Outcome‐based comparison of SMFM and ISUOG definitions of fetal growth restriction
ABSTRACT Objective The recent international guidelines by the Society for Maternal–Fetal Medicine (SMFM) and the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) differ in their definitions of fetal growth restriction (FGR). Our aim was to compare the performance of the two d...
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| Veröffentlicht in: | Ultrasound in obstetrics & gynecology 2021-06, Vol.57 (6), p.925-930 |
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| creator | Roeckner, J. T. Pressman, K. Odibo, L. Duncan, J. R. Odibo, A. O. |
| description | ABSTRACT
Objective
The recent international guidelines by the Society for Maternal–Fetal Medicine (SMFM) and the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) differ in their definitions of fetal growth restriction (FGR). Our aim was to compare the performance of the two definitions in predicting neonatal small‐for‐gestational age (SGA) and composite adverse neonatal outcome (ANO).
Methods
This was a secondary analysis of data from a prospective study of women referred for fetal growth ultrasound examination between 26 + 0 and 36 + 6 weeks' gestation. The SMFM and ISUOG guidelines were used to define pregnancies with FGR. The SMFM definition of FGR is estimated fetal weight (EFW) or abdominal circumference (AC) |
| doi_str_mv | 10.1002/uog.23638 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2508580327</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2508580327</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3888-64cacecfc74924b552e89c9de52c80d34a3886cd8fd470dd02c29b7f6e4f77eb3</originalsourceid><addsrcrecordid>eNp10MtKAzEUBuAgiq2XhS8gATe6GM0kmSSzFPEGLV2o65DJRVOmk5rMIO58BJ_RJzG16kJwdQjn48_hB-CgRKclQvhsCI-nmDAiNsC4pKwuEEfVJhijmqGCsxqPwE5Kc4QQo4RtgxEhvBaY0zG4nw29Dgv78fbeqGQNzI-lij6FDgYH76ZXU6g6A2_vHmbX0FjnO9_70KXV1tletfAxhpf-CUab-uj1arkHtpxqk93_nrvg4ery_uKmmMyuby_OJ4UmQoiCUa201U5zWmPaVBW2ota1sRXWAhlCVWZMG-EM5cgYhDWuG-6YpY5z25BdcLzOXcbwPOT_5cInbdtWdTYMSeIKiUoggnmmR3_oPAyxy9dlRSrBKC7LrE7WSseQUrROLqNfqPgqSyRXVctctfyqOtvD78ShWVjzK3-6zeBsDV58a1__T5K52XXkJ6qdiKQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2535864211</pqid></control><display><type>article</type><title>Outcome‐based comparison of SMFM and ISUOG definitions of fetal growth restriction</title><source>MEDLINE</source><source>Wiley Online Library Free Content</source><source>Access via Wiley Online Library</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Roeckner, J. T. ; Pressman, K. ; Odibo, L. ; Duncan, J. R. ; Odibo, A. O.</creator><creatorcontrib>Roeckner, J. T. ; Pressman, K. ; Odibo, L. ; Duncan, J. R. ; Odibo, A. O.</creatorcontrib><description>ABSTRACT
Objective
The recent international guidelines by the Society for Maternal–Fetal Medicine (SMFM) and the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) differ in their definitions of fetal growth restriction (FGR). Our aim was to compare the performance of the two definitions in predicting neonatal small‐for‐gestational age (SGA) and composite adverse neonatal outcome (ANO).
Methods
This was a secondary analysis of data from a prospective study of women referred for fetal growth ultrasound examination between 26 + 0 and 36 + 6 weeks' gestation. The SMFM and ISUOG guidelines were used to define pregnancies with FGR. The SMFM definition of FGR is estimated fetal weight (EFW) or abdominal circumference (AC) < 10th percentile. The ISUOG‐FGR definition follows the Delphi consensus criteria and includes either EFW or AC < 3rd percentile or EFW or AC < 10th percentile combined with abnormal Doppler findings or a decrease in growth centiles. The primary outcome was the prediction of neonatal SGA, defined as birth weight < 10th percentile, and a composite of ANO, which was defined as one or more of: Grade‐III or ‐IV intraventricular hemorrhage, respiratory distress syndrome, neonatal death, cord blood pH < 7.1, seizures and admission to the neonatal intensive care unit. Test characteristics (sensitivity, specificity, positive predictive value (PPV), negative predictive value and positive (LR+) and negative likelihood ratios) and area under the receiver‐operating‐characteristics curve were determined. The association between FGR detected by each definition and selected adverse outcomes was assessed using logistic regression analysis.
Results
Of the 1054 pregnancies that met the inclusion criteria, 137 (13.0%) and 55 (5.2%) were defined as having FGR by the SMFM and ISUOG definitions, respectively. Composite ANO and SGA neonate each occurred in 139 (13.2%) pregnancies. For the prediction of neonatal SGA, the SMFM‐FGR definition had a higher sensitivity (54.7%) than did the ISUOG definition (28.8%). The ISUOG‐FGR definition had higher specificity (98.4% vs 93.3%), LR+ (18.0 vs 8.2) and PPV (72.7% vs 55.5%) than did the SMFM definition for the prediction of a SGA neonate. The SMFM‐ and ISUOG‐FGR definitions had similarly poor performance in predicting composite ANO, with sensitivities of 15.1% and 10.1%, respectively.
Conclusions
The SMFM definition of FGR is associated with a higher detection rate for SGA neonates but at the cost of some reduction in specificity. The ISUOG‐FGR definition has a higher specificity, LR+ and PPV for the prediction of neonatal SGA. Both definitions of FGR performed poorly in predicting a composite ANO. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.</description><identifier>ISSN: 0960-7692</identifier><identifier>EISSN: 1469-0705</identifier><identifier>DOI: 10.1002/uog.23638</identifier><identifier>PMID: 33798274</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Adult ; Birth weight ; Cord blood ; Criteria ; estimated fetal weight ; Female ; fetal growth restriction ; Fetal Growth Retardation - diagnosis ; Fetal Weight ; Fetuses ; Gestation ; Gestational Age ; Guidelines ; Gynecology ; Hemorrhage ; Humans ; Infant, Small for Gestational Age ; Likelihood ratio ; Neonates ; Obstetrics ; Performance prediction ; Practice Guidelines as Topic ; Predictions ; Pregnancy ; Prenatal Diagnosis ; Prospective Studies ; Regression analysis ; Respiratory distress syndrome ; Secondary analysis ; Seizures ; Sensitivity ; Sensitivity analysis ; small‐for‐gestational age ; Societies, Medical ; Ultrasonic imaging ; Ultrasound ; Weight ; Young Adult</subject><ispartof>Ultrasound in obstetrics & gynecology, 2021-06, Vol.57 (6), p.925-930</ispartof><rights>2021 International Society of Ultrasound in Obstetrics and Gynecology.</rights><rights>2021 International Society of Ultrasound in Obstetrics and Gynecology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3888-64cacecfc74924b552e89c9de52c80d34a3886cd8fd470dd02c29b7f6e4f77eb3</citedby><cites>FETCH-LOGICAL-c3888-64cacecfc74924b552e89c9de52c80d34a3886cd8fd470dd02c29b7f6e4f77eb3</cites><orcidid>0000-0002-0770-7477 ; 0000-0001-8464-9744 ; 0000-0003-4340-450X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fuog.23638$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fuog.23638$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33798274$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Roeckner, J. T.</creatorcontrib><creatorcontrib>Pressman, K.</creatorcontrib><creatorcontrib>Odibo, L.</creatorcontrib><creatorcontrib>Duncan, J. R.</creatorcontrib><creatorcontrib>Odibo, A. O.</creatorcontrib><title>Outcome‐based comparison of SMFM and ISUOG definitions of fetal growth restriction</title><title>Ultrasound in obstetrics & gynecology</title><addtitle>Ultrasound Obstet Gynecol</addtitle><description>ABSTRACT
Objective
The recent international guidelines by the Society for Maternal–Fetal Medicine (SMFM) and the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) differ in their definitions of fetal growth restriction (FGR). Our aim was to compare the performance of the two definitions in predicting neonatal small‐for‐gestational age (SGA) and composite adverse neonatal outcome (ANO).
Methods
This was a secondary analysis of data from a prospective study of women referred for fetal growth ultrasound examination between 26 + 0 and 36 + 6 weeks' gestation. The SMFM and ISUOG guidelines were used to define pregnancies with FGR. The SMFM definition of FGR is estimated fetal weight (EFW) or abdominal circumference (AC) < 10th percentile. The ISUOG‐FGR definition follows the Delphi consensus criteria and includes either EFW or AC < 3rd percentile or EFW or AC < 10th percentile combined with abnormal Doppler findings or a decrease in growth centiles. The primary outcome was the prediction of neonatal SGA, defined as birth weight < 10th percentile, and a composite of ANO, which was defined as one or more of: Grade‐III or ‐IV intraventricular hemorrhage, respiratory distress syndrome, neonatal death, cord blood pH < 7.1, seizures and admission to the neonatal intensive care unit. Test characteristics (sensitivity, specificity, positive predictive value (PPV), negative predictive value and positive (LR+) and negative likelihood ratios) and area under the receiver‐operating‐characteristics curve were determined. The association between FGR detected by each definition and selected adverse outcomes was assessed using logistic regression analysis.
Results
Of the 1054 pregnancies that met the inclusion criteria, 137 (13.0%) and 55 (5.2%) were defined as having FGR by the SMFM and ISUOG definitions, respectively. Composite ANO and SGA neonate each occurred in 139 (13.2%) pregnancies. For the prediction of neonatal SGA, the SMFM‐FGR definition had a higher sensitivity (54.7%) than did the ISUOG definition (28.8%). The ISUOG‐FGR definition had higher specificity (98.4% vs 93.3%), LR+ (18.0 vs 8.2) and PPV (72.7% vs 55.5%) than did the SMFM definition for the prediction of a SGA neonate. The SMFM‐ and ISUOG‐FGR definitions had similarly poor performance in predicting composite ANO, with sensitivities of 15.1% and 10.1%, respectively.
Conclusions
The SMFM definition of FGR is associated with a higher detection rate for SGA neonates but at the cost of some reduction in specificity. The ISUOG‐FGR definition has a higher specificity, LR+ and PPV for the prediction of neonatal SGA. Both definitions of FGR performed poorly in predicting a composite ANO. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.</description><subject>Adult</subject><subject>Birth weight</subject><subject>Cord blood</subject><subject>Criteria</subject><subject>estimated fetal weight</subject><subject>Female</subject><subject>fetal growth restriction</subject><subject>Fetal Growth Retardation - diagnosis</subject><subject>Fetal Weight</subject><subject>Fetuses</subject><subject>Gestation</subject><subject>Gestational Age</subject><subject>Guidelines</subject><subject>Gynecology</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Infant, Small for Gestational Age</subject><subject>Likelihood ratio</subject><subject>Neonates</subject><subject>Obstetrics</subject><subject>Performance prediction</subject><subject>Practice Guidelines as Topic</subject><subject>Predictions</subject><subject>Pregnancy</subject><subject>Prenatal Diagnosis</subject><subject>Prospective Studies</subject><subject>Regression analysis</subject><subject>Respiratory distress syndrome</subject><subject>Secondary analysis</subject><subject>Seizures</subject><subject>Sensitivity</subject><subject>Sensitivity analysis</subject><subject>small‐for‐gestational age</subject><subject>Societies, Medical</subject><subject>Ultrasonic imaging</subject><subject>Ultrasound</subject><subject>Weight</subject><subject>Young Adult</subject><issn>0960-7692</issn><issn>1469-0705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10MtKAzEUBuAgiq2XhS8gATe6GM0kmSSzFPEGLV2o65DJRVOmk5rMIO58BJ_RJzG16kJwdQjn48_hB-CgRKclQvhsCI-nmDAiNsC4pKwuEEfVJhijmqGCsxqPwE5Kc4QQo4RtgxEhvBaY0zG4nw29Dgv78fbeqGQNzI-lij6FDgYH76ZXU6g6A2_vHmbX0FjnO9_70KXV1tletfAxhpf-CUab-uj1arkHtpxqk93_nrvg4ery_uKmmMyuby_OJ4UmQoiCUa201U5zWmPaVBW2ota1sRXWAhlCVWZMG-EM5cgYhDWuG-6YpY5z25BdcLzOXcbwPOT_5cInbdtWdTYMSeIKiUoggnmmR3_oPAyxy9dlRSrBKC7LrE7WSseQUrROLqNfqPgqSyRXVctctfyqOtvD78ShWVjzK3-6zeBsDV58a1__T5K52XXkJ6qdiKQ</recordid><startdate>202106</startdate><enddate>202106</enddate><creator>Roeckner, J. T.</creator><creator>Pressman, K.</creator><creator>Odibo, L.</creator><creator>Duncan, J. R.</creator><creator>Odibo, A. O.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0770-7477</orcidid><orcidid>https://orcid.org/0000-0001-8464-9744</orcidid><orcidid>https://orcid.org/0000-0003-4340-450X</orcidid></search><sort><creationdate>202106</creationdate><title>Outcome‐based comparison of SMFM and ISUOG definitions of fetal growth restriction</title><author>Roeckner, J. T. ; Pressman, K. ; Odibo, L. ; Duncan, J. R. ; Odibo, A. O.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3888-64cacecfc74924b552e89c9de52c80d34a3886cd8fd470dd02c29b7f6e4f77eb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Birth weight</topic><topic>Cord blood</topic><topic>Criteria</topic><topic>estimated fetal weight</topic><topic>Female</topic><topic>fetal growth restriction</topic><topic>Fetal Growth Retardation - diagnosis</topic><topic>Fetal Weight</topic><topic>Fetuses</topic><topic>Gestation</topic><topic>Gestational Age</topic><topic>Guidelines</topic><topic>Gynecology</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Infant, Small for Gestational Age</topic><topic>Likelihood ratio</topic><topic>Neonates</topic><topic>Obstetrics</topic><topic>Performance prediction</topic><topic>Practice Guidelines as Topic</topic><topic>Predictions</topic><topic>Pregnancy</topic><topic>Prenatal Diagnosis</topic><topic>Prospective Studies</topic><topic>Regression analysis</topic><topic>Respiratory distress syndrome</topic><topic>Secondary analysis</topic><topic>Seizures</topic><topic>Sensitivity</topic><topic>Sensitivity analysis</topic><topic>small‐for‐gestational age</topic><topic>Societies, Medical</topic><topic>Ultrasonic imaging</topic><topic>Ultrasound</topic><topic>Weight</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Roeckner, J. T.</creatorcontrib><creatorcontrib>Pressman, K.</creatorcontrib><creatorcontrib>Odibo, L.</creatorcontrib><creatorcontrib>Duncan, J. R.</creatorcontrib><creatorcontrib>Odibo, A. O.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Ultrasound in obstetrics & gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Roeckner, J. T.</au><au>Pressman, K.</au><au>Odibo, L.</au><au>Duncan, J. R.</au><au>Odibo, A. O.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcome‐based comparison of SMFM and ISUOG definitions of fetal growth restriction</atitle><jtitle>Ultrasound in obstetrics & gynecology</jtitle><addtitle>Ultrasound Obstet Gynecol</addtitle><date>2021-06</date><risdate>2021</risdate><volume>57</volume><issue>6</issue><spage>925</spage><epage>930</epage><pages>925-930</pages><issn>0960-7692</issn><eissn>1469-0705</eissn><abstract>ABSTRACT
Objective
The recent international guidelines by the Society for Maternal–Fetal Medicine (SMFM) and the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) differ in their definitions of fetal growth restriction (FGR). Our aim was to compare the performance of the two definitions in predicting neonatal small‐for‐gestational age (SGA) and composite adverse neonatal outcome (ANO).
Methods
This was a secondary analysis of data from a prospective study of women referred for fetal growth ultrasound examination between 26 + 0 and 36 + 6 weeks' gestation. The SMFM and ISUOG guidelines were used to define pregnancies with FGR. The SMFM definition of FGR is estimated fetal weight (EFW) or abdominal circumference (AC) < 10th percentile. The ISUOG‐FGR definition follows the Delphi consensus criteria and includes either EFW or AC < 3rd percentile or EFW or AC < 10th percentile combined with abnormal Doppler findings or a decrease in growth centiles. The primary outcome was the prediction of neonatal SGA, defined as birth weight < 10th percentile, and a composite of ANO, which was defined as one or more of: Grade‐III or ‐IV intraventricular hemorrhage, respiratory distress syndrome, neonatal death, cord blood pH < 7.1, seizures and admission to the neonatal intensive care unit. Test characteristics (sensitivity, specificity, positive predictive value (PPV), negative predictive value and positive (LR+) and negative likelihood ratios) and area under the receiver‐operating‐characteristics curve were determined. The association between FGR detected by each definition and selected adverse outcomes was assessed using logistic regression analysis.
Results
Of the 1054 pregnancies that met the inclusion criteria, 137 (13.0%) and 55 (5.2%) were defined as having FGR by the SMFM and ISUOG definitions, respectively. Composite ANO and SGA neonate each occurred in 139 (13.2%) pregnancies. For the prediction of neonatal SGA, the SMFM‐FGR definition had a higher sensitivity (54.7%) than did the ISUOG definition (28.8%). The ISUOG‐FGR definition had higher specificity (98.4% vs 93.3%), LR+ (18.0 vs 8.2) and PPV (72.7% vs 55.5%) than did the SMFM definition for the prediction of a SGA neonate. The SMFM‐ and ISUOG‐FGR definitions had similarly poor performance in predicting composite ANO, with sensitivities of 15.1% and 10.1%, respectively.
Conclusions
The SMFM definition of FGR is associated with a higher detection rate for SGA neonates but at the cost of some reduction in specificity. The ISUOG‐FGR definition has a higher specificity, LR+ and PPV for the prediction of neonatal SGA. Both definitions of FGR performed poorly in predicting a composite ANO. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>33798274</pmid><doi>10.1002/uog.23638</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-0770-7477</orcidid><orcidid>https://orcid.org/0000-0001-8464-9744</orcidid><orcidid>https://orcid.org/0000-0003-4340-450X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Free Content; Access via Wiley Online Library; EZB-FREE-00999 freely available EZB journals |
| subjects | Adult Birth weight Cord blood Criteria estimated fetal weight Female fetal growth restriction Fetal Growth Retardation - diagnosis Fetal Weight Fetuses Gestation Gestational Age Guidelines Gynecology Hemorrhage Humans Infant, Small for Gestational Age Likelihood ratio Neonates Obstetrics Performance prediction Practice Guidelines as Topic Predictions Pregnancy Prenatal Diagnosis Prospective Studies Regression analysis Respiratory distress syndrome Secondary analysis Seizures Sensitivity Sensitivity analysis small‐for‐gestational age Societies, Medical Ultrasonic imaging Ultrasound Weight Young Adult |
| title | Outcome‐based comparison of SMFM and ISUOG definitions of fetal growth restriction |
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