Fetal Size Classified Using Gestational Days rather than Gestational
Weeks Improves Correlation with Stillbirth Risk: A Statewide Population
Study.
Abstract
Objective: Many growth charts provide single centile cutoffs for each
week of gestation, yet fetuses gain weight throughout the week. We aimed
to assess whether using a single centile per week distorts the
proportion of infants classified as small and their risk of stillbirth
across the week. Design: Retrospective cohort study. Setting: Victoria,
Australia. Population: Singleton, non-anomalous infants born from
2005-2015 (529,261). Methods: We applied growth charts to identify
small-for-gestational-age (SGA) fetuses on week-based charts (single
centile per gestational week) and day-based charts (centile per
gestational day). Main outcome measures: Proportions <10th
centile by each chart, and stillbirth risk amongst SGA infants. Results:
Using week-based charts, 12.1% of infants born on the first day of a
gestational week were SGA, but only 7.8% on the final day; ie. an
infant born at the end of the week was 44% less likely to be classed as
SGA (p<0.0001). The relative risk of stillbirth amongst SGA
infants born on the final day of the week compared with the first was
1.47 (95%CI 1.09-2.00, p=0.01). Using day charts, SGA proportions were
similar and stillbirth risk equal between the beginning and end of the
week (9.5% vs 9.9%). Conclusions: Growth standards using a single
cutoff for a gestational week overestimate the proportion of infants
that are small at the beginning of the week and underestimate the
proportion at the end. This distorts the risk of stillbirth amongst SGA
infants based on when in the week an infant is born. Day-based charts
should be used