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Abstract Objective To identify neonatal risk for severe adverse perinatal outcomes across birth weight centiles in two Dutch and one international birth weight chart. Background Growth restricted newborns have not reached their intrinsic growth potential in utero and are at risk of perinatal morbidity and mortality. There is no golden standard for the confirmation of the diagnosis of fetal growth restriction after birth. Estimated fetal weight and birth weight below the 10th percentile are generally used as proxy for growth restriction. The choice of birth weight chart influences the specific cut-off by which birth weight is defined as abnormal, thereby triggering clinical management. Ideally, this cut-off should discriminate appropriately between newborns at low and at high risk of severe adverse perinatal outcomes and consequently correctly inform clinical management. Methods This is a secondary analysis of the IUGR Risk Selection (IRIS) study. Newborns (n = 12 953) of women with a low-risk status at the start of pregnancy and that received primary antenatal care in the Netherlands were included. We examined the distribution of severe adverse perinatal outcomes across birth weight centiles for three birth weight charts (Visser, Hoftiezer and INTERGROWTH) by categorizing birth weight centile groups and comparing the prognostic performance for severe adverse perinatal outcomes. Severe adverse perinatal outcomes were defined as a composite of one or more of the following: perinatal death, Apgar score

Objective: To identify neonatal risk for severe adverse perinatal outcomes across birth weight centiles in two Dutch and one international birth weight chart.Background: Growth restricted newborns have not reached their intrinsic growth potential in utero and are at risk of perinatal morbidity and mortality. There is no golden standard for the confirmation of the diagnosis of fetal growth restriction after birth. Estimated fetal weight and birth weight below the 10th percentile are generally used as proxy for growth restriction. The choice of birth weight chart influences the specific cut-off by which birth weight is defined as abnormal, thereby triggering clinical management. Ideally, this cut-off should discriminate appropriately between newborns at low and at high risk of severe adverse perinatal outcomes and consequently correctly inform clinical management.Methods: This is a secondary analysis of the IUGR Risk Selection (IRIS) study. Newborns (n = 12 953) of women with a low-risk status at the start of pregnancy and that received primary antenatal care in the Netherlands were included. We examined the distribution of severe adverse perinatal outcomes across birth weight centiles for three birth weight charts (Visser, Hoftiezer and INTERGROWTH) by categorizing birth weight centile groups and comparing the prognostic performance for severe adverse perinatal outcomes. Severe adverse perinatal outcomes were defined as a composite of one or more of the following: perinatal death, Apgar score < 4 at 5 min, impaired consciousness, asphyxia, seizures, assisted ventilation, septicemia, meningitis, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, or necrotizing enterocolitis.Results: We found the highest rates of severe adverse perinatal outcomes among the smallest newborns (< 3rd percentile) (6.2% for the Visser reference curve, 8.6% for the Hoftiezer chart and 12.0% for the INTERGROWTH chart). Discriminative abilities of the three birth weight charts across the entire range of birth weight centiles were poor with areas under the curve ranging from 0.57 to 0.61. Sensitivity rates of the various cut-offs were also low.Conclusions: The clinical utility of all three charts in identifying high risk of severe adverse perinatal outcomes is poor. There is no single cut-off that discriminates clearly between newborns at low or high risk.Trial Registration: Netherlands Trial Register NTR4367 . Registration date March 20th, 2014. [ABSTRACT FROM AUTHOR]

Objectives To compare the role of two nomograms to classify large-for-gestational age (LGA) neonates in women with pre-eclampsia and to determine the frequency of placental vascular lesions according to the timing of delivery. Method This cohort study included 118 consecutive women with pre-eclampsia delivering between 23 and 41 weeks' gestation. The frequencies of LGA neonates according to customized growth curves and a national birth weight (BW) chart were compared. Similarly, the frequencies of LGA neonates and histological placental vascular lesions were compared between pre-eclamptic women delivering at < 34 weeks (n = 40) and those delivering later (n = 78). Results Customized growth curves allowed classification of a higher proportion of LGA neonates than did BW curves (18.6% (22/118) vs 10.2% (12/118); P = 0.002). Among pre-eclamptic women delivering at ≥ 34 weeks, but not earlier, the proportion of neonates classified as LGA by customized growth curves was higher than that classified by BW curves (26.9% (21/78) vs 15.4% (12/78); P = 0.004). Placental vascular lesions were less frequent in pre-eclamptic women delivering at ≥ 34 weeks than in those delivering earlier (41% (32/78) vs 62.5% (25/40); P = 0.03). Conclusions Customized growth curves allow classification of a higher proportion of LGA neonates than do population birth weight curves among women with pre-eclampsia delivering at ≥ 34 weeks. Pre-eclamptic women delivering at ≥ 34 weeks have fewer placental vascular lesions than do those delivering earlier. [ABSTRACT FROM AUTHOR]