{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T18:15:23Z","timestamp":1769969723450,"version":"3.49.0"},"reference-count":47,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T00:00:00Z","timestamp":1614556800000},"content-version":"vor","delay-in-days":0,"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":[[2021,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The value of using customized birth\u2010weight centiles to improve the diagnostic accuracy for fetal growth restriction (FGR), in comparison with using population\u2010based charts, remains a matter of debate. One potential explanation for the conflicting data is that most studies used measures of perinatal mortality and morbidity as proxies for placenta\u2010mediated FGR, many of which are not specific and may be confounded by other factors such as prematurity. The aim of this study was to compare the diagnostic accuracy of small\u2010for\u2010gestational age (SGA) at birth, defined according to customized <jats:italic>vs<\/jats:italic> population\u2010based charts, for associated abnormal placental pathology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a secondary analysis of data from a prospective cohort study on risk factors for placenta\u2010mediated complications and abnormal placental pathology in low\u2010risk nulliparous women. All placentae were sent for detailed histopathological examination by two perinatal pathologists. The primary exposure was SGA, defined as birth weight &lt;\u200910<jats:sup>th<\/jats:sup> centile for gestational age using either a customized (SGA<jats:sub>cust<\/jats:sub>) or a population\u2010based (SGA<jats:sub>pop<\/jats:sub>) birth\u2010weight reference. The outcomes of interest were one of three types of abnormal placental pathology associated with FGR: maternal vascular malperfusion (MVM), chronic villitis and fetal vascular malperfusion (FVM). Adjusted relative risks (aRR) with 95%\u2009CIs were estimated using modified Poisson regression analysis, with adjustment for smoking, body mass index and aspirin treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 857 nulliparous women met the study criteria. The proportions of infants identified as SGA based on the customized and population\u2010based charts were 12.6% (108\/857) and 11.4% (98\/857), respectively. A diagnosis of SGA using either customized or population\u2010based charts was associated with an increased risk of any placental pathology (aRR, 3.04 (95%\u2009CI, 2.29\u20134.04) and 1.60 (95%\u2009CI, 1.10\u20132.31), respectively) and MVM pathology (aRR, 12.33 (95%\u2009CI, 6.60\u201323.03) and 5.29 (95%\u2009CI, 2.87\u20139.76), respectively). SGA<jats:sub>cust<\/jats:sub>, but not SGA<jats:sub>pop<\/jats:sub>, was also associated with an increased risk for chronic villitis (aRR, 1.85 (95%\u2009CI, 1.07\u20133.18)) and FVM pathology (aRR, 2.48 (95%\u2009CI, 1.25\u20134.93)). SGA<jats:sub>cust<\/jats:sub> had a higher detection rate for any placental pathology (30.3% <jats:italic>vs<\/jats:italic> 17.1%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), MVM pathology (63.2% <jats:italic>vs<\/jats:italic> 39.5%; <jats:italic>P<\/jats:italic>\u2009=\u20090.003) and chronic villitis (20.8% <jats:italic>vs<\/jats:italic> 8.3%; <jats:italic>P<\/jats:italic>\u2009=\u20090.007) than did SGA<jats:sub>pop<\/jats:sub>, for a similar false\u2010positive rate. This was mainly the result of a higher detection rate for abnormal pathology in the white and East\u2010Asian subgroups and a lower false\u2010positive rate for abnormal pathology in the South\u2010Asian subgroup by SGA<jats:sub>cust<\/jats:sub> than by SGA<jats:sub>pop<\/jats:sub>. In addition, pregnancies in the SGA<jats:sub>cust<\/jats:sub> group, but not those in the SGA<jats:sub>pop<\/jats:sub> group, were more likely to be complicated by preterm birth and a low 5\u2010min Apgar score than were the corresponding non\u2010SGA group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These findings suggest that customized birth\u2010weight centiles may be superior to population\u2010based birth\u2010weight centiles in detecting FGR that is due to underlying placental disease. \u00a9 2020 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23516","type":"journal-article","created":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T17:11:23Z","timestamp":1603127483000},"page":"409-416","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Customized birth\u2010weight centiles and placenta\u2010related fetal growth restriction"],"prefix":"10.1002","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2704-1385","authenticated-orcid":false,"given":"N.","family":"Melamed","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Toronto  Toronto Ontario Canada"},{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Sunnybrook Health Sciences Centre  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4443-388X","authenticated-orcid":false,"given":"L.","family":"Hiersch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Toronto  Toronto Ontario Canada"},{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Sunnybrook Health Sciences Centre  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2741-3679","authenticated-orcid":false,"given":"A.","family":"Aviram","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Toronto  Toronto Ontario Canada"},{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Sunnybrook Health Sciences Centre  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Keating","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology Mount Sinai Hospital  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. 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