The National Standard for Normal Fetal Growth

NCT ID: NCT00912132

Last Updated: 2022-03-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

2802 participants

Study Classification

OBSERVATIONAL

Study Start Date

2009-05-19

Study Completion Date

2013-08-25

Brief Summary

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Normal fetal growth is a critical component of a healthy pregnancy and the long-term health of the offspring. Pivotal to understanding the dynamics of human fetal growth and to defining normal and abnormal fetal growth is the development of standards for fetal growth. The study's purpose was to establish standards for normal fetal growth and size for gestational age for 4 racial/ethnic groups of pregnant women with the eventual creation of individualized standards for fetal growth and improvements in fetal weight estimation. These data for a contemporary cohort of pregnant women should provide data for clinical management.

Detailed Description

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Summary and aims:

Normal fetal growth is a critical component of a healthy pregnancy and the long-term health of the offspring. Pivotal to understanding the dynamics of human fetal growth and to defining normal and abnormal fetal growth is the development of standards for fetal anthropometric parameters measured longitudinally throughout gestation, which, in turn, can be used to develop interval velocity curves and customized for genetic and physiological factors. We propose to conduct a multi-center prospective observational study (1) to establish a standard for normal fetal growth (velocity) and size for gestational age in the U.S. population; (2) to create an individualized standard for fetal growth potential; and (3) to improve accuracy of fetal weight estimation.

Eligibility:

• Healthy, low-risk pregnant women (both obese and nonobese) between the ages of 18 and 40 from each of the following four self-identified race/ethnicity backgrounds: African American, Asian, Caucasian, and Hispanic.

Design:

* Observational cohort design where pregnant women are recruited prior to 13 weeks gestation and followed throughout pregnancy and delivery for women having livebirths.
* After a sonogram at enrollment (10-13 weeks), women were randomized to receive sonograms according to one of the following four schedules: schedule A: 16, 24, 30, 34, and 38 weeks; schedule B: 18, 26, 31, 35, and 39 weeks; schedule C: 20, 28, 32, 36, and 40 weeks; schedule D: 22, 29, 33, 37, and 41 weeks.
* An enrollment interview was followed by depression screening, physical activity, anthropometric assessment and ultrasonology screening for measurement of fetal growth, and at each of the 5 subsequent visits.
* Uterine artery and fetal Doppler studies at selected gestational weeks.
* Women were asked to provide blood samples at enrollment and at follow-up visits at 16-22 weeks, 24-29 weeks, and 34-37 weeks of gestation.
* Neonatal anthropometry completed for all infants within 12-24 hours after birth.
* Cord blood, plasma, and placenta samples were collected for a smaller subsample of newborns.
* Post-study evaluations: Women who were diagnosed with gestational diabetes during pregnancy were asked to return for a follow-up visit 6 weeks after delivery.

Enrollment:

Final recruitment included 2,802 women with singleton pregnancies of which 2,334 were healthy, low-risk women with pre-pregnancy body mass indices (BMI) between 19-29.9 kg/m2. The racial/ethnic distribution of participating women were: Caucasians (n=614), African American (n=611), Hispanics (n=649), and Asians (n=460), and reflects natality characteristics of contemporary U.S. births. An additional 468 obese women (BMI 30-44.9 kg/m2) were also recruited.

Quality Control:

The quality of the ultrasound measures was guaranteed by implementation of: (1) a comprehensive quality control protocol for ante hoc training and credentialing of all site sonographers, developed by the sonology center at Columbia University, and (2) a rigorous protocol for post hoc quality control, whereby a random sample of all scans, stratified by clinical site and visit, was re-measured for accuracy and reliability.

Conditions

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Pregnancy Fetal Growth

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Low risk singleton cohort

Women with singleton gestations were enrolled between 8w0d and 13w6d and followed up to nine months (2009-2013) in this prospective cohort study. A sub-set of women with and without gestational diabetes were followed up to 6 weeks postpartum. Enrollment was based upon a predefined set of criteria including medical/reproductive history and pre-pregnancy body mass index. Women with a body mass index between 19.0-29.9 kg/m2 were in the low-risk cohort.

No interventions assigned to this group

Obese cohort

Women with singleton gestations were enrolled between 8w0d and 13w6d and followed up to nine months (2009-2013) in this prospective cohort study. A sub-set of women with and without gestational diabetes were followed up to 6 weeks postpartum. Enrollment was based upon a predefined set of criteria including medical/reproductive history and pre-pregnancy body mass index. Women with a body mass index between 30.0-44.9 kg/m2 were in the obese cohort.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Singleton, viable pregnancy
* 8 plus 0 - 13 plus 6 weeks of gestation
* Maternal age 18 - 40 years
* BMI 19.0 -29.9kg/m(2) for low risk group; BMI 30.0 - 45.0kg/m(2) for obese group
* Firm LMP
* LMP-date and ultrasound date match within 5 days for gestation estimates between 8 weeks + 0 days and 10 weeks + 6 days, 6 days for those between 11 weeks + 0 days and 12 weeks + 6 days, and 7 days for estimates between 13 weeks + 0 days and 13 weeks + 6 days
* No confirmed or suspected fetal congenital structural or chromosomal anomalies
* Expect to deliver at one of the participating hospitals
* No previous participation in the NICHD Fetal Growth Study

Exclusion Criteria

* Smoked cigarettes or used illicit drugs in the six months
* Used illicit drugs in the past year
* Having at least 1 alcoholic drink per day
* Conception by ovulation stimulation drugs or assisted reproductive technology
* Chronic hypertension or renal disease under medical supervision
* Asthma requiring weekly medication
* Diabetes mellitus
* Thyroid disease under medical supervision
* Autoimmune disorder (rheumatoid arthritis, lupus, antiphospholipid antibody syndrome,scleroderma)
* Hematologic disorders (chronic anemia, sickle cell disease thrombocytopenia coagulation defects, thrombophilia)
* Cancer
* HIV or AIDS
* Epilepsy or seizure on medication or occurrence within 2 years
* Psychiatric disorder (bipolar disorder, depression, anxiety disorder currently requiring medication)
* Current anorexia nervosa or bulimia
* Previous severe preclampsia, eclampsia, HELLP syndrome
* Previous stillbirth or neonatal death
* Previous very preterm birth (less than 34 weeks)
* Previous low birthweight (less than 2,500 g)
* Previous macrosomia (greater than or equal to 4,500 g)

The following criteria apply only to obese women only:

* Chronic hypertension or high blood pressure requiring two or more medications
* Diabetes while not pregnant
* Chronic renal disease under medical supervision
* Autoimmune disease (rheumatoid arthritis, lupus, antiphospholipid antibody syndrome, scleroderma)
* Psychiatric disorder (bipolar disorder, depression, anxiety disorder currently requiring medication)
* Cancer (currently receiving treatment)
* HIV or AIDS
Minimum Eligible Age

18 Years

Maximum Eligible Age

40 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Germaine M Louis, M.D.

Role: PRINCIPAL_INVESTIGATOR

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Locations

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University of Alabama

Birmingham, Alabama, United States

Site Status

Fountain Valley Regional Hospital

Fountain Valley, California, United States

Site Status

University of California-Long Beach

Long Beach, California, United States

Site Status

University of California, Irvine Medical Center

Orange, California, United States

Site Status

Christiana Care Health Services

Newark, Delaware, United States

Site Status

Northwestern University

Chicago, Illinois, United States

Site Status

Saint Peters University Hospital

New Brunswick, New Jersey, United States

Site Status

New York Presbyterian Healthcare System

Flushing, New York, United States

Site Status

Columbia University

New York, New York, United States

Site Status

Women and Infants

Providence, Rhode Island, United States

Site Status

Medical University of South Carolina

Charleston, South Carolina, United States

Site Status

Countries

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United States

References

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Chatterjee S, Zeng X, Ouidir M, Tesfaye M, Zhang C, Tekola-Ayele F. Sex-specific placental gene expression signatures of small for gestational age at birth. Placenta. 2022 Apr;121:82-90. doi: 10.1016/j.placenta.2022.03.004. Epub 2022 Mar 12.

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Ouidir M, Zeng X, Chatterjee S, Zhang C, Tekola-Ayele F. Ancestry-Matched and Cross-Ancestry Genetic Risk Scores of Type 2 Diabetes in Pregnant Women and Fetal Growth: A Study in an Ancestrally Diverse Cohort. Diabetes. 2022 Feb 1;71(2):340-349. doi: 10.2337/db21-0655.

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Grantz KL, Ortega-Villa AM, Pugh SJ, Bever A, Grobman W, Newman RB, Owen J, Wing DA, Albert PS. Combination of Fundal Height and Ultrasound to Predict Small for Gestational Age at Birth. Am J Perinatol. 2023 Jan;40(2):155-162. doi: 10.1055/s-0041-1728837. Epub 2021 May 3.

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Tekola-Ayele F, Ouidir M, Shrestha D, Workalemahu T, Rahman ML, Mendola P, Grantz KL, Hinkle SN, Wu J, Zhang C. Admixture mapping identifies African and Amerindigenous local ancestry loci associated with fetal growth. Hum Genet. 2021 Jul;140(7):985-997. doi: 10.1007/s00439-021-02265-4. Epub 2021 Feb 15.

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Vafai Y, Yeung EH, Sundaram R, Smarr MM, Gerlanc N, Grobman WA, Skupski D, Chien EK, Hinkle SN, Newman RB, Wing DA, Ranzini AC, Sciscione A, Grewal J, Zhang C, Grantz KL. Racial/Ethnic Differences in Prenatal Supplement and Medication Use in Low-Risk Pregnant Women. Am J Perinatol. 2022 Apr;39(6):623-632. doi: 10.1055/s-0040-1717097. Epub 2020 Oct 8.

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Ouidir M, Zeng X, Workalemahu T, Shrestha D, Grantz KL, Mendola P, Zhang C, Tekola-Ayele F. Early pregnancy dyslipidemia is associated with placental DNA methylation at loci relevant for cardiometabolic diseases. Epigenomics. 2020 Jun;12(11):921-934. doi: 10.2217/epi-2019-0293. Epub 2020 Jul 17.

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Tekola-Ayele F, Zeng X, Ouidir M, Workalemahu T, Zhang C, Delahaye F, Wapner R. DNA methylation loci in placenta associated with birthweight and expression of genes relevant for early development and adult diseases. Clin Epigenetics. 2020 Jun 3;12(1):78. doi: 10.1186/s13148-020-00873-x.

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Tekola-Ayele F, Zhang C, Wu J, Grantz KL, Rahman ML, Shrestha D, Ouidir M, Workalemahu T, Tsai MY. Trans-ethnic meta-analysis of genome-wide association studies identifies maternal ITPR1 as a novel locus influencing fetal growth during sensitive periods in pregnancy. PLoS Genet. 2020 May 14;16(5):e1008747. doi: 10.1371/journal.pgen.1008747. eCollection 2020 May.

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Li M, Hinkle SN, Grantz KL, Kim S, Grewal J, Grobman WA, Skupski DW, Newman RB, Chien EK, Sciscione A, Zork N, Wing DA, Nageotte M, Tekola-Ayele F, Louis GMB, Albert PS, Zhang C. Glycaemic status during pregnancy and longitudinal measures of fetal growth in a multi-racial US population: a prospective cohort study. Lancet Diabetes Endocrinol. 2020 Apr;8(4):292-300. doi: 10.1016/S2213-8587(20)30024-3. Epub 2020 Mar 2.

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Workalemahu T, Ouidir M, Shrestha D, Wu J, Grantz KL, Tekola-Ayele F. Differential DNA Methylation in Placenta Associated With Maternal Blood Pressure During Pregnancy. Hypertension. 2020 Apr;75(4):1117-1124. doi: 10.1161/HYPERTENSIONAHA.119.14509. Epub 2020 Feb 10.

Reference Type DERIVED
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Smarr MM, Bible J, Gerlanc N, Buck Louis GM, Bever A, Grantz KL. Comparison of fetal growth by maternal prenatal acetaminophen use. Pediatr Res. 2019 Aug;86(2):261-268. doi: 10.1038/s41390-019-0379-7. Epub 2019 Mar 25.

Reference Type DERIVED
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Rawal S, Tsai MY, Hinkle SN, Zhu Y, Bao W, Lin Y, Panuganti P, Albert PS, Ma RCW, Zhang C. A Longitudinal Study of Thyroid Markers Across Pregnancy and the Risk of Gestational Diabetes. J Clin Endocrinol Metab. 2018 Jul 1;103(7):2447-2456. doi: 10.1210/jc.2017-02442.

Reference Type DERIVED
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Zhu Y, Tsai MY, Sun Q, Hinkle SN, Rawal S, Mendola P, Ferrara A, Albert PS, Zhang C. A prospective and longitudinal study of plasma phospholipid saturated fatty acid profile in relation to cardiometabolic biomarkers and the risk of gestational diabetes. Am J Clin Nutr. 2018 Jun 1;107(6):1017-1026. doi: 10.1093/ajcn/nqy051.

Reference Type DERIVED
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Bever AM, Pugh SJ, Kim S, Newman RB, Grobman WA, Chien EK, Wing DA, Li H, Albert PS, Grantz KL. Fetal Growth Patterns in Pregnancies With First-Trimester Bleeding. Obstet Gynecol. 2018 Jun;131(6):1021-1030. doi: 10.1097/AOG.0000000000002616.

Reference Type DERIVED
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Grantz KL, Hediger ML, Liu D, Buck Louis GM. Fetal growth standards: the NICHD fetal growth study approach in context with INTERGROWTH-21st and the World Health Organization Multicentre Growth Reference Study. Am J Obstet Gynecol. 2018 Feb;218(2S):S641-S655.e28. doi: 10.1016/j.ajog.2017.11.593. Epub 2017 Dec 22.

Reference Type DERIVED
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Other Identifiers

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09-CH-N152

Identifier Type: -

Identifier Source: secondary_id

999909152

Identifier Type: -

Identifier Source: org_study_id

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