Objectives: To compare the accuracy of the INTERGROWTH-21st (IG-21) with the Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG) abdominal circumference (AC) standards in the detection of small-for-gestational-age (SGA) fetuses in a high-risk population. Material and Methods: Our study included all pregnant patients with an increased risk of placental insufficiency that were seen in two Italian university hospitals between 2014 and 2015. The accuracy of IG-21 and SIEOG AC standards in the detection of SGA neonates was analyzed by means of the area under the receiver operating characteristic curve (ROC-AUC) at 4 gestational age intervals (24-27, 28-31, 32-35, >35 weeks). Results: We enrolled 428 patients (278 Italians). There was no significant difference between the ROC-AUC of AC according to IG-21 and SIEOG standards for all birthweight thresholds and gestational intervals that were considered. The diagnostic performance was similar in Italian and non-Italian patients. The accuracy was, however, limited, with values of ROC-AUC ranging between 0.80 and 0.89. Conclusions: The IG-21 and SIEOG AC standards are interchangeable for the diagnosis of SGA fetuses. The diagnostic accuracy is, however, limited. We provide figures that can be used to stratify the probability that an infant will be SGA in an obstetric population at increased risk of growth restriction.

Keywords:
Abdominal circumference, Small for gestational age, INTERGROWTH-21st, Fetal growth restriction
1.
American College of Obstetricians and Gynecologists: ACOG Practice bulletin no. 134: fetal growth restriction. Obstet Gynecol 2013;121:1122-1133.
2.
Royal College of Obstetricians and Gynaecologists: The Investigation and Management of the Small-for-Gestational-Age Fetus. Green-top Guideline No. 31. 2nd Edition, February 2013, Minor revisions - January 2014. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_31.pdf.
3.
Davis RO, Cutter GR, Goldenberg RL, Hoffman HJ, Cliver SP, Brumfield CG: Fetal biparietal diameter, head circumference, abdominal circumference and femur length. A comparison by race and sex. J Reprod Med 1993;38:201-206.
4.
Paladini D, Rustico M, Viora E, Giani U, Bruzzese D, Campogrande M, Martinelli P: Fetal size charts for the Italian population. Normative curves of head, abdomen and long bones. Prenat Diagn 2005;25:456-464.
5.
Romano-Zelekha O, Freedman L, Olmer L, Green MS, Shohat T; Israel Network for Ultrasound in Obstetrics and Gynecology: Should fetal weight growth curves be population specific? Prenat Diagn 2005;25:709-714.
6.
Papageorghiou AT, Ohuma EO, Altman DG, Todros T, Cheikh Ismail L, Lambert A, Jaffer YA, Bertino E, Gravett MG, Purwar M, Noble JA, Pang R, Victora CG, Barros FC, Carvalho M, Salomon LJ, Bhutta ZA, Kennedy SH, Villar J; International Fetal and Newborn Growth Consortium for the 21st Century: International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. Lancet 2014;384:869-879.
7.
Villar J, Cheikh Ismail L, Victora CG, Ohuma EO, Bertino E, Altman DG, Lambert A, Papageorghiou AT, Carvalho M, Jaffer YA, Gravett MG, Purwar M, Frederick IO, Noble AJ, Pang R, Barros FC, Chumlea C, Bhutta ZA, Kennedy SH; International Fetal and Newborn Growth Consortium for the 21st Century: International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet 2014;384:857-868.
8.
Villar J, Papageorghiou AT, Pang R, Salomon LJ, Langer A, Victora C, Purwar M, Chumlea C, Qingqing W, Scherjon SA, Barros FC, Carvalho M, Altman DG, Giuliani F, Bertino E, Jaffer YA, Cheikh Ismail L, Ohuma EO, Lambert A, Noble JA, Gravett MG, Bhutta ZA, Kennedy SH: Monitoring human growth and development: a continuum from the womb to the classroom. Am J Obstet Gynecol 2015;213:494-499.
9.
Unterscheider J, Daly S, Geary MP, Kennelly MM, McAuliffe FM, O'Donoghue K, Hunter A, Morrison JJ, Burke G, Dicker P, Tully EC, Malone FD: Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am J Obstet Gynecol 2013;208:290.e1-e6.
10.
Casarett D, Karlawish JH, Sugarman J: Determining when quality improvement initiatives should be considered research: proposed criteria and potential implications. JAMA 2000;283:2275-2280.
11.
Anderson NH, Sadler LC, McKinlay CJ, McCowan LM: INTERGROWTH-21st vs customized birthweight standards for identification of perinatal mortality and morbidity. Am J Obstet Gynecol 2016;214:509.e1-e7.
12.
de Jong CL, Gardosi J, Dekker GA, Colenbrander GJ, van Geijn HP: Application of a customised birthweight standard in the assessment of perinatal outcome in a high risk population. Br J Obstet Gynaecol 1998;105:531-535.
13.
Sciscione AC, Gorman R, Callan NA: Adjustment of birth weight standards for maternal and infant characteristics improves the prediction of outcome in the small-for-gestational-age infant. Am J Obstet Gynecol 1996;175:544-547.
14.
Gardosi J, Francis A: Adverse pregnancy outcome and association with small for gestational age birthweight by customized and population-based percentiles. Am J Obstet Gynecol 2009;201:28.e1-e8.
15.
Grobman WA, Lai Y, Rouse DJ, Spong CY, Varner MW, Mercer BM, Leveno KJ, Iams JD, Wapner RJ, Sorokin Y, Thorp JM, Jr., Ramin SM, Malone FD, O'Sullivan MJ, Hankins GD, Caritis SN; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network: The association of cerebral palsy and death with small-for-gestational-age birthweight in preterm neonates by individualized and population-based percentiles. Am J Obstet Gynecol 2013;209:340.e1-5.
16.
Hemming K, Hutton JL, Bonellie S: A comparison of customized and population-based birth-weight standards: the influence of gestational age. Eur J Obstet Gynecol Reprod Biol 2009;146:41-45.
17.
Zhang X, Platt RW, Cnattingius S, Joseph KS, Kramer MS: The use of customised versus population-based birthweight standards in predicting perinatal mortality. BJOG 2007;114:474-477.
18.
Poljak B, Agarwal U, Jackson R, Alfirevic Z, Sharp A: Diagnostic accuracy of individual antenatal tools for the detection of the small for gestational age newborn. Ultrasound Obstet Gynecol 2016, DOI: 10.1002/uog.17211.
19.
Sovio U, White IR, Dacey A, Pasupathy D, Smith GC: Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. Lancet 2015;386:2089-2097.
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2017
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