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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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“We did not assess centiles on the recent Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) chart [4] or other customized charts [20] since we had no information on race/ethnicity and our population has a high proportion of mixed-ethnicity unions [21], which creates pragmatic chall…”
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“Those with birthweights above the 90th percentile were classified as LGA, and their birth weights below the 10th percentile were defined as SGA, based on gestational age birthweights from NICHD [25].”
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“In contrast, South Asian women fulfilling the IG-21 criteria had a lower and European women a similar prevalence of gestational diabetes to women not fulfilling the criteria.”
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“It is increasingly understood that fetal growth trajectories are nonlinear, and the growth patterns vary by gestation time [9, 10].”
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“TO THE EDITORS: We recently discovered an aspect of our paper entitled “Racial/ethnic differences in fetal growth, the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies” that we want to bring to readers’ attention but one that does not change the results or interpreta…”
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Is the Biphasic Effect of Diabetes and Obesity on Fetal Growth a Risk Factor for Childhood Obesity?
van Poppel, M. N. M., Damm, P., Mathiesen, E. R., Ringholm, L., Zhang, C., & Desoyé, G. (2023) · Diabetes Care · doi:10.2337/dc22-2409 · Cited by 19
Self-citationFetal Growth Patterns in Pregnancies With First-Trimester Bleeding
Bever, A. M., Pugh, S. J., Kim, S., Newman, R., Grobman, W. A., Chien, E. K., Wing, D. A., Li, H., Albert, P. S., & Grantz, K. L. (2018) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000002616 · Cited by 17
Self-citationKarahanoğlu, E., Akpınar, F., Demirdağ, E., Yerebasmaz, N., Ensarı, T. A., Akyol, A., Işık, D. U., & Yalvaç, S. (2016) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.13024 · Cited by 17
“When we compared the birthweight of isolated oligohydramnios infants with the general birthweight percentiles that were recently published, the oligohydramnios group had a higher birthweight.(16,17) This may be a result of excluding SGA fetuses from the study.”
ResultMaternal stress and neonatal anthropometry: the NICHD Fetal Growth Studies
Wing, D. A., Ortega‐Villa, A. M., Grobman, W. A., Hediger, M. L., Grewal, J., Pugh, S. J., Kim, S., Newman, R., Chien, E. K., Owen, J., et al. (2017) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2017.02.039 · Cited by 17
“Full details of the protocol and study methods have been published previously.(16) Human subjects’ approval was obtained from all participating sites before initiation of the study, and all women gave informed consent before enrollment and data collection.”
MethodSelf-citationShould Fetal Growth Charts Be References or Standards?
Hutcheon, J. A., & Liauw, J. (2020) · Epidemiology · doi:10.1097/ede.0000000000001275 · Cited by 17
Lin, Y., Hu, P., Li, H., Luo, C., Liang, D., & Xu, Z. (2022) · Journal of Cellular and Molecular Medicine · doi:10.1111/jcmm.17245 · Cited by 16
Beck, C., Blue, N. R., Silver, R. M., Na, M., Grobman, W. A., Steller, J. G., Parry, S. I., Scifres, C., & Gernand, A. D. (2024) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2024.11.018 · Cited by 16
Self-citationKwiatkowski, S., Torbè, A., Borowski, D., Bręborowicz, G. H., Czajkowski, K., Huras, H. K., Kajdy, A., Kalinka, J., Kosińska–Kaczyńska, K., Leszczyńska‐Gorzelak, B., et al. (2020) · Ginekologia Polska · doi:10.5603/gp.2020.0158 · Cited by 16
“Przy ocenianiu masy płodu powinno się wykorzystywać populacyjne siatki centylowe [20].”
BackgroundAIUM Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound
(2024) · Journal of Ultrasound in Medicine · doi:10.1002/jum.16406 · Cited by 19
Do We Need Another Set of Growth Charts for Premature Infants?
Clark, R. H., & Olsen, I. E. (2016) · PEDIATRICS · doi:10.1542/peds.2016-3128 · Cited by 15
High burden of birthweight-lowering genetic variants in Africans and Asians
Ayele, F. T., Workalemahu, T., & Amare, A. T. (2018) · BMC Medicine · doi:10.1186/s12916-018-1061-3 · Cited by 15
“There is growing interest in understanding the roles of gene–environment interactions in population differences in fetal growth following two recent studies led by the World Health Organization (WHO) [7] and the National Institute of Child Health and Human Development (NICHD) at the National Institutes of Health (NIH)…”
BackgroundResultInfluentialAyele, F. T., Ouidir, M., Shrestha, D., Workalemahu, T., Rahman, M. L., Mendola, P., Grantz, K. L., Hinkle, S. N., Wu, J., & Zhang, C. (2021) · Human Genetics · doi:10.1007/s00439-021-02265-4 · Cited by 15
Self-citationMonier, I., Ego, A., Benachi, A., Hocquette, A., Blondel, B., Goffinet, F., & Zeitlin, J. A. (2021) · American Journal of Obstetrics & Gynecology MFM · doi:10.1016/j.ajogmf.2021.100527 · Cited by 15
Hinkle, S., Hediger, M., Kim, S., Albert, P. S., Grobman, W., Newman, R., Wing, D., Grewal, J., Zhang, C.-L., Louis, G. B. B., et al. (2017) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.117.158873 · Cited by 15
“Fetal measurements were obtained according to a standardized ultrasound protocol (11, 14).”
MethodSelf-citationZhang, L., Lin, J., Liang, S., Sun, J. H., Gao, N., Wu, Q., Zhang, H., Liu, H.-J., Cheng, X., Cao, Y. Y., et al. (2021) · Frontiers in Pediatrics · doi:10.3389/fped.2021.595882 · Cited by 14
Song, Y., Lu, R., Yu, G., Rahman, M. L., Chen, L., Zhu, Y., Tsai, M. Y., Fiehn, O., Chen, Z., & Zhang, C. (2023) · EBioMedicine · doi:10.1016/j.ebiom.2023.104881 · Cited by 14
Self-citationA New Approach to Developing Birth Weight Reference Charts: A Retrospective Observational Study
Joseph, F. A., Hyett, J. A., McGeechan, K., Schlüter, P. J., Gordon, A., McLennan, A., & de Vries, B. S. (2017) · Fetal Diagnosis and Therapy · doi:10.1159/000475662 · Cited by 14
Fetal weight estimation by ultrasound: development of Indian population-based models
Hiwale, S. S., Misra, H., & Ulman, S. (2018) · ULTRASONOGRAPHY · doi:10.14366/usg.18004 · Cited by 14
“Furthermore, studies have also pointed out that the use of racial/ethnic-specific standards improves the precision of fetal growth monitoring [6].”
BackgroundCaradeux, J., Eixarch, E., Mazarico, E., Basuki, T. R., Gratacós, E., & Figueras, F. (2017) · Fetal Diagnosis and Therapy · doi:10.1159/000477460 · Cited by 14
Günay, T., Bılır, R. A., Hocaoğlu, M., Bör, E. D., Özdamar, Ö., & Turgut, A. (2020) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.13469 · Cited by 13
Verspyck, É., Gascoin-Lachambre, G., Senat, M. V., Ego, A., Simon, L., Guellec, I., Monier, I., Zeitlin, J. A., Subtil, D., & Vayssière, C. (2022) · Gynécologie Obstétrique Fertilité & Sénologie · doi:10.1016/j.gofs.2022.06.008 · Cited by 13
Ultrasound prediction of Zika virus-associated congenital injury using the profile of fetal growth
Walker, C. L., Ehinger, N. J., Mason, B., Oler, E., Little, M.-T. E., Ohuma, E. O., Papageorghiou, A. T., Nayeri, U. A., Curry, C. L., & Waldorf, K. M. A. (2020) · PLoS ONE · doi:10.1371/journal.pone.0233023 · Cited by 13
“[27] Therefore, we applied the International Fetal and Newborn Growth Consortium for the 21 Century (INTERGROWTH-21) standards, which was a multi-ethnic study of more than 13,000 pregnancies in 18 countries with which we could calculate HC: FL ratio Z-scores.”
MethodYusuf, K. K., Dongarwar, D., Agili, D. E. A., Maiyegun, S. O., & Salihu, H. M. (2021) · Annals of Epidemiology · doi:10.1016/j.annepidem.2021.07.004 · Cited by 13
Available Evidence of Association between Zika Virus and Microcephaly
Wu, J., Huang, D., Ma, J.-T., Ma, Y.-H., & Hu, Y. (2016) · Chinese Medical Journal · doi:10.4103/0366-6999.190672 · Cited by 13
“[18] Microcephaly is a rare condition defined as a smaller head size, compared to other fetuses/babies of the same age/sex/ethnicity,[19] often with prognosis of intellectual disabilities.”
BackgroundComparison of fetal growth by maternal prenatal acetaminophen use
Smarr, M. M., Bible, J., Gerlanc, N., Louis, G. M. B., Bever, A. M., & Grantz, K. L. (2019) · Pediatric Research · doi:10.1038/s41390-019-0379-7 · Cited by 13
Self-citationPrediction of Large‐for‐Gestational‐Age Neonates by Different Growth Standards
Duncan, J. R., Odibo, L., Hoover, E. A., & Odibo, A. O. (2020) · Journal of Ultrasound in Medicine · doi:10.1002/jum.15470 · Cited by 13
“One of the newer fetal growth charts, the NICHD ethnic/race specific fetal growth standard, was developed to improve the diagnostic accuracy of fetal growth disorders.(13) Another promising growth chart is the Fetal Medicine Foundation (FMF) fetal and neonatal growth chart that was created with the aim to develop a si…”
MethodIshiyama, A., Jang, H., Dintaman, J. M., Duess, J. W., Tragesser, C. J., & Sodhi, C. P. (2025) · Biomedicines · doi:10.3390/biomedicines13092288 · Cited by 17
Erken ve geç başlangıçlı intrauterin gelişme geriliğinin perinatal sonuçları
ALİYEVA, G., & Sucu, M. (2020) · Çukurova medical journal (Online)/Çukurova medical journal · doi:10.17826/cumj.839861 · Cited by 12
“0,155 Sekelli taburcu veya zaman içinde oluşan sekel 1(1,3) 2(5,4) 3(4,8) 4(2,7)”
InfluentialBadr, D. A., Cannie, M., Kadji, C., Kang, X., Carlin, A., & Jani, J. C. (2023) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2023.10.011 · Cited by 12
Longitudinal changes in maternal anthropometry in relation to neonatal anthropometry
Pugh, S. J., Ortega‐Villa, A. M., Grobman, W. A., Hinkle, S. N., Newman, R., Hediger, M. L., Grewal, J., Wing, D. A., Albert, P. S., & Grantz, K. L. (2019) · Public Health Nutrition · doi:10.1017/s1368980018003749 · Cited by 12
“Additional exclusion criteria included smoking, pre-gestational diabetes, chronic renal disease under medical supervision, autoimmune disease, psychiatric disorders, cancer and HIV/ AIDS((16,17)).”
BackgroundMethodSelf-citationThe Association between Infant Birth Weight, Head Circumference, and Neurodevelopmental Outcomes
Costantine, M. M., Tita, A., Mele, L., Casey, B. M., Peaceman, A. M., Varner, M. W., Reddy, U. M., Wapner, R. J., Thorp, J. M., Saade, G. R., et al. (2023) · American Journal of Perinatology · doi:10.1055/s-0043-1761920 · Cited by 12
Self-citationMaternal Depressive Symptoms, Perceived Stress, and Fetal Growth
Grobman, W. A., Wing, D. A., Albert, P. S., Kim, S., Grewal, J., Guille, C., Newman, R., Chien, E. K., Owen, J., D’Alton, M. E., et al. (2017) · Journal of Ultrasound in Medicine · doi:10.7863/ultra.16.08085 · Cited by 12
“Full details of the protocol and study methods have been published previously.(6) In summary, women were eligible for the study if they were at low risk of obstetric or medical complications.”
MethodSelf-citationCurrent Issues in the Development of Foetal Growth References and Standards
Ohuma, E. O., Njim, T. N., & Sharps, M. C. (2018) · Current Epidemiology Reports · doi:10.1007/s40471-018-0168-6 · Cited by 12
Vitner, D., Bleicher, I., Kadour‐Peero, E., Borenstein‐Levin, L., Kugelman, A., Sagi, S., & Gonen, R. (2018) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2018.1531121 · Cited by 12
“Recent reports suggest that the statistical approach to define fetal macrosomia, using customized growth curves based on ethnicity or individual characteristics, may improve precision in evaluating fetal growth [5,6].”
BackgroundBlue, N. R., Mele, L., Grobman, W. A., Bailit, J. L., Wapner, R. J., Thorp, J. M., Caritis, S. N., Prasad, M. R., Tita, A., Saade, G. R., et al. (2022) · American Journal of Obstetrics & Gynecology MFM · doi:10.1016/j.ajogmf.2022.100599 · Cited by 11
Self-citationKiefer, M. K., Finneran, M. M., Ware, C. A., Foy, P. M., Thung, S., Gabbe, S. G., Landon, M. B., Grobman, W. A., & Venkatesh, K. K. (2022) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.26071 · Cited by 11
Self-citationComparing population-based fetal growth standards in a US cohort
Gleason, J. L., Reddy, U. M., Chen, Z., Grobman, W. A., Wapner, R. J., Steller, J. G., Simhan, H. N., Scifres, C., Blue, N. R., Parry, S. I., et al. (2023) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2023.12.034 · Cited by 11
Self-citationBirth weight prediction models for the different gestational age stages in a Chinese population
Li, C., Yang, P., Zhang, B., Ji, W., Li, L., Gong, J., Xia, W., Li, Y., Jin, S., Song, R., et al. (2019) · Scientific Reports · doi:10.1038/s41598-019-47056-0 · Cited by 11
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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