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dc.contributor.CRUESPUNIVERSIDADE DE ESTADUAL DE CAMPINASpt_BR;; widmerm@who.intpt_BR
dc.titleThe World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study Of Ultrasound Biometric Measurements And Estimated Fetal Weighten
dc.contributor.authorTorvid; Piaggiopt_BR
dc.contributor.authorGilda; Carrolipt_BR
dc.contributor.authorGuillermo; Widmerpt_BR
dc.contributor.authorMariana; Carvalhopt_BR
dc.contributor.authorJose; Jensenpt_BR
dc.contributor.authorLisa Neerup; Giordanopt_BR
dc.contributor.authorDaniel; Cecattipt_BR
dc.contributor.authorJose Guilherme; Aleempt_BR
dc.contributor.authorHany Abdel; Taiegawkarpt_BR
dc.contributor.authorSameera A.; Benachipt_BR
dc.contributor.authorAlexandara; Diemertpt_BR
dc.contributor.authorAnke; Kitotopt_BR
dc.contributor.authorAntoinettte Tshefu; Thinkhamroppt_BR
dc.contributor.authorJadsada; Lumbiganonpt_BR
dc.contributor.authorPisake; Taborpt_BR
dc.contributor.authorAnn; Kriplanipt_BR
dc.contributor.authorAlka; Gonzalez Perezpt_BR
dc.contributor.authorRogelio; Hecherpt_BR
dc.contributor.authorKurt; Hansonpt_BR
dc.contributor.authorMark A.; Guelmezoglupt_BR
dc.contributor.authorMetin; Plattpt_BR
dc.contributor.authorLawrence D.pt_BR[Cecatti, Jose Guilherme] Univ Estadual Campinas, Sch Med Sci, Dept Obstet & Gynecol, Campinas, Brazilpt_BR[Kiserud, Torvid] Haukeland Hosp, Dept Obstet & Gynecol, Bergen, Norwaypt_BR[Kiserud, Torvid] Univ Bergen, Dept Clin Sci, Bergen, Norwaypt_BR[Piaggio, Gilda] London Sch Hyg &Trop Med, Dept Med Stat, London, Englandpt_BR[Piaggio, Gildapt_BR, Jose] Stat Consultoria, Sao Paulo, Brazilpt_BR[Carroli, Guillermo] Ctr Rosarino Estudios Perinatales, Rosario, Argentinapt_BR[Widmer, Marianapt_BR, Metin] World Hlth Org, World Bank Special Programme Res Dev & Res Traini, UNDP UNFPA UNICEF WHO, Dept Reprod Hlth & Res, Geneva, Switzerlandpt_BR[Jensen, Lisa Neeruppt_BR, Ann] Univ Copenhagen, Rigshosp, Ctr Fetal Med, Dept Obstet, Copenhagen, Denmarkpt_BR[Aleem, Hany Abdel] Assiut Univ, Fac Med, Dept Obstet & Gynecol, Assiut, Egyptpt_BR[Taiegawkar, Sameera A.] George Washington Univ, Milken Inst Sch Publ Hlth, Dept Exercise & Nutr Sci, Washington, DC USApt_BR[Benachi, Alexandara] Univ Paris Sud, AP HP, Hop Antoine Beclere, Serv Gynecol Obstet, Clamart, Francept_BR[Diemert, Anke] Univ Med Ctr Hamburg Eppendorf, Dept Obstet & Fetal Med, Hamburg, Germanypt_BR[Kitoto, Antoinettte Tshefu] Univ Kinshasa, Fac Med, Ecole Sante Publ, Kinshasa, DEM REP CONGOpt_BR[Thinkhamrop, Jadsadapt_BR, Pisake] Khon Kaen Univ, Dept Obstet & Gynecol, Fac Med, Khon Kaen, Thailandpt_BR[Kriplani, Alka] All India Inst Med Sci, Dept Obstet & Gynecol, New Delhi, Indiapt_BR[Gonzalez Perez, Rogelio] Pontificia Univ Catolica Chile, Escuela Med, Div Obstet & Ginecol, Santiago, Chilept_BR[Hanson, Mark A.] Univ Southampton, Inst Dev Sci, Southampton SO9 5NH, Hants, Englandpt_BR[Platt, Lawrence D.] Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA 90095 USApt_BR[Platt, Lawrence D.] Ctr Fetal Med & Womens Ultrasound, Los Angeles, CA USApt_BR
dc.description.abstractBackground Perinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common non-communicable diseases in adulthood. Against this background, WHO made it a high priority to provide the present fetal growth charts for estimated fetal weight (EFW) and common ultrasound biometric measurements intended for worldwide use. Methods and Findings We conducted a multinational prospective observational longitudinal study of fetal growth in low-risk singleton pregnancies of women of high or middle socioeconomic status and without known environmental constraints on fetal growth. Centers in ten countries (Argentina, Brazil, Democratic Republic of the Congo, Denmark, Egypt, France, Germany, India, Norway, and Thailand) recruited participants who had reliable information on last menstrual period and gestational age confirmed by crown-rump length measured at 8-13 wk of gestation. Participants had anthropometric and nutritional assessments and seven scheduled ultrasound examinations during pregnancy. Fifty-two participants withdrew consent, and 1,387 participated in the study. At study entry, median maternal age was 28 y (interquartile range [IQR] 25-31), median height was 162 cm (IQR 157-168), median weight was 61 kg (IQR 55-68), 58% of the women were nulliparous, and median daily caloric intake was 1,840 cal (IQR 1,487-2,222). The median pregnancy duration was 39 wk (IQR 38-40) although there were significant differences between countries, the largest difference being 12 d (95% CI 8-16). The median birthweight was 3,300 g (IQR 2,980-3,615). There were differences in birthweight between countries, e. g., India had significantly smaller neonates than the other countries, even after adjusting for gestational age. Thirty-one women had a miscarriage, and three fetuses had intrauterine death. The 8,203 sets of ultrasound measurements were scrutinized for outliers and leverage points, and those measurements taken at 14 to 40 wk were selected for analysis. A total of 7,924 sets of ultrasound measurements were analyzed by quantile regression to establish longitudinal reference intervals for fetal head circumference, biparietal diameter, humerus length, abdominal circumference, femur length and its ratio with head circumference and with biparietal diameter, and EFW. There was asymmetric distribution of growth of EFW: a slightly wider distribution among the lower percentiles during early weeks shifted to a notably expanded distribution of the higher percentiles in late pregnancy. Male fetuses were larger than female fetuses as measured by EFW, but the disparity was smaller in the lower quantiles of the distribution (3.5%) and larger in the upper quantiles (4.5%). Maternal age and maternal height were associated with a positive effect on EFW, particularly in the lower tail of the distribution, of the order of 2% to 3% for each additional 10 y of age of the mother and 1% to 2% for each additional 10 cm of height. Maternal weight was associated with a small positive effect on EFW, especially in the higher tail of the distribution, of the order of 1.0% to 1.5% for each additional 10 kg of bodyweight of the mother. Parous women had heavier fetuses than nulliparous women, with the disparity being greater in the lower quantiles of the distribution, of the order of 1% to 1.5%, and diminishing in the upper quantiles. There were also significant differences in growth of EFW between countries. In spite of the multinational nature of the study, sample size is a limiting factor for generalization of the charts. Conclusions This study provides WHO fetal growth charts for EFW and common ultrasound biometric measurements, and shows variation between different parts of the world.en
dc.relation.ispartofPlos Medicinept_BR
dc.publisherPublic Library Sciencept_BR
dc.publisherSan Franciscopt_BR
dc.identifier.citationPlos Medicine. Public Library Science, v. 14, p. , 2017.pt_BR
dc.description.sponsorshipUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organizationpt_BR
dc.description.provenanceMade available in DSpace on 2017-11-13T13:22:37Z (GMT). No. of bitstreams: 1 000395719900016.pdf: 2779281 bytes, checksum: 745de4e3efbc8d34ef49549c0ade3543 (MD5) Previous issue date: 2017en
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