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Fetal Size in a Rural Melanesian Population with Minimal Risk Factors for Growth Restriction: An Observational Ultrasound Study from Papua New Guinea
We conducted a prospective longitudinal study of fetal size in rural Papua New Guinea (PNG) involving 439 ultrasound-dated singleton pregnancies with no obvious risk factors for growth restriction. Sonographically estimated fetal weights (EFWs; N = 788) and birth weights (N = 376) were included in a second-order polynomial regression model (optimal fit) to generate fetal weight centiles. Means for specific fetal biometric measurements were also estimated. Fetal weight centiles from a healthy PNG cohort were consistently lower than those derived from Caucasian and Congolese populations, which overestimated the proportion of fetuses measuring small for gestational age (SGA; < 10th centile). Tanzanian and global reference centiles (Caucasian weight reference adapted to our PNG cohort) were more similar to those observed in our cohort, but the global reference underestimated SGA. Individual biometric measurements did not differ significantly from other cohorts. In rural PNG, a locally derived nomogram may be most appropriate for detection of SGA fetuses.
Author Notes
Financial support: Aspects of this research were supported by the Malaria in Pregnancy Consortium through Bill and Melinda Gates Foundation Grant 46099, Pfizer Inc. Investigator-Initiated Research Grant WS394663, an Internal Competitive Research Award (to M.O.), and the Pregvax Consortium through the European Union's Seventh Framework Programme Grant FP7-2007-HEALTH (PREGVAX 201588). SK is supported by an NHMRC Early Career Fellowship (#1052760). IM is supported by an NHMRC Senior Research Fellowship (#1043345).
Authors' addresses: Holger W. Unger and Stephen J. Rogerson, Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia, E-mails: hwunger@doctors.org.uk and sroger@unimelb.edu.au. Stephan Karl, Walter and Eliza Hall Institute, Parkville, VIC, Australia, E-mail: karl@wehi.edu.au. Regina A. Wangnapi, Peter Siba, and Maria Ome, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea, E-mails: wangnapi.regina@yahoo.com, pmaxsiba@gmail.com, and marai.kaius@gmail.com. Glen Mola, Department of Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea, E-mail: glenmola@dg.com.pg. Jane Walker, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom, E-mail: jane.walker@nhslothian.scot.nhs.uk. Ivo Mueller, Walter and Eliza Hall Institute, Parkville, VIC, Australia, and Centre de Recerca en Salut Internacional de Barcelona (CRESIB), Barcelona, Spain, E-mail: ivomueller@fastmail.fm.