Interpretation
Our results compare well with the most recently published observational
study on antenatal detection of SGA following implementation of GAP in
an Australian hospital clinic setting. 7 Antenatal SGA
detection rates increased significantly following implementation of GAP
from 21% to 41% (OR=2.6, 95% CI 1.3, 4.9). Consistent with our
findings, these authors also reported reduced overall neonatal unit
admission after implementation of GAP. Pre-GAP, admission of SGA babies
to the special care nursery was 18% compared to 12% post GAP whereas
admission of SGA babies to the neonatal intensive care unit was 5%
pre-GAP and 4.8% post-GAP. The effect of antenatal identification of
SGA on other measures of neonatal outcome was not reported.
Conclusion
In our study, which is the first to evaluate the effect of
implementation of GAP in a New Zealand District Health Board where women
receive continuity of midwifery antenatal care, we found that
introduction of GAP was associated with an almost five-fold increased
likelihood of detection of SGA. While there was an increase in maternal
intervention and preterm birth between epochs, this effect was not more
pronounced in SGA pregnancies.
Amongst SGA babies who were identified during pregnancy, there was some
evidence of reduced composite neonatal morbidity and reduced prolonged
neonatal admission. GAP is a safe tool for increasing detection of SGA
and suitable for application in an ethnically diverse population with
high levels of obesity. Future studies should be powered to detect
perinatal mortality and severe morbidity, and also to detect the impact
of GAP on false positive diagnosis of SGA and on utilisation of
ultrasound scanning.
Acknowledgements :
Disclosure of Interests
FJC is an educator for the New Zealand GAP programme. LMEMcC was the
lead author on the NZMFMN SGA Guideline. No conflicts of interest were
declared by other authors. Completed disclosure of interest forms are
available to view online as supporting information.
Contribution to
Authorship
All authors met authorship criteria. FJC, LMEMcC, JMcA-C and NG
contributed to the concept and design of the study. AO’B and FJC
performed searches, screening and data extraction. FJC, LMEMcC, JW and
CMcK analysed the data. FJC and LMEMcC drafted the manuscript. RST
formatted the tables and diagrams, and assisted in editing the
manuscript. LMEMcC, JMcC-C, and NG supervised the study and contributed
to interpretation of data. All authors reviewed draft versions of the
manuscript and accepted the final version. LMEMcC is the senior author
on this manuscript.
Transparency declaration
As the lead author, FJC affirms that this manuscript is an honest,
accurate, and transparent account of the study being reported; that no
important aspects of the study have been omitted.