{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T07:22:00Z","timestamp":1790493720991,"version":"4.1.0"},"reference-count":46,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T00:00:00Z","timestamp":1627948800000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate three birth\u2010weight (BW) standards (Australian population\u2010based, Fenton and INTERGROWTH\u201021<jats:sup>st<\/jats:sup>) and three estimated\u2010fetal\u2010weight (EFW) standards (Hadlock, INTERGROWTH\u201021<jats:sup>st<\/jats:sup>and WHO) for classifying small\u2010for\u2010gestational age (SGA) and large\u2010for\u2010gestational age (LGA) and predicting adverse perinatal outcomes in preterm and term babies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a nationwide population\u2010based study conducted on a total of 2.4\u2009million singleton births that occurred from 24\u2009+\u20090 to 40\u2009+\u20096\u2009weeks' gestation between 2004 and 2013 in Australia. The performance of the growth charts was evaluated according to SGA and LGA classification, and relative risk (RR) and diagnostic accuracy based on the areas under the receiver\u2010operating\u2010characteristics curves (AUCs) for stillbirth, neonatal death, perinatal death, composite morbidity and a composite of perinatal death and morbidity outcomes. The analysis was stratified according to gestational age at delivery (&lt;\u200937\u2009+\u20090<jats:italic>vs<\/jats:italic>\u2265\u200937\u2009+\u20090\u2009weeks).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Following exclusions, 2\u2009392\u2009782 singleton births were analyzed. There were significant differences in the SGA and LGA classification and risk of adverse outcomes between the six BW and EFW standards evaluated. For the term group, compared with the other standards, the INTERGROWTH\u201021<jats:sup>st<\/jats:sup>BW and EFW standards classified half the number of SGA (&lt;\u200910<jats:sup>th<\/jats:sup>centile) babies (3\u20134%<jats:italic>vs<\/jats:italic>7\u201311%) and twice the number of LGA (&gt;\u200990<jats:sup>th<\/jats:sup>centile) babies (24\u201325%<jats:italic>vs<\/jats:italic>8\u201315%), resulting in a smaller cohort of term SGA at higher risk of adverse outcome and a larger LGA cohort at lower risk of adverse outcome. For term SGA (&lt;\u20093<jats:sup>rd<\/jats:sup>centile) babies, the RR of perinatal death using the two INTERGROWTH\u201021<jats:sup>st<\/jats:sup>standards was up to 1.5\u2010fold higher than those of the other standards (including the WHO\u2010EFW and Hadlock\u2010EFW), while the INTERGROWTH\u201021<jats:sup>st<\/jats:sup>\u2010EFW standard indicated a 12\u201326% reduced risk of perinatal death for LGA cases across centile thresholds. Conversely, for the preterm group, the WHO\u2010EFW and Hadlock\u2010EFW standards identified a higher SGA classification rate than did the other standards (18\u201319%<jats:italic>vs<\/jats:italic>10\u201311%) and a 20\u201365% increased risk of perinatal death in term LGA babies. All BW and EFW charts had similarly poor performance in predicting adverse outcomes, including the composite outcome (AUC range, 0.49\u20130.62) for both preterm (AUC range, 0.58\u20130.62) and term (AUC range, 0.49\u20130.50) cases and across centiles. Furthermore, specific centile thresholds for identifying adverse outcomes varied markedly by chart between BW and EFW standards.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study addresses the recurrent problem of identifying fetuses at risk of morbidity and perinatal mortality associated with growth disorders and provides new insights into the applicability of international growth standards. Our findings of marked variation in classification and the similarly poor performance of prescriptive international standards and the other commonly used standards raise questions about whether the prescriptive international standards that were constructed for universal adoption are indeed applicable to a multiethnic population such as that of Australia. Thus, caution is needed when adopting universal standards for clinical and epidemiological use. \u00a9 2020 International Society of Ultrasound in Obstetrics and Gynecology<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.22151","type":"journal-article","created":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T09:24:48Z","timestamp":1594891488000},"page":"264-277","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["Performance of six birth\u2010weight and estimated\u2010fetal\u2010weight standards\u2009for\u2009predicting\u2009adverse\u2009perinatal\u2009outcome:\u2009a 10\u2010year nationwide population\u2010based study"],"prefix":"10.1002","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3019-5729","authenticated-orcid":false,"given":"S. K. Y.","family":"Choi","sequence":"first","affiliation":[{"name":"Centre for Big Data Research in Health, Faculty of Medicine University of New South Wales Sydney New South Wales Australia"},{"name":"National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine University of New South Wales Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2328-1066","authenticated-orcid":false,"given":"A.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Newborn Care, Royal Prince Alfred Hospital Sydney New South Wales Australia"},{"name":"Charles Perkins Centre, Faculty of Medicine University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5174-3451","authenticated-orcid":false,"given":"L.","family":"Hilder","sequence":"additional","affiliation":[{"name":"Centre for Big Data Research in Health, Faculty of Medicine University of New South Wales Sydney New South Wales Australia"},{"name":"National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine University of New South Wales Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7351-8922","authenticated-orcid":false,"given":"A.","family":"Henry","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine University of New South Wales Sydney New South Wales Australia"},{"name":"Women's and Children's Health, St\u00a0George Hospital Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8019-1289","authenticated-orcid":false,"given":"J. A.","family":"Hyett","sequence":"additional","affiliation":[{"name":"Department of High Risk Obstetrics, Royal Prince Alfred Hospital Sydney New\u00a0South Wales Australia"},{"name":"Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9885-8261","authenticated-orcid":false,"given":"B. 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