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Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies
Open accessAbstract
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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“This evidence has included analyses of databases of birthweight(4-6) and prospective evaluation of growth curves in different ethnic groups in the National Institute of Child Health and Human Development fetal growth studies.(7)”
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“First, the multicenter Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project (hereafter called Intergrowth-21st) was published and presented fetal biometrical standards17 followed by an article on estimated fetal weight (EFW).18 Second, another relevant large study appeared from the United States, the Nation…”
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Self-citationGrantz, K. L., Hediger, M. L., Liu, D., & Buck Louis, G. M. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2017.11.593 · Cited by 154
“Highly statistically significant racial/ ethnic differences in fetal growth were found, and by order of detection were as follows: humerus and femur lengths (beginning as early as 10 weeks), abdominal circumference (16 weeks), head circumference (21 weeks), and biparietal diameter (27 weeks) with racial/ethnic differe…”
Self-citationCohort Profile: NICHD Fetal Growth Studies–Singletons and Twins
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Is cerebroplacental ratio a marker of impaired fetal growth velocity and adverse pregnancy outcome?
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Self-citationDichorionic twin trajectories: the NICHD Fetal Growth Studies
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“This case-control study was nested within the Eunice Kennedy ShriverNational Institute of Child Health andHuman Development (NICHD) Fetal Growth Studies—Singleton Cohort (2009–2013), a multiracial and multicenter pregnancy cohort consisting of 2334 nonobese (20) and 468 obese women.”
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“The National Institute of Child Health and Development Fetal Growth Studies also contested this claim with its recently published references by race and ethnicity in the United States (23).”
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“This study was conducted in participants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies–Singleton Cohort, a multiracial prospective study in low-risk, singleton pregnant women (22).”
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“Exclusion criteria were similar between nonobese and obese women and included chronic hypertension or high blood pressure under medical supervision (obese women if requiring (cid:1) 2 medications), pregesta-tional diabetes, chronic renal disease under medical supervision, autoimmune disease, psychiatric disorders, can…”
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“The present study is a nested case-control study among participants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies – Singleton cohort, which is a multicenter prospective cohort study conducted by the NICHD between 2009 and 2013.(20) One of the seco…”
Self-citationShould twin-specific growth charts be used to assess fetal growth in twin pregnancies?
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“Study Population and Design The case-control study was nested among participants in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Study–Singletons cohort, a multicenter, multiracial prospective cohort study of healthy (without prepregnancy hypertension, diabet…”
MethodSelf-citationEndocrine disruptors and neonatal anthropometry, NICHD Fetal Growth Studies - Singletons
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“In 2015, the Eunice Kennedy ShriverNational Institute of Child Health and Human Development (NICHD) published new intrauterine growth standards that were more methodologically robust and allowed for customization to race/ethnicity.(9) If”
BackgroundThe Hadlock Method Is Superior to Newer Methods for the Prediction of the Birth Weight Percentile
Blue, N. R., Savabi, M., Beddow, M. E., Katukuri, V. R., Fritts, C. M., Izquierdo, L. A., & Chao, C. R. (2018) · Journal of Ultrasound in Medicine · doi:10.1002/jum.14725 · Cited by 54
“The Eunice Kennedy Shriver National Institute of Child Health and Human Development recently published USderived intrauterine growth tables specific to race and ethnicity, but the publication only describes the EFWs for multiple percentile cutoffs and does not provide a formula or smooth curve by which to estimate an…”
MethodResultVegetarian diets during pregnancy, and maternal and neonatal outcomes
Yisahak, S. F., Hinkle, S. N., Mumford, S. L., Li, M., Andriessen, V. C., Grantz, K. L., Zhang, C., & Grewal, J. (2020) · International Journal of Epidemiology · doi:10.1093/ije/dyaa200 · Cited by 66
Self-citationUltrasound Quality Assurance (QA) for Singletons in the NICHD Fetal Growth Studies
Hediger, M., Fuchs, K., Grantz, K., Grewal, J., Kim, S., Gore-Langton, R. E., Louis, G. B. B., D'Alton, M., & Albert, P. S. (2016) · Journal of ultrasound in medicine · doi:10.7863/ultra.15.09087 · Cited by 48
Self-citationKloog, I., Novack, L., Erez, O., Just, A. C., & Raz, R. (2018) · Environmental Health · doi:10.1186/s12940-018-0420-z · Cited by 53
“The second and third trimesters are important times for fetal growth [52].”
BackgroundHinkle, S. N., Rawal, S., Liu, D., Chen, J., Tsai, M. Y., & Zhang, C. (2018) · International Journal of Obesity · doi:10.1038/s41366-018-0255-2 · Cited by 53
Self-citationFetal growth patterns in pregnancy-associated hypertensive disorders: NICHD Fetal Growth Studies
Mateus, J., Newman, R., Zhang, C., Pugh, S. J., Grewal, J., Kim, S., Grobman, W. A., Owen, J., SCISCIONE, A. C., Wapner, R. J., et al. (2019) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2019.06.028 · Cited by 51
Self-citationAssociation Between Maternal Caffeine Consumption and Metabolism and Neonatal Anthropometry
Gleason, J. L., Ayele, F. T., Sundaram, R., Hinkle, S. N., Vafai, Y., Louis, G. M. B., Gerlanc, N., Amyx, M. M., Bever, A. M., Smarr, M. M., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.3238 · Cited by 49
Self-citationEstimating Gestational Age From Ultrasound Fetal Biometrics
Skupski, D. W., Owen, J., Kim, S., Fuchs, K. M., Albert, P. S., & Grantz, K. L. (2017) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000002137 · Cited by 48
Self-citationAlterations in the Gut Microbiome and Metabolisms in Pregnancies with Fetal Growth Restriction
Tao, Z., Chen, Y., He, F., Tang, J., Zhan, L., Hu, H., Ding, Z., Ruan, S., Chen, Y., Chen, B., et al. (2023) · Microbiology Spectrum · doi:10.1128/spectrum.00076-23 · Cited by 46
Maternal dyslipidemia during early pregnancy and epigenetic ageing of the placenta
Shrestha, D., Workalemahu, T., & Ayele, F. T. (2019) · Epigenetics · doi:10.1080/15592294.2019.1629234 · Cited by 48
Development of a Machine Learning Model for Sonographic Assessment of Gestational Age
Lee, C., Willis, A., Chen, C., Sieniek, M., Watters, A., Stetson, B., Uddin, A., Wong, J., Pilgrim, R., Chou, K., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.48685 · Cited by 42
Nwabuobi, C. K., Odibo, L., Camisasca-Lopina, H., Leavitt, K., Tuuli, M. G., & Odibo, A. O. (2019) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2018.1533945 · Cited by 42
Maternal diet patterns during early pregnancy in relation to neonatal outcomes
Yisahak, S. F., Mumford, S. L., Grewal, J., Li, M., Zhang, C., Grantz, K. L., & Hinkle, S. N. (2021) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqab019 · Cited by 45
“This analysis was a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies-Singletons (2009–2013) which was a prospective cohort study of women with singleton pregnancies with a primary aim of establishing standards for fetal growth (20).”
MethodSelf-citationPrevalence of small for gestational age infants in 21 cities in China, 2014–2019
He, H., Miao, H., Liang, Z., Zhang, Y., Jiang, W., Deng, Z., Tang, J., Liu, G., & Luo, X. (2021) · Scientific Reports · doi:10.1038/s41598-021-87127-9 · Cited by 40
Theorizing Race and Racism: Preliminary Reflections on the Medical Curriculum
Braun, L. (2017) · American Journal of Law & Medicine · doi:10.1177/0098858817723662 · Cited by 40
A new customized fetal growth standard for African American women: the PRB/NICHD Detroit study
Tarca, A. L., Romero, R. J., Gudicha, D. W., Erez, O., Hernandez‐Andrade, E. A., Yeo, L., Bhatti, G., Pacora, P., Maymon, E., & Hassan, S. S. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2017.12.229 · Cited by 39
Młynarczyk, M., Chauhan, S. P., Baydoun, H., Wilkes, C. M., Earhart, K. R., Zhao, Y., GOODIER, C. G., Chang, E., Plenty, N., Mize, E. K., et al. (2017) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2017.04.020 · Cited by 38
“uspected small for gestational age S (SGA) has been defined variably as sonographic-estimated fetal weight (SEFW) <10th percentile or <5th percentile for gestational age (GA), as abdominal circumference <10th or <5th percentile for GA, as flattening of the growth curve, or as abnormal of umbilical artery Doppler; the…”
BackgroundMethodOdibo, A. O., Nwabuobi, C. K., Odibo, L., Leavitt, K., Običan, S. G., & Tuuli, M. G. (2018) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.13394 · Cited by 38
Differential DNA Methylation in Placenta Associated With Maternal Blood Pressure During Pregnancy
Workalemahu, T., Ouidir, M., Shrestha, D., Wu, J., Grantz, K. L., & Ayele, F. T. (2020) · Hypertension · doi:10.1161/hypertensionaha.119.14509 · Cited by 38
Self-citationHugh, O., Williams, M., Turner, S., & Gardosi, J. O. (2020) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.22187 · Cited by 37
Walker, C. L., Merriam, A. A., Ohuma, E. O., Dighe, M., Gale, M., Rajagopal, L., Papageorghiou, A. T., Gyamfi‐Bannerman, C., & Waldorf, K. M. A. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2018.04.047 · Cited by 37
Association of Supine Going-to-Sleep Position in Late Pregnancy With Reduced Birth Weight
Anderson, N. H., Gordon, A., Li, M., Cronin, R. S., Thompson, J., Raynes‐Greenow, C. H., Heazell, A. E. P., Stacey, T., Culling, V., Wilson, J., et al. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.12614 · Cited by 37
Stevens, D. R., Bommarito, P. A., Keil, A. P., McElrath, T. F., Trasande, L., Barrett, E. S., Bush, N. R., Nguyen, R. H. N., Sathyanarayana, S., Swan, S. H., et al. (2022) · Environment International · doi:10.1016/j.envint.2022.107235 · Cited by 36
A comparison of methods to determine center of mass during pregnancy
Catena, R. D., Connolly, C. P., McGeorge, K. M., & Campbell, N. (2018) · Journal of Biomechanics · doi:10.1016/j.jbiomech.2018.02.004 · Cited by 36
Antiracism in the Field of Neonatology: A Foundation and Concrete Approaches
Montoya‐Williams, D., Fraiman, Y. S., Peña, M.-M., Burris, H. H., & Pursley, D. M. (2021) · NeoReviews · doi:10.1542/neo.23-1-e1 · Cited by 36
Characteristics of the gut microbiota in pregnant women with fetal growth restriction
Tu, X., Duan, C., Lin, B., Li, K., Gao, J., Yan, H., Wang, K., & Zhao, Z. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-04635-w · Cited by 34
“The birth weight curve used in this study was based on data from 342 Asian women published by the National Institute of Child Health and Human Development [19].”
MethodThe inheritance of cardiovascular disease risk
Hanson, M. A. (2019) · Acta Paediatrica · doi:10.1111/apa.14813 · Cited by 34
“Fetal growth patterns vary substantially between populations and so, although this has been discounted (76) they need to be considered in context as it is not appropriate to assume that such patterns are similar across geographical regions or ethnic groups (77,78).”
Background(2020) · Journal of Ultrasound in Medicine · doi:10.1002/jum.15477 · Cited by 38
Preterm newborn's postnatal growth patterns: how to evaluate them
Silveira, R. C., & Procianoy, R. S. (2018) · Jornal de Pediatria · doi:10.1016/j.jped.2018.10.006 · Cited by 32
Does prenatal identification of fetal macrosomia change management and outcome?
Vitner, D., Bleicher, I., Kadour‐Peero, E., Lipworth, H., Sagi, S., & Gonen, R. (2018) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-018-5003-2 · Cited by 32
Fetal anogenital distance using ultrasound
Aydin, E., Holt, R., Chaplin, D., Hawkes, R., Allison, C. L., Hackett, G. A., Austin, T., Tsompanidis, A., Gabis, L. V., Ziv, S. I., et al. (2019) · Prenatal Diagnosis · doi:10.1002/pd.5459 · Cited by 31
Dichorionic twin-specific vs singleton growth references for diagnosis of fetal growth restriction
Shea, S. K., Likins, B., Boan, A. D., Newman, R., & Finneran, M. M. (2021) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2021.03.022 · Cited by 30
Self-citationBabineau, V., Fonge, Y. N., Miller, E. S., Grobman, W. A., Ferguson, P. L., Hunt, K. J., Vena, J. E., Newman, R., Guille, C., Tita, A., et al. (2022) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2022.03.021 · Cited by 31
“The study established fetal growth standards using a sample with a broad representation of self-reported race and ethnicity.(9,28) Eligibility criteria were maternal age 18 to 40 years at delivery, pregravid body mass index (BMI) between 19.”
BackgroundMethodInfluentialSelf-citationEnhancing Fetal Health Monitoring through TPOT and Optuna in Machine Learning-Driven Prenatal Care
Akilandeswari, A., Ganesan, A., Yamsani, N., Radhika, S., Legapriyadharshini, N., & Padmakala, S. (2024) · International Conference on Advancements in Power, Communication and Intelligent Systems (APCI) · doi:10.1109/apci61480.2024.10617339 · Cited by 30
Reported Outcomes in Perinatal Iron Deficiency Anemia Trials: A Systematic Review
Malinowski, A. K., D'Souza, R. D., Khan, K. S., Shehata, N., Malinowski, M., & Daru, J. (2019) · Gynecologic and Obstetric Investigation · doi:10.1159/000495566 · Cited by 30
Choi, S. K. Y., Henry, A., Hilder, L., Gordon, A., Jorm, L. R., & Chambers, G. M. (2019) · Paediatric and Perinatal Epidemiology · doi:10.1111/ppe.12583 · Cited by 30
Hong, J., Yun, H. J., Park, G., Kim, S., Ou, Y., Vasung, L., Rollins, C. K., Ortinau, C. M., Takeoka, E., Akiyama, S., et al. (2021) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.714252 · Cited by 30
Self-citationAnthropometric Charts for Infants Born Between 22 and 29 Weeks’ Gestation
Boghossian, N. S., Geraci, M., Edwards, E. M., Morrow, K. A., & Horbar, J. D. (2016) · PEDIATRICS · doi:10.1542/peds.2016-1641 · Cited by 30
Lin, Y., Wu, J., Zhu, Y., Hinkle, S. N., Rawal, S., Liang, L., Weir, N. L., Tsai, M. Y., & Zhang, C. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.07.008 · Cited by 29
Self-citationAutomated Fetal Head Classification and Segmentation Using Ultrasound Video
Rasheed, K., Junejo, F., Malik, A. I., & Saqib, M. (2021) · IEEE Access · doi:10.1109/access.2021.3131518 · Cited by 32
Grantz, K. L., Grewal, J., Kim, S., Grobman, W. A., Newman, R., Owen, J., SCISCIONE, A. C., Skupski, D. W., Chien, E. K., Wing, D. A., et al. (2021) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2021.12.006 · Cited by 29
Self-citationPlacental multi-omics integration identifies candidate functional genes for birthweight
Ayele, F. T., Zeng, X., Chatterjee, S., Ouidir, M., Lesseur, C., Hao, K., Chen, J., Tesfaye, M., Marsit, C. J., Workalemahu, T., et al. (2022) · Nature Communications · doi:10.1038/s41467-022-30007-1 · Cited by 30
Self-citationPregnancy Weight Gain by Gestational Age in Women with Uncomplicated Dichorionic Twin Pregnancies
Hutcheon, J. A., Platt, R. W., Abrams, B. F., Braxter, B., Eckhardt, C. L., Himes, K. P., & Bodnar, L. M. (2018) · Paediatric and Perinatal Epidemiology · doi:10.1111/ppe.12446 · Cited by 29
In-Hospital Outcomes in Large for Gestational Age Infants at 22-29 Weeks of Gestation
Boghossian, N. S., Geraci, M., Edwards, E. M., & Horbar, J. D. (2018) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2018.02.042 · Cited by 29
Owen, J., Albert, P. S., Louis, G. M. B., Fuchs, K. M., Grobman, W. A., Kim, S., D’Alton, M. E., Wapner, R. J., Wing, D. A., & Grantz, K. L. (2019) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2019.02.030 · Cited by 28
Self-citation
Metadata
- 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)
- 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
- green
- www.ncbi.nlm.nih.gov
- 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 › Medicine › Pediatrics, Perinatology and Child Health › 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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