Abstract
Objective
This study aims to update the current reference for sex-specific birth weight percentiles by gestational age, overall and for specific ethnic groups, based on data from all singleton live-birth deliveries from 2005 to 2014 in Alberta, Canada.
Methods
Infant and maternal information were captured in the Alberta Vital Statistics-Births Database for 473,115 singleton infants born to 311,800 women between January 1, 2005 and December 31, 2014. Within each sex, and each sex-ethnic group, birth weights were modelled by gestational age using generalized additive models and natural cubic splines. Crude and corrected estimates for birth weight percentiles including cut-off values for large for gestational age (LGA) and small for gestational age (SGA) were calculated by sex and sex-ethnic group, and gestational age for singleton live births.
Results
LGA and SGA cut-offs were lower for females than for males for all gestational ages. The SGA and LGA percentiles were greater for both male and female very preterm infants in Alberta compared to previous national references. Ethnicity-specific LGA and SGA cut-offs for term Chinese and preterm and at-term South Asian infants were consistently lower than those for both the general population in Alberta and the previous national reference. South Asian infants had lower birth weights at almost all gestational ages compared with the other groups.
Conclusion
The updated birth weight percentiles presented in this study highlight the differences in SGA and LGA cut-offs among infants from South Asian, Chinese, and the general population, which may be important for clinical perinatal care.
Résumé
Objectifs
L’objectif de cette étude est d’actualiser la référence actuelle pour les percentiles de poids à la naissance spécifique au sexe par l’âge gestationnel, globalement et pour des groupes ethniques spécifiques, basé sur les données de tous les accouchements de naissances vivante uniques entre 2005 et 2014 en Alberta, au Canada.
Méthodes
L’information infantile et maternelle ont été capturées dans les statistiques de l’état civil – base de données sur les naissances, en Alberta, pour 473 115 nourrissons uniques nés de 311 800 femmes entre le 1er janvier 2005 et le 31 décembre 2014. Dans chaque sexe, et dans chaque groupe sexe-ethnique, les poids de naissances ont été modélisés par l’âge gestationnel grâce à l’utilisation de modèles additifs généralisés et de splines cubiques naturelles. Des estimations grossières et corrigées pour les percentiles de poids à la naissance, y compris les valeurs seuils pours les nourrissons gros pour l’âge gestationnel (GAG) et petits pour l’âge gestationnel (PAG), ont été calculées par sexe et groupe sexe-ethnique, et par l’âge gestationnel pour les naissances vivantes uniques.
Résultats
Les critères pour GAG et PAG étaient plus bas pour les femelles que pour les mâles pour tous les âges gestationnels. Les percentiles pour PAG et GAG étaient plus élevés pour les nourrissons mâles et femelles nés très prématurés en Alberta en comparaison avec les références nationales précédentes. Les critères pour GAG et PAG spécifiques à l’ethnicité chinoise, pour les nourrissons nés à termes, et sud-asiatiques, pour les nourrissons nés avant et à termes, étaient régulièrement plus basses que ceux de la population générale en Alberta et de la référence nationale précédente. Les nourrissons sud-asiatiques avaient des poids de naissances plus basses à presque tous les âges gestationnels en comparaison avec les autres groupes.
Conclusion
Les percentiles de poids à la naissance actualisés présentés dans cette étude mettent en évidence les différences de PAG et GAG entre les nourrissons sud-asiatiques, chinoises et de la population générale, qui peuvent êtres importantes pour les soins cliniques périnatales.
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References
Alexander, G. R., Himes, J. H., Kaufman, R. B., Mor, J., & Kogan, M. (1996). A United States national reference for fetal growth. Obstetrics & Gynecology, 87(2), 163–168.
Arbuckle, T. E., Wilkins, R., & Sherman, G. J. (1993). Birth weight percentiles by gestational age in Canada. Obstetrics & Gynecology, 81(1), 39–48.
Boghossian, N. S., Geraci, M., Edwards, E. M., & Horbar, J. D. (2018). Morbidity and mortality in small for gestational age infants at 22 to 29 weeks’ gestation. Pediatrics, 141(2), e20172533.
Boshari, T., Urquia, M. L., Sgro, M., De Souza, L. R., & Ray, J. G. (2013). Differences in birthweight curves between newborns of immigrant mothers vs. infants born in their corresponding native countries: Systematic overview. Paediatr Perinat Epidemiol, 27(2), 118–130. https://doi.org/10.1111/ppe.12038.
Brenner, W. E., Edelman, D. A., & Hendricks, C. H. (1976). A standard of fetal growth for the United States of America. American Journal of Obstetrics & Gynecology, 126(5), 555–564.
Cantoni, E., & Hastie, T. (2002). Degrees-of-freedom tests for smoothing splines. Biometrika, 89(2), 251–263.
Carter, E. B., Stockburger, J., Tuuli, M. G., Macones, G. A., Odibo, A. O., & Trudell, A. S. (2018). Large for gestational age and stillbirth: Is there a role for antenatal testing? Ultrasound in Obstetrics & Gynecology.
Charles, E., Harris, C., Hickey, A., & Greenough, A. (2018). G202 (P) Outcomes of extremely low birth weight infants–the effect of being small for gestational age. BMJ Publishing Group Ltd.
Chui, T. W., & Flanders, J. (2013). Immigration and ethnocultural diversity in Canada: National Household Survey, 2011: Statistics Canada.
de Onis, M., & Habicht, J. P. (1996). Anthropometric reference data for international use: Recommendations from a World Health Organization Expert Committee. The American Journal of Clinical Nutrition, 64(4), 650–658. https://doi.org/10.1093/ajcn/64.4.650.
Edmonston, B. (2016). Canada’s immigration trends and patterns. Canadian Studies in Population, 43(1-2), 78–116.
Fenton, T. R. (2003). A new growth chart for preterm babies: Babson and Benda’s chart updated with recent data and a new format. BMC Pediatrics, 3(1), 13. https://doi.org/10.1186/1471-2431-3-13.
Fenton, T. R., & Kim, J. H. (2013). A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatrics, 13(1), 59. https://doi.org/10.1186/1471-2431-13-59.
Forna, F., Jamieson, D. J., Sanders, D., & Lindsay, M. K. (2003). Pregnancy outcomes in foreign-born and US-born women. International Journal of Gynecology & Obstetrics, 83(3), 257–265. https://doi.org/10.1016/S0020-7292(03)00307-2.
Gardosi, J., Madurasinghe, V., Williams, M., Malik, A., & Francis, A. (2013). Maternal and fetal risk factors for stillbirth: Population based study. BMJ, 346, f108.
Gjessing, H. K., Skjaerven, R., & Wilcox, A. J. (1999). Errors in gestational age: Evidence of bleeding early in pregnancy. American Journal of Public Health, 89(2), 213–218.
Government of Alberta. (n.d.). Alberta Health, Surveillance & Assessment Branch Interactive Health Data application-low birth weight 2000-2013. http://www.ahw.gov.ab.ca/IHDA_Retrieval/.
Guendelman, S., Buekens, P., Blondel, B., Kaminski, M., Notzon, F. C., & Masuy-Stroobant, G. (1999). Birth outcomes of immigrant women in the United States, France, and Belgium. Maternal and Child Health Journal, 3(4), 177–187. https://doi.org/10.1023/A:1022328020935.
Hanley, G. E., & Janssen, P. A. (2012). Ethnicity-specific growth distributions for prediction of newborn morbidity. Journal of Obstetrics and Gynaecology Canada, 34(9), 826–829.
Hanley, G. E., & Janssen, P. A. (2013). Ethnicity-specific birthweight distributions improve identification of term newborns at risk for short-term morbidity. American Journal of Obstetrics and Gynecology, 209(5), 428. e421–428. e426.
Hastie, T., & Tibshirani, R. (1995). Generalized additive models for medical research. Statistical Methods in Medical Research, 4(3), 187–196.
Hernán, M. A., & Robins, J. M. (2006). Estimating causal effects from epidemiological data. Journal of Epidemiology & Community Health, 60(7), 578–586.
Joseph, K., Kramer, M. S., Allen, A. C., Mery, L. S., Platt, R. W., & Wu Wen, S. (2001). Implausible birth weight for gestational age. American Journal of Epidemiology, 153(2), 110–113.
Joseph, K. S., Allen, A. C., Dodds, L., Turner, L. A., Scott, H., & Liston, R. (2005). The perinatal effects of delayed childbearing. Obstetrics & Gynecology, 105(6), 1410–1418. https://doi.org/10.1097/01.aog.0000163256.83313.36.
Kierans, W. J., Joseph, K., Luo, Z.-C., Platt, R., Wilkins, R., & Kramer, M. S. (2008). Does one size fit all? The case for ethnic-specific standards of fetal growth. BMC Pregnancy and Childbirth, 8(1), 1.
Kramer, M. S., McLean, F. H., Boyd, M. E., & Usher, R. H. (1988). The validity of gestational age estimation by menstrual dating in term, preterm, and postterm gestations. JAMA, 260(22), 3306–3308.
Kramer, M. S., Platt, R. W., Wen, S. W., Joseph, K., Allen, A., Abrahamowicz, M., et al. (2001). A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics, 108(2), e35–e35.
Lubchenco, L. O., Hansman, C., Dressler, M., & Boyd, E. (1963). Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation. Pediatrics, 32(5), 793–800.
Luo, Z.-C., Wilkins, R., & Kramer, M. S. (2006). Effect of neighbourhood income and maternal education on birth outcomes: A population-based study. Canadian Medical Association Journal, 174(10), 1415–1420. https://doi.org/10.1503/cmaj.051096.
Magee, L. A., von Dadelszen, P., Rey, E., Ross, S., Asztalos, E., Murphy, K. E., et al. (2015). Less-tight versus tight control of hypertension in pregnancy. New England Journal of Medicine, 372(5), 407–417. https://doi.org/10.1056/NEJMoa1404595.
Mikolajczyk, R. T., Zhang, J., Betran, A. P., Souza, J. P., Mori, R., Gülmezoglu, A. M., et al. (2011). A global reference for fetal-weight and birthweight percentiles. The Lancet, 377(9780), 1855–1861.
Parker, J. D., & Schoendorf, K. C. (2002). Implications of cleaning gestational age data. Paediatric and Perinatal Epidemiology, 16(2), 181–187.
Platt, R. W., Abrahamowicz, M., Kramer, M. S., Joseph, K., Mery, L., Blondel, B., et al. (2001). Detecting and eliminating erroneous gestational ages: A normal mixture model. Statistics in Medicine, 20(23), 3491–3503.
Poon, L., Tan, M., Yerlikaya, G., Syngelaki, A., & Nicolaides, K. (2016). Birth weight in live births and stillbirths. Ultrasound in Obstetrics & Gynecology, 48(5), 602–606.
Provencher, C., Milan, A., Hallman, S., & D’Aoust, C. (2018). Fertility: Overview, 2012 to 2016. Statistics Canada.
Quan, H., Wang, F., Schopflocher, D., Norris, C., Galbraith, P. D., Faris, P., et al. (2006). Development and validation of a surname list to define Chinese ethnicity. Medical Care, 328–333.
Ray, J. G., Jiang, D., Sgro, M., Shah, R., Singh, G., & Mamdani, M. M. (2009). Thresholds for small for gestational age among newborns of East Asian and South Asian ancestry. Journal of Obstetrics and Gynaecology Canada, 31(4), 322–330.
Ray, J. G., Sgro, M., Mamdani, M. M., Glazier, R. H., Bocking, A., Hilliard, R., et al. (2012). Birth weight curves tailored to maternal world region. Journal of Obstetrics and Gynaecology Canada, 34(2), 159–171.
Robertson, C. M., Svenson, L. W., & Kyle, J. M. (2002). Birth weight by gestational age for Albertan liveborn infants, 1985 through 1998. Journal of Obstetrics and Gynaecology Canada, 24(2), 138–148.
Saito, M., Yazawa, K., Hashiguchi, A., Kumasaka, T., Nishi, N., & Kato, K. (1972). Time of ovulation and prolonged pregnancy. American Journal of Obstetrics & Gynecology, 112(1), 31–38.
Savchev, S., Figueras, F., Cruz-Martinez, R., Illa, M., Botet, F., & Gratacos, E. (2012). Estimated weight centile as a predictor of perinatal outcome in small-for-gestational-age pregnancies with normal fetal and maternal Doppler indices. Ultrasound in Obstetrics & Gynecology, 39(3), 299–303.
Savitz, D. A., Terry Jr., J. W., Dole, N., Thorp Jr., J. M., Siega-Riz, A. M., & Herring, A. H. (2002). Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination. American Journal of Obstetrics and Gynecology, 187(6), 1660–1666.
Schmidt, B., Roberts, R. S., Davis, P., Doyle, L. W., Barrington, K. J., Ohlsson, A., et al. (2006). Caffeine therapy for apnea of prematurity. New England Journal of Medicine, 354(20), 2112–2121.
Schmidt, B., Whyte, R. K., Asztalos, E. V., & et al. (2013). Effects of targeting higher vs lower arterial oxygen saturations on death or disability in extremely preterm infants: A randomized clinical trial. JAMA, 309(20), 2111-2120, https://doi.org/10.1001/jama.2013.5555.
Shah, B. R., Chiu, M., Amin, S., Ramani, M., Sadry, S., & Tu, J. V. (2010). Surname lists to identify South Asian and Chinese ethnicity from secondary data in Ontario, Canada: A validation study. BMC Medical Research Methodology, 10(1), 42.
Skjaerven, R., Gjessing, H. K., & Bakketeig, L. S. (2000). Birthweight by gestational age in Norway. Acta obstetricia et gynecologica Scandinavica, 79(6), 440–449.
Statistics Canada. (2016). Immigration and ethnocultural diversity highlight tables, 2016 Census. Statistics Canada.
Statistics Canada. (2017). Focus on geography series, 2016 census. Statistics Canada Catalogue no. 98-404-X2016001. Ottawa, Ontario. Data products, 2016 Census.
Talge, N. M., Mudd, L. M., Sikorskii, A., & Basso, O. (2014). United States birth weight reference corrected for implausible gestational age estimates. Pediatrics peds. 2013-3285.
Tyson, J. E., Parikh, N. A., Langer, J., Green, C., & Higgins, R. D. (2008). Intensive care for extreme prematurity—moving beyond gestational age. New England Journal of Medicine, 358(16), 1672–1681.
Vital Statistics, Annual Review. (2005). Alberta Government Services.
Vital Statistics, Annual Review. (2014). Alberta Government Services.
Voldner, N., Frey Frøslie, K., Godang, K., Bollerslev, J., & Henriksen, T. (2009). Determinants of birth weight in boys and girls. Human_ontogenetics, 3(1), 7–12. https://doi.org/10.1002/huon.200900001.
World Health Organization. (2018). Preterm birth: Key facts.
Yang, H., Kramer, M. S., Platt, R. W., Blondel, B., Bréart, G., Morin, I., et al. (2002). How does early ultrasound scan estimation of gestational age lead to higher rates of preterm birth? American Journal of Obstetrics and Gynecology, 186(3), 433–437.
Acknowledgements
The results of this study were presented at the Eighth Annual Canadian Statistics Student Conference as an oral presentation. This study is based in part on data provided by Alberta Health and Alberta Health Services. We thank the Customer Relationship Management and Data Access Unit at Alberta Health for creating the linked database. The authors appreciate the editorial assistance of colleagues in the Canadian VIGOUR Centre.
Dr. Kaul is a Canadian Institutes of Health Research Chair in Sex and Gender Science and is supported by the Heart & Stroke Chair in Cardiovascular Research.
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This study was funded by the Canadian Institutes of Health Research (#377645).
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PK conceived of the presented idea. AS, LM, and MH developed the theory and performed the computations. ID verified the analytical methods. All the authors discussed the results and contributed to the final manuscript.
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This study was approved by the University of Alberta Research Ethics Board (Pro00056999).
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Hajihosseini, M., Savu, A., Moore, L. et al. An updated reference for age-sex-specific birth weight percentiles stratified for ethnicity based on data from all live birth infants between 2005 and 2014 in Alberta, Canada. Can J Public Health 113, 272–281 (2022). https://doi.org/10.17269/s41997-021-00520-9
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DOI: https://doi.org/10.17269/s41997-021-00520-9