International standards for early fetal size and pregnancy dating based on ultrasound measurement of crown-rump length in the first trimester of pregnancy

A T Papageorghiou, S H Kennedy, L J Salomon, E O Ohuma, L Cheikh Ismail, F C Barros, A Lambert, M Carvalho, Y A Jaffer, E Bertino, M G Gravett, D G Altman, M Purwar, J A Noble, R Pang, C G Victora, Z A Bhutta, J Villar, International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st), M Katz, M K Bhan, C Garza, S Zaidi, A Langer, P M Rothwell, D Weatherall, J Villar, S Kennedy, D G Altman, F C Barros, E Bertino, F Burton, M Carvalho, L Cheikh Ismail, W C Chumlea, M G Gravett, Y A Jaffer, A Lambert, P Lumbiganon, R Y Pang, M Purwar, J Rivera, C Victora, J Villar, D G Altman, Z A Bhutta, S Kennedy, A Lambert, J A Noble, A T Papageorghiou, J Villar, S Kennedy, A Lambert, A T Papageorghiou, M Shorten, L Hoch, H E Knight, E O Ohuma, C Cosgrove, I Blakey, D G Altman, E O Ohuma, J Villar, F Roseman, N Kunnawar, S H Gu, J H Wang, M H Wu, M Domingues, P Gilli, L Juodvirsiene, L Hoch, N Musee, H Al-Jabri, S Waller, C Cosgrove, D Muninzwa, D Yellappan, A Carter, D Reade, R Miller, A T Papageorghiou, L Salomon, A Mitidieri, F Al-Aamri, W Paulsene, J Sande, W K S Al-Zadjali, C Batiuk, S Bornemeier, M Carvalho, M Dighe, P Gaglioti, N Jacinta, S Jaiswal, J A Noble, K Oas, M Oberto, E Olearo, M G Owende, J Shah, S Sohoni, T Todros, S Vinayak, L Wang, D Wilson, Q Q Wu, S Zaidi, Y Zhang, P Chamberlain, D Danelon, I Sarris, J Dhami, C Ioannou, C L Knight, R Napolitano, S Wanyonyi, C Pace, V Mkrtychyan, L Cheikh Ismail, W C Chumlea, F Al-Habsi, Z A Bhutta, A Carter, M Alija, J M Jimenez-Bustos, J Kizidio, F Puglia, N Kunnawar, H Liu, S Lloyd, D Mota, R Ochieng, C Rossi, M Sanchez Luna, Y J Shen, H E Knight, D A Rocco, I O Frederick, Z A Bhutta, E Albernaz, M Batra, B A Bhat, E Bertino, P Di Nicola, F Giuliani, I Rovelli, K McCormick, R Ochieng, R Y Pang, V Paul, V Rajan, A Wilkinson, A Varalda, B Eskenazi, L A Corra, H Dolk, J Golding, A Matijasevich, T de Wet, J J Zhang, A Bradman, D Finkton, O Burnham, F Farhi, F C Barros, M Domingues, S Fonseca, A Leston, A Mitidieri, D Mota, I K Sclowitz, M F da Silveira, R Y Pang, Y P He, Y Pan, Y J Shen, M H Wu, Q Q Wu, J H Wang, Y Yuan, Y Zhang, M Purwar, A Choudhary, S Choudhary, S Deshmukh, D Dongaonkar, M Ketkar, V Khedikar, N Kunnawar, C Mahorkar, I Mulik, K Saboo, C Shembekar, A Singh, V Taori, K Tayade, A Somani, E Bertino, P Di Nicola, M Frigerio, G Gilli, P Gilli, M Giolito, F Giuliani, M Oberto, L Occhi, C Rossi, I Rovelli, F Signorile, T Todros, W Stones, M Carvalho, J Kizidio, R Ochieng, J Shah, S Vinayak, N Musee, C Kisiang, D Muninzwa, Y A Jaffer, J Al-Abri, J Al-Abduwani, F M Al-Habsi, H Al-Lawatiya, B Al-Rashidiya, F R Juangco, M Venkataraman, H Al-Jabri, D Yellappan, S Kennedy, A T Papageorghiou, F Roseman, A Lambert, E O Ohuma, S Lloyd, R Napolitano, C Ioannou, I Sarris, M G Gravett, C Batiuk, M Batra, S Bornemeier, M Dighe, K Oas, W Paulsene, D Wilson, I O Frederick, H F Andersen, S E Abbott, A A Carter, H Algren, D A Rocco, T K Sorensen, D Enquobahrie, S Waller, A T Papageorghiou, S H Kennedy, L J Salomon, E O Ohuma, L Cheikh Ismail, F C Barros, A Lambert, M Carvalho, Y A Jaffer, E Bertino, M G Gravett, D G Altman, M Purwar, J A Noble, R Pang, C G Victora, Z A Bhutta, J Villar, International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st), M Katz, M K Bhan, C Garza, S Zaidi, A Langer, P M Rothwell, D Weatherall, J Villar, S Kennedy, D G Altman, F C Barros, E Bertino, F Burton, M Carvalho, L Cheikh Ismail, W C Chumlea, M G Gravett, Y A Jaffer, A Lambert, P Lumbiganon, R Y Pang, M Purwar, J Rivera, C Victora, J Villar, D G Altman, Z A Bhutta, S Kennedy, A Lambert, J A Noble, A T Papageorghiou, J Villar, S Kennedy, A Lambert, A T Papageorghiou, M Shorten, L Hoch, H E Knight, E O Ohuma, C Cosgrove, I Blakey, D G Altman, E O Ohuma, J Villar, F Roseman, N Kunnawar, S H Gu, J H Wang, M H Wu, M Domingues, P Gilli, L Juodvirsiene, L Hoch, N Musee, H Al-Jabri, S Waller, C Cosgrove, D Muninzwa, D Yellappan, A Carter, D Reade, R Miller, A T Papageorghiou, L Salomon, A Mitidieri, F Al-Aamri, W Paulsene, J Sande, W K S Al-Zadjali, C Batiuk, S Bornemeier, M Carvalho, M Dighe, P Gaglioti, N Jacinta, S Jaiswal, J A Noble, K Oas, M Oberto, E Olearo, M G Owende, J Shah, S Sohoni, T Todros, S Vinayak, L Wang, D Wilson, Q Q Wu, S Zaidi, Y Zhang, P Chamberlain, D Danelon, I Sarris, J Dhami, C Ioannou, C L Knight, R Napolitano, S Wanyonyi, C Pace, V Mkrtychyan, L Cheikh Ismail, W C Chumlea, F Al-Habsi, Z A Bhutta, A Carter, M Alija, J M Jimenez-Bustos, J Kizidio, F Puglia, N Kunnawar, H Liu, S Lloyd, D Mota, R Ochieng, C Rossi, M Sanchez Luna, Y J Shen, H E Knight, D A Rocco, I O Frederick, Z A Bhutta, E Albernaz, M Batra, B A Bhat, E Bertino, P Di Nicola, F Giuliani, I Rovelli, K McCormick, R Ochieng, R Y Pang, V Paul, V Rajan, A Wilkinson, A Varalda, B Eskenazi, L A Corra, H Dolk, J Golding, A Matijasevich, T de Wet, J J Zhang, A Bradman, D Finkton, O Burnham, F Farhi, F C Barros, M Domingues, S Fonseca, A Leston, A Mitidieri, D Mota, I K Sclowitz, M F da Silveira, R Y Pang, Y P He, Y Pan, Y J Shen, M H Wu, Q Q Wu, J H Wang, Y Yuan, Y Zhang, M Purwar, A Choudhary, S Choudhary, S Deshmukh, D Dongaonkar, M Ketkar, V Khedikar, N Kunnawar, C Mahorkar, I Mulik, K Saboo, C Shembekar, A Singh, V Taori, K Tayade, A Somani, E Bertino, P Di Nicola, M Frigerio, G Gilli, P Gilli, M Giolito, F Giuliani, M Oberto, L Occhi, C Rossi, I Rovelli, F Signorile, T Todros, W Stones, M Carvalho, J Kizidio, R Ochieng, J Shah, S Vinayak, N Musee, C Kisiang, D Muninzwa, Y A Jaffer, J Al-Abri, J Al-Abduwani, F M Al-Habsi, H Al-Lawatiya, B Al-Rashidiya, F R Juangco, M Venkataraman, H Al-Jabri, D Yellappan, S Kennedy, A T Papageorghiou, F Roseman, A Lambert, E O Ohuma, S Lloyd, R Napolitano, C Ioannou, I Sarris, M G Gravett, C Batiuk, M Batra, S Bornemeier, M Dighe, K Oas, W Paulsene, D Wilson, I O Frederick, H F Andersen, S E Abbott, A A Carter, H Algren, D A Rocco, T K Sorensen, D Enquobahrie, S Waller

Abstract

Objectives: There are no international standards for relating fetal crown-rump length (CRL) to gestational age (GA), and most existing charts have considerable methodological limitations. The INTERGROWTH-21(st) Project aimed to produce the first international standards for early fetal size and ultrasound dating of pregnancy based on CRL measurement.

Methods: Urban areas in eight geographically diverse countries that met strict eligibility criteria were selected for the prospective, population-based recruitment, between 9 + 0 and 13 + 6 weeks' gestation, of healthy well-nourished women with singleton pregnancies at low risk of fetal growth impairment. GA was calculated on the basis of a certain last menstrual period, regular menstrual cycle and lack of hormonal medication or breastfeeding in the preceding 2 months. CRL was measured using strict protocols and quality-control measures. All women were followed up throughout pregnancy until delivery and hospital discharge. Cases of neonatal and fetal death, severe pregnancy complications and congenital abnormalities were excluded from the study.

Results: A total of 4607 women were enrolled in the Fetal Growth Longitudinal Study, one of the three main components of the INTERGROWTH-21(st) Project, of whom 4321 had a live singleton birth in the absence of severe maternal conditions or congenital abnormalities detected by ultrasound or at birth. The CRL was measured in 56 women at < 9 + 0 weeks' gestation; these were excluded, resulting in 4265 women who contributed data to the final analysis. The mean CRL and SD increased with GA almost linearly, and their relationship to GA is given by the following two equations (in which GA is in days and CRL in mm): mean CRL = -50.6562 + (0.815118 × GA) + (0.00535302 × GA(2) ); and SD of CRL = -2.21626 + (0.0984894 × GA). GA estimation is carried out according to the two equations: GA = 40.9041 + (3.21585 × CRL(0.5) ) + (0.348956 × CRL); and SD of GA = 2.39102 + (0.0193474 × CRL).

Conclusions: We have produced international prescriptive standards for early fetal linear size and ultrasound dating of pregnancy in the first trimester that can be used throughout the world.

Keywords: crown-rump length; dating; gestational age; global health; growth; pregnancy.

© 2014 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Figures

Figure 1
Figure 1
Flow diagram of progress of 13 108 women through the study to determine a new, internationally based method of ascertaining fetal gestational age from measurement of crown–rump length (CRL). *Some women were ineligible at ultrasound for more than one reason. †Congenital malformations diagnosed by ultrasound during pregnancy or at birth during clinical examination. LMP, last menstrual period.
Figure 2
Figure 2
Fetal crown–rump length (CRL) as a function of gestational age (GA). Gray open circles represent raw data and lines represent mean, 3rd and 97th centiles (±1.88 SD) of CRL for a given GA value. Black open circles represent empirical means, 3rd and 97th centiles.
Figure 3
Figure 3
Estimation of gestational age (GA) as a function of crown–rump length (CRL). Gray open circles represent raw data and lines represent mean, 3rd and 97th centiles (±1.88 SD) of GA for a given CRL value. Black open circles represent empirical means, 3rd and 97th centiles.

References

    1. Miller J, Turan S, Baschat AA. Fetal growth restriction. Semin Perinatol. 2008;32:274–280.
    1. Taipale P, Hiilesmaa V. Predicting delivery date by ultrasound and last menstrual period in early gestation. Obstet Gynecol. 2001;97:189–194.
    1. Ananth CV. Menstrual versus clinical estimate of gestational age dating in the United States: temporal trends and variability in indices of perinatal outcomes. Paediatr Perinat Epidemiol. 2007;21(Suppl 2):22–30.
    1. Callaghan WM, Dietz PM. Differences in birth weight for gestational age distributions according to the measures used to assign gestational age. Am J Epidemiol. 2010;171:826–836.
    1. Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C GAPPS Review Group. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childbirth. 2010;10(Suppl 1) S1.
    1. Lynch CD, Zhang J. The research implications of the selection of a gestational age estimation method. Paediatr Perinat Epidemiol. 2007;21(Suppl 2):86–96.
    1. Nguyen TH, Larsen T, Engholm G, Moller H. Increased adverse pregnancy outcomes with unreliable last menstruation. Obstet Gynecol. 2000;95:867–873.
    1. National Institute for Health and Clinical Excellence. Antenatal care. NICE clinical guideline 62. Issued March 2008; last modified June 2010. [Accessed 19 September 2013]
    1. Kalish RB, Thaler HT, Chasen ST, Gupta M, Berman SJ, Rosenwaks Z, Chervenak FA. First- and second-trimester ultrasound assessment of gestational age. Am J Obstet Gynecol. 2004;191:975–978.
    1. Napolitano R, Dhami J, Ohuma EO, Ioannou C, Conde-Agudelo A, Kennedy SH, Villar J, Papageorghiou AT. Pregnancy dating by fetal crown–rump length: systematic review of charts. BJOG. 2014;121:556–565.
    1. Ioannou C, Talbot K, Ohuma E, Sarris I, Villar J, Conde-Agudelo A, Papageorghiou AT. Systematic review of methodology used in ultrasound studies aimed at creating charts of fetal size. BJOG. 2012;119:1425–1439.
    1. Garza C, de Onis M. Rationale for developing a new international growth reference. Food Nutr Bull. 2004;25(Suppl 1):S5–S14.
    1. Villar J, Altman DG, Purwar M, Noble JA, Knight HE, Ruyan P, Cheikh Ismail L, Barros FC, Lambert A, Papageorghiou AT, Carvalho M, Jaffer YA, Bertino E, Gravett MG, Bhutta ZA, Kennedy SH International Fetal and Newborn Growth Consortium for the 21st. The objectives, design and implementation of the INTERGROWTH-21st Century Project. BJOG. 2013;120(Suppl 2):9–26.
    1. de Onis M, Garza C, Onyango AW, Martorell R. WHO Child Growth Standards. Acta Paediatr. 2006;450:1–101.
    1. Eskenazi B, Bradman A, Finkton D, Purwar M, Noble JA, Pang R, Burnham O, Cheikh Ismail L, Farhi F, Barros FC, Lambert A, Papageorghiou AT, Carvalho M, Jaffer YA, Bertino E, Gravett MG, Altman DG, Ohuma EO, Kennedy SH, Bhutta ZA, Villar J International Fetal and Newborn Growth Consortium for the 21st. A rapid questionnaire assessment of environmental exposures to pregnant women in the INTERGROWTH-21st Century Project. BJOG. 2013;120(Suppl 2):129–138.
    1. Ioannou C, Sarris I, Hoch L, Salomon LJ, Papageorghiou AT International Fetal and Newborn Growth Consortium for the 21st Century. Standardisation of crown–rump length measurement. BJOG. 2013;120(Suppl 2):38–41.
    1. Sarris I, Ioannou C, Ohuma EO, Altman DG, Hoch L, Cosgrove C, Fathima S, Salomon LJ, Papageorghiou AT International Fetal and Newborn Growth Consortium for the 21st Century. Standardisation and quality control of ultrasound measurements taken in the INTERGROWTH-21st Project. BJOG. 2013;120(Suppl 2):33–37.
    1. Wanyonyi SZ, Napolitano R, Ohuma EO, Salomon LJ, Papageorphiou AT. Image-scoring system for crown–rump length measurments. Ultrasound Obstet Gynecol. 2014;44:649–654.
    1. Bellera CA, Hanley JA. A method is presented to plan the required sample size when estimating regression-based reference limits. J Clin Epidemiol. 2007;60:610–615.
    1. Royston P. Constructing time-specific reference ranges. Stat Med. 1991;10:675–690.
    1. Altman D, Ohuma E. Statistical considerations for the development of prescriptive fetal and newborn growth standards in the INTERGROWTH-21st Project. BJOG. 2013;120(Suppl 2):71–76.
    1. Ohuma E, Papageorghiou AT, Villar J, Altman DG. Estimation of gestational age in early pregnancy from crown–rump length when gestational age range is truncated: the case study of the INTERGROWTH-21st Project. BMC Med Res Methodol. 2013;13:151–165.
    1. Altman DG, Chitty LS. Design and analysis of studies to derive charts of fetal size. Ultrasound Obstet Gynecol. 1993;3:378–384.
    1. Royston P, Altman DG. Regression using fractional polynomials of continuous covariates: parsimonious parametric modelling. J Royal Stat Soc Series C (Applied Statistics) 1994;43:429–467.
    1. Villar J, Papageorghiou AT, Pang R, Ohuma EO, Cheikh Ismail L, Barros FC, Lambert A, Carvalho M, Jaffer YA, Bertino E, Gravett MG, Altman DG, Purwar M, Frederick IO, Noble JA, Victora CG, Bhutta ZA, Kennedy SH. The likeness of fetal growth and newborn size across non-isolated populations in the INTERGROWTH-21st Project: the Fetal Growth Longitudinal Study and Newborn Cross-Sectional Study. Lancet Diabetes Endocrinol. 2014 ; for the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st. DOI: 10.1016/S2213-8587(14)70121-4.
    1. Robinson HP, Fleming JE. A critical evaluation of sonar “crown–rump length” measurements. Br J Obstet Gynaecol. 1975;82:702–710.
    1. Verburg BO, Steegers EA, De Ridder M, Snijders RJ, Smith E, Hofman A, Moll HA, Jaddoe VW, Witteman JC. New charts for ultrasound dating of pregnancy and assessment of fetal growth: longitudinal data from a population-based cohort study. Ultrasound Obstet Gynecol. 2008;31:388–396.
    1. Papageorghiou AT, Sarris I, Ioannou C, Todros T, Carvalho M, Pilu G, Salomon LJ International Fetal and Newborn Growth Consortium for the 21st Century. Ultrasound methodology used to construct the fetal growth standards in the INTERGROWTH-21st Project. BJOG. 2013;120(Suppl 2):27–32.
    1. Sarris I, Ioannou C, Dighe M, Mitidieri A, Oberto M, Qingqing W, Shah J, Sohoni S, Al Zidjali W, Hoch L, Altman DG, Papageorghiou AT. Standardization of fetal ultrasound biometry measurements: improving the quality and consistency of measurements; International Fetal and Newborn Growth Consortium for the 21st Century. Ultrasound Obstet Gynecol. 2011;38:681–687.
    1. Salomon LJ. Early fetal growth: concepts and pitfalls. Ultrasound Obstet Gynecol. 2010;35:385–389.
    1. Mukri F, Bourne T, Bottomley C, Schoeb C, Kirk E, Papageorghiou AT. Evidence of early first-trimester growth restriction in pregnancies that subsequently end in miscarriage. BJOG. 2008;115:1273–1278.
    1. Smith GC, Stenhouse EJ, Crossley JA, Aitken DA, Cameron AD, Connor JM. Early-pregnancy origins of low birth weight. Nature. 2002;417:916.

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