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American Journal of Epidemiology Advance Access originally published online on January 6, 2009
American Journal of Epidemiology 2009 169(5):616-624; doi:10.1093/aje/kwn374
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American Journal of Epidemiology Published by Oxford University Press 2009.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ORIGINAL CONTRIBUTIONS

An Outcome-based Approach for the Creation of Fetal Growth Standards: Do Singletons and Twins Need Separate Standards?

K. S. Joseph, John Fahey, Robert W. Platt, Robert M. Liston, Shoo K. Lee, Reg Sauve, Shiliang Liu, Alexander C. Allen and Michael S. Kramer

Correspondence to Dr. K. S. Joseph, Division of Neonatal-Perinatal Medicine, IWK Health Centre, 5980 University Avenue, Halifax, Nova Scotia, Canada B3K 6R8 (e-mail: ksjoseph{at}dal.ca).

Received for publication June 20, 2008. Accepted for publication November 3, 2008.

Contemporary fetal growth standards are created by using theoretical properties (percentiles) of birth weight (for gestational age) distributions. The authors used a clinically relevant, outcome-based methodology to determine if separate fetal growth standards are required for singletons and twins. All singleton and twin livebirths between 36 and 42 weeks’ gestation in the United States (1995–2002) were included, after exclusions for missing information and other factors (n = 17,811,922). A birth weight range was identified, at each gestational age, over which serious neonatal morbidity and neonatal mortality rates were lowest. Among singleton males at 40 weeks, serious neonatal morbidity/mortality rates were lowest between 3,012 g (95% confidence interval (CI): 3,008, 3,018) and 3,978 g (95% CI: 3,976, 3,980). The low end of this optimal birth weight range for females was 37 g (95% CI: 21, 53) less. The low optimal birth weight was 152 g (95% CI: 121, 183) less for twins compared with singletons. No differences were observed in low optimal birth weight by period (1999–2002 vs. 1995–1998), but small differences were observed for maternal education, race, parity, age, and smoking status. Patterns of birth weight-specific serious neonatal morbidity/neonatal mortality support the need for plurality-specific fetal growth standards.

birth weight; fetal development; gestational age; infant mortality; morbidity

Abbreviations: CI, confidence interval


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