • University of Alabama (US)
  • Women & Infants Hospital of Rhode Island (US)
  • Tufts Medical Center (US)
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2015-10
Volume
213
Issue
4
Pages
449.e1-449.e41
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2015.08.032
PMC
PMC4584427
OpenAlex
W2134751634
Semantic Scholar
8d33b1784bf29d9cc114d1428637e2a03c7b59d1
Cited by
532
References
41
Citations by year
2026: 37 · 2025: 56 · 2024: 48 · 2023: 49 · 2022: 68 · 2021: 70 · 2020: 44 · 2019: 47 · 2018: 46 · 2017: 44 · 2016: 23
FWCI
42.86
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
Funders
  • National Institutes of Health (UL1TR001414)
  • National Center for Advancing Translational Sciences
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (HHSN275200800012C, HHSN275200800002C, HHSN275200800014C, HHSN275200800003C, HHSN275201000009C, HHSN275200800003I, HHSN275200800013C, HHSN275 200800028C, HHSN275200800002I, ZIAHD008852)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
fetal growth standards, fetal growth curves, racial and ethnic differences, estimated fetal weight, low-risk singleton pregnancy, fetal overgrowth, gestational age, fetal biometry, maternal sociodemographic factors, macrosomia
MeSH terms
Adolescent, Adult, Anthropometry, Asian, Black or African American, Cephalometry, Female, Hispanic or Latino, Humans, Longitudinal Studies, Pregnancy, Prospective Studies, Reference Values, United States, Cohort Studies, Ultrasonography, Prenatal, White People, Fetal Development, National Institute of Child Health and Human Development (U.S.), Young Adult

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