Comparison of the Hadlock and INTERGROWTH formulas for calculating estimated fetal weight in a preterm population in France

Isabelle Monier; Anne Ego; Alexandra Benachi; Pierre-Yves Ancel; François Goffinet; Jennifer Zeitlin

doi:10.1016/j.ajog.2018.08.012

Comparison of the Hadlock and INTERGROWTH formulas for calculating estimated fetal weight in a preterm population in France

Am J Obstet Gynecol. 2018 Nov;219(5):476.e1-476.e12. doi: 10.1016/j.ajog.2018.08.012. Epub 2018 Aug 14.

Authors

Isabelle Monier¹, Anne Ego², Alexandra Benachi³, Pierre-Yves Ancel⁴, François Goffinet⁵, Jennifer Zeitlin⁶

Affiliations

¹ National Institute of Health and Medical Research Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris-Descartes University, Paris, France; Antoine Béclère Maternity Unit, Department of Obstetrics and Gynecology, University Paris Sud, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: isabelle.monier@inserm.fr.
² University Grenoble Alpes, CNRS, Public Health Department Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institute of Engineering University Grenoble Alpes, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble, Grenoble, France; National Institute of Health and Medical Research Center for Clinical Investigation U1406, Grenoble, France.
³ Antoine Béclère Maternity Unit, Department of Obstetrics and Gynecology, University Paris Sud, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁴ National Institute of Health and Medical Research Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris-Descartes University, Paris, France; Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France.
⁵ National Institute of Health and Medical Research Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris-Descartes University, Paris, France; Maternité Port-Royal, University Paris-Descartes, Departement Hospitalo-Universitaire Risk in Pregnancy, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁶ National Institute of Health and Medical Research Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris-Descartes University, Paris, France.

PMID: 30118693
DOI: 10.1016/j.ajog.2018.08.012

Abstract

Background: Accurate estimation of fetal weight is needed for growth monitoring and decision-making in obstetrics; the INTERGROWTH project developed an estimated fetal weight formula to construct new intrauterine growth standards.

Objective: We sought to compare the accuracy of the Hadlock and INTERGROWTH formulas for the estimation of fetal weight among preterm infants.

Study design: Using the EPIPAGE 2 population-based study of births between 22-34 weeks of gestation, we included 578 nonanomalous singleton fetuses with an ultrasound-to-delivery interval <2 days. We used abdominal circumference, head circumference, and femur length to calculate estimated fetal weight with Hadlock formula and abdominal and head circumferences to calculate estimated fetal weight according to INTERGROWTH. The mean percentage errors and the proportions of estimated fetal weight measures within ±10% of birthweight were compared between the 2 methods.

Results: Mean (SD) gestational age and birthweight were 29.1 (SD 2.7) weeks and 1219 (SD 489) g. Mean (SD) percentage errors for Hadlock and INTERGROWTH were significantly different: -0.7 (SD 10.1) and -3.5 (SD 11.6), respectively (P < .001), and more infants were classified within ±10% of their birthweight with Hadlock compared to INTERGROWTH (68.7% vs 57.8%, P < .001). The INTERGROWTH formula overestimated birthweight at 22-23 weeks compared to Hadlock [mean errors of 18.8 (SD 13.6) vs 5.5 (SD 10.2)] and underestimated birthweight >28 weeks: at 29-31 weeks, mean errors were -5.8 (SD 10.9) for INTERGROWTH and -0.6 (SD 10.4) for Hadlock.

Conclusion: Hadlock estimated fetal weight formula was more accurate than INTERGROWTH formula for fetuses delivered between 22-34 weeks of gestation. Our results support continued use of Hadlock formula in France and raise questions about the applicability of INTERGROWTH intrauterine growth standards.

Keywords: Hadlock; INTERGROWTH; estimated fetal weight; ultrasound; very preterm.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Abdomen / diagnostic imaging
Abdomen / embryology
Adult
Birth Weight
Ethnicity
Female
Femur / diagnostic imaging
Femur / embryology
Fetal Development
Fetal Weight*
France
Gestational Age
Growth Charts
Head / diagnostic imaging
Head / embryology
Humans
Infant, Newborn
Infant, Newborn, Diseases / diagnosis
Infant, Premature*
Pregnancy
Prenatal Diagnosis / methods*
Prenatal Diagnosis / standards*
Reproducibility of Results
Ultrasonography, Prenatal