Ramesh P, Lemon L, Larkin J C
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Ultrasound Obstet Gynecol. 2025 Sep 5. doi: 10.1002/uog.70096.
Fetal growth standards determine which fetuses are diagnosed with fetal growth restriction (FGR) and become candidates for enhanced fetal monitoring. Given the existence of race-based differences in fetal and neonatal weights, we sought to determine the impact of race-based customization of fetal growth curves on the antenatal detection of FGR.
This was a retrospective cohort study of 8731 individuals who identified as either White or Black and delivered a liveborn singleton at Magee-Womens Hospital (MWH), Pittsburgh, PA, USA, between January 2003 and January 2013, with at least one sonographic measurement of estimated fetal weight (EFW) taken at 23-41 weeks' gestation. We compared the rates of antenatal FGR diagnosis when EFW was assessed using three distinct growth standards: (1) a standard used at MWH from 2012 to 2018, customized based on the height, weight, parity and race of the pregnant individual (Cust-Race); (2) the same standard without adjustment for race (Cust-NoRace); and (3) the Hadlock standard. Analyses were stratified by the race of the pregnant individual and classification of the neonate as small-for-gestational age (SGA) based on birth weight < 10 percentile.
The study population included 1458 (16.7%) individuals who self-identified as Black and 7273 (83.3%) who self-identified as White. SGA was diagnosed in 663 (7.6%) newborns, and was significantly more common in those born to Black vs White individuals (172/1458 (11.8%) vs 491/7273 (6.8%); P < 0.001). Among SGA newborns, 286 (43.1%) had at least one antenatal ultrasound scan that met the diagnostic criteria for FGR using the Cust-Race standard, compared with 306 (46.2%) using Cust-NoRace and 335 (50.5%) using Hadlock; only the difference in FGR diagnosis rate between Cust-Race and Hadlock was significant (P = 0.007). For newborns of Black individuals who were SGA at birth, the Cust-Race growth standard diagnosed 52 (30.2%) cases of antenatal FGR, compared with 72 (41.9%) for Cust-NoRace and 77 (44.8%) for Hadlock; again, only the difference in FGR diagnosis rate between Cust-Race and Hadlock was significant (P = 0.005). The antenatal detection of FGR among newborns of White individuals who were SGA at birth was similar across standards, with 234 (47.7%) detected by Cust-Race, 234 (47.7%) by Cust-NoRace and 258 (52.5%) by Hadlock.
Customization of growth standards with a race variable did not improve the antenatal detection of FGR compared with the Hadlock standard. The Hadlock standard demonstrated an improved ability to detect FGR among Black patients without a negative effect on White patients. Moving away from race-specific growth standards may help to eliminate inequities in resource allocation and reduce racial disparities in obstetric care. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
胎儿生长标准决定了哪些胎儿被诊断为胎儿生长受限（FGR），并成为加强胎儿监测的对象。鉴于胎儿和新生儿体重存在基于种族的差异，我们试图确定基于种族定制胎儿生长曲线对产前FGR检测的影响。
这是一项回顾性队列研究，研究对象为8731名自我认定为白人或黑人的个体，他们于2003年1月至2013年1月在美国宾夕法尼亚州匹兹堡的梅杰妇女医院（MWH）分娩了单胎活产儿，且在妊娠23 - 41周期间至少进行了一次超声估计胎儿体重（EFW）测量。我们比较了使用三种不同生长标准评估EFW时的产前FGR诊断率：（1）2012年至2018年在MWH使用的一种标准，根据孕妇的身高、体重、产次和种族进行定制（Cust - Race）；（2）不考虑种族因素的相同标准（Cust - NoRace）；（3）哈德洛克标准。分析按孕妇种族以及根据出生体重低于第10百分位数将新生儿分类为小于胎龄儿（SGA）进行分层。
研究人群包括1458名（16.7%）自我认定为黑人的个体和7273名（83.3%）自我认定为白人的个体。663名（7.6%）新生儿被诊断为SGA，在黑人母亲所生新生儿中比白人母亲所生新生儿中更为常见（172/1458（11.8%）对491/7273（6.8%）；P < 0.001）。在SGA新生儿中，286名（43.1%）至少有一次产前超声扫描符合使用Cust - Race标准的FGR诊断标准，使用Cust - NoRace标准的为306名（46.2%），使用哈德洛克标准的为335名（50.5%）；只有Cust - Race和哈德洛克标准之间的FGR诊断率差异具有统计学意义（P = 0.007）。对于出生时为SGA的黑人个体的新生儿，Cust - Race生长标准诊断出52例（30.2%）产前FGR，Cust - NoRace为72例（41.9%），哈德洛克标准为77例（44.8%）；同样，只有Cust - Race和哈德洛克标准之间的FGR诊断率差异具有统计学意义（P = 0.005）。对于出生时为SGA的白人个体的新生儿，各标准下产前FGR的检测情况相似，Cust - Race检测出234例（47.7%），Cust - NoRace检测出234例（47.7%），哈德洛克标准检测出258例（52.5%）。
与哈德洛克标准相比，包含种族变量的生长标准定制并未改善产前FGR的检测。哈德洛克标准显示出在黑人患者中检测FGR的能力有所提高，且对白人患者没有负面影响。摒弃基于种族的生长标准可能有助于消除资源分配中的不公平现象，并减少产科护理中的种族差异。© 2025作者。《妇产科超声》由约翰·威利父子有限公司代表国际妇产科超声学会出版。
