A home calendar and recall method of last menstrual period for estimating gestational age in rural Bangladesh: a validation study

Alison D Gernand, Rina Rani Paul, Barkat Ullah, Muhammad A Taher, Frank R Witter, Lee Wu, Alain B Labrique, Keith P West Jr, Parul Christian, Alison D Gernand, Rina Rani Paul, Barkat Ullah, Muhammad A Taher, Frank R Witter, Lee Wu, Alain B Labrique, Keith P West Jr, Parul Christian

Abstract

Background: The best method of gestational age assessment is by ultrasound in the first trimester; however, this method is impractical in large field trials in rural areas. Our objective was to assess the validity of gestational age estimated from prospectively collected date of last menstrual period (LMP) using crown-rump length (CRL) measured in early pregnancy by ultrasound.

Methods: As part of a large, cluster-randomized, controlled trial in rural Bangladesh, we collected dates of LMP by recall and as marked on a calendar every 5 weeks in women likely to become pregnant. Among those with a urine-test confirmed pregnancy, a subset with gestational age of <15 weeks (n = 353) were enrolled for ultrasound follow-up to measure CRL. We compared interview-assessed LMP with CRL gestational age estimates and classification of preterm, term, and post-term births.

Results: LMP-based gestational age was higher than CRL by a mean (SD) of 2.8 (10.7) days; differences varied by maternal education and preterm birth (P < 0.05). Lin's concordance correlation coefficient was good at ultrasound [0.63 (95 % CI 0.56, 0.69)] and at birth [0.77 (95 % CI 0.73, 0.81)]. Validity of classifying preterm birth was high but post-term was lower, with specificity of 96 and 89 % and sensitivity of 86 and 67 %, respectively. Results were similar by parity.

Conclusions: Prospectively collected LMP provided a valid estimate of gestational age and preterm birth in a rural, low-income setting and may be a suitable alternative to ultrasound in programmatic settings and large field trials.

Trial registration: ClinicalTrials.gov NCT00860470.

Keywords: Bangladesh; Crown-rump length; Gestational age; Last menstrual period; Ultrasound; Validation.

Figures

Fig. 1
Fig. 1
Distribution of gestational age estimations by crown-rump length (CRL) and the first day of the last menstrual period (LMP) at ultrasound visit (n = 353, a) and live birth (n = 332, b). Figure excludes three women with LMP-based gestational age <30 weeks
Fig. 2
Fig. 2
Lin’s concordance correlation plot of last menstrual period (LMP)- vs. crown-rump length (CRL)-based gestational age, n = 353

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