1. Assessing fetal growth in Africa: Application of the international WHO and INTERGROWTH-21st standards in a Beninese pregnancy cohort
- Author
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Emmanuel Yovo, Manfred Accrombessi, Gino Agbota, Alice Hocquette, William Atade, Olaiitan T. Ladikpo, Murielle Mehoba, Auguste Degbe, Ghyslain Mombo-Ngoma, Achille Massougbodji, Nikki Jackson, Nadine Fievet, Barbara Heude, Jennifer Zeitlin, Valérie Briand, Institut de Recherche Clinique du Bénin [Abomey-Calavi, Bénin] (IRCB), London School of Hygiene and Tropical Medicine (LSHTM), Infectious and Tropical Diseases Department [Montpellier], Institut de Recherche pour le Développement (IRD)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM), Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre de Recherches Médicales de Lambaréné, University of Tübingen, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), University of Oxford, Mère et enfant en milieu tropical : pathogènes, système de santé et transition épidémiologique (MERIT - UMR_D 261), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), Research Team on Early life Origins of Health (EarOH), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Global Health in the Global South (GHiGS), Institut de Recherche pour le Développement (IRD)- Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Agence Nationale de la Recherche, Fondation de France, and ANR-13-JSV1-0004,RECIPAL,Impact du paludisme précoce au cours de la grossesse sur la croissance fœtale au Bénin(2013)
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Adult ,Computer and Information Sciences ,Embryology ,Epidemiology ,Maternal Health ,Science ,Blood Pressure ,World Health Organization ,Tanzania ,Infographics ,Vascular Medicine ,Fetal Development ,Young Adult ,Medical Conditions ,Pregnancy ,Hypertensive Disorders in Pregnancy ,Medicine and Health Sciences ,Parasitic Diseases ,Benin ,Humans ,Growth Charts ,Data Management ,Fetuses ,Multidisciplinary ,Data Visualization ,Obstetrics and Gynecology ,Biology and Life Sciences ,Anemia ,Hematology ,Tropical Diseases ,Charts ,Malaria ,Pregnancy Complications ,Medical Risk Factors ,Hypertension ,Birth ,Women's Health ,Medicine ,Female ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Research Article ,Developmental Biology - Abstract
Background Fetal growth restriction is a major complication of pregnancy and is associated with stillbirth, infant death and child morbidity. Ultrasound monitoring of pregnancy is becoming more common in Africa for fetal growth monitoring in clinical care and research, but many countries have no national growth charts. We evaluated the new international fetal growth standards from INTERGROWTH-21st and WHO in a cohort from southern Benin. Methods Repeated ultrasound and clinical data were collected in women from the preconceptional RECIPAL cohort (241 women with singleton pregnancies, 964 ultrasounds). We modelled fetal biometric parameters including abdominal circumference (AC) and estimated fetal weight (EFW) and compared centiles to INTERGROWTH-21st and WHO standards, using the Bland and Altman method to assess agreement. For EFW, we used INTERGROWTH-21st standards based on their EFW formula (IG21st) as well as a recent update using Hadlock’s EFW formula (IG21hl). Proportions of fetuses with measurements under the 10th percentile were compared. Results Maternal malaria and anaemia prevalence was 43% and 69% respectively and 11% of women were primigravid. Overall, the centiles in the RECIPAL cohort were higher than that of INTERGROWTH-21st and closer to that of WHO. Consequently, the proportion of fetuses under 10th percentile thresholds was systematically lower when applying IG21st compared to WHO standards. At 27–31 weeks and 33–38 weeks, respectively, 7.4% and 5.6% of fetuses had EFW th percentile using IG21hl standards versus 10.7% and 11.6% using WHO standards. Conclusion Despite high anemia and malaria prevalence in the cohort, IG21st and WHO standards did not identify higher than expected proportions of fetuses under the 10th percentiles of ultrasound parameters or EFW. The proportions of fetuses under the 10th percentile threshold for IG21st charts were particularly low, raising questions about its use to identify growth-restricted fetuses in Africa.
- Published
- 2022