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Performance of the Intergrowth-21st and World Health Organization fetal growth charts for the detection of small for gestational age neonates in a population from Latin America
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  • Jezid Miranda,
  • Natalia Maestre,
  • Angel Paternina,
  • Miguel Parra-Saavedra,
  • Javier Caradeux,
  • Alvaro Sepulveda-Martinez,
  • Melisa Pelaez,
  • Andrés Torrres,
  • Mauro Parra-Cordero,
  • Pilar Diaz,
  • Dahiana Gallo,
  • Dario Santacruz,
  • Nicolás Rodriguez,
  • Andres Sarmiento,
  • Jesus Benavides,
  • Sergio Girado,
  • Jose Rojas-Suarez,
  • Eduard Gratacos,
  • Francesc Figueras
Jezid Miranda
Cartagena University Faculty of Natural Sciences

Corresponding Author:jmirandaq@unicartagena.edu.co

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Natalia Maestre
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Angel Paternina
Universidad de Cartagena
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Miguel Parra-Saavedra
Universidad Simón Bolívar Facultad de Ciencias de la Salud
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Javier Caradeux
Clínica Dávila
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Alvaro Sepulveda-Martinez
Hospital Clinico de la Universidad de Chile
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Melisa Pelaez
Hospital Nacional Docente Madre Niño San Bartolomé
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Andrés Torrres
Instituto Mexicano del Seguro Social
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Mauro Parra-Cordero
University of Chile Hospital
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Pilar Diaz
Clínica Dávila
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Dahiana Gallo
Universidad del Valle
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Dario Santacruz
Clínica Versalles
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Nicolás Rodriguez
Fundacion Santa Fe de Bogota
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Andres Sarmiento
Universidad de los Andes
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Jesus Benavides
Universidad Tecnológica de Pereira
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Sergio Girado
Cartagena University Faculty of Natural Sciences
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Jose Rojas-Suarez
Universidad de Cartagena Facultad de Medicina
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Eduard Gratacos
BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic and Hospital Sant Joan de Deu)
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Francesc Figueras
Hospital Clinic de Barcelona
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Objective: To evaluate the performance of INTERGROWTH-21st and World Health Organization (WHO) fetal growth charts to identify small-for-gestational-age (SGA) and fetal growth restriction (FGR) neonates as well as their specific risks for adverse neonatal outcomes. Design: Multicenter cross-sectional study. Setting: Ten maternity units across four Latin American countries, 2016-2018. Population: 67,968 singleton live births. Methods: According to each standard, the neonates were classified as SGA and FGR (birthweight <10th and <3rd centiles, respectively). Main Outcomes Measures: The relative risk (RR) and diagnostic performance for the occurrence of a low Apgar score and low ponderal index were calculated for each standard. Results: The WHO charts identified more neonates as SGA than IG-21st (13.9% vs. 7%, respectively). 6.9% babies were considered SGA only by the WHO chart. Compared to normally grown babies, neonates classified as FGRs by both standards had the highest RR for a low Apgar (RR: 5.57; 95% CI: 3.99–7.78), followed by those SGA by both curves (RR: 3.27; 95% CI: 2.52–4.24), while SGAs identified by WHO alone did not have an additional risk (RR: 0.87; 95% CI: 0.55–1.39). Furthermore, the diagnostic odds ratio for a low Apgar was higher when INTERGROWTH-21st was used than when SGA and FGR were defined by WHO charts. Conclusions: In a large population of singleton deliveries from Latin America, the WHO fetal growth charts seem to identify significantly more SGA neonates than the INTERGROWTH-21st charts, but the diagnostic performance of the latter for low Apgar score and low ponderal index is better.
21 Apr 2022Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
25 Apr 2022Assigned to Editor
25 Apr 2022Submission Checks Completed
28 Apr 2022Reviewer(s) Assigned
16 May 2022Review(s) Completed, Editorial Evaluation Pending