TY - JOUR
T1 - Antenatal detection of large-for-gestational-age fetuses following implementation of the Growth Assessment Protocol
T2 - secondary analysis of a randomised control trial
AU - the DESiGN trial team
AU - Relph, Sophie
AU - Vieira, Matias C.
AU - Copas, Andrew
AU - Winsloe, Chivon
AU - Coxon, Kirstie
AU - Alagna, Alessandro
AU - Briley, Annette
AU - Johnson, Mark
AU - Page, Louise
AU - Peebles, Donald
AU - Shennan, Andrew
AU - Thilaganathan, Baskaran
AU - Marlow, Neil
AU - Lees, Christoph
AU - Lawlor, Deborah A.
AU - Khalil, Asma
AU - Sandall, Jane
AU - Pasupathy, Dharmintra
N1 - Publisher Copyright:
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
PY - 2023/9
Y1 - 2023/9
N2 - Objective: To determine whether the Growth Assessment Protocol (GAP) affects the antenatal detection of large for gestational age (LGA) or maternal and perinatal outcomes amongst LGA babies. Design: Secondary analysis of a pragmatic open randomised cluster control trial comparing the GAP with standard care. Setting: Eleven UK maternity units. Population: Pregnant women and their LGA babies born at ≥36+0 weeks of gestation. Methods: Clusters were randomly allocated to GAP implementation or standard care. Data were collected from electronic patient records. Trial arms were compared using summary statistics, with unadjusted and adjusted (two-stage cluster summary approach) differences. Main outcome measures: Rate of detection of LGA (estimated fetal weight on ultrasound scan above the 90th centile after 34+0 weeks of gestation, defined by either population or customised growth charts), maternal and perinatal outcomes (e.g. mode of birth, postpartum haemorrhage, severe perineal tears, birthweight and gestational age, neonatal unit admission, perinatal mortality, and neonatal morbidity and mortality). Results: A total of 506 LGA babies were exposed to GAP and 618 babies received standard care. There were no significant differences in the rate of LGA detection (GAP 38.0% vs standard care 48.0%; adjusted effect size −4.9%; 95% CI −20.5, 10.7; p = 0.54), nor in any of the maternal or perinatal outcomes. Conclusions: The use of GAP did not change the rate of antenatal ultrasound detection of LGA when compared with standard care.
AB - Objective: To determine whether the Growth Assessment Protocol (GAP) affects the antenatal detection of large for gestational age (LGA) or maternal and perinatal outcomes amongst LGA babies. Design: Secondary analysis of a pragmatic open randomised cluster control trial comparing the GAP with standard care. Setting: Eleven UK maternity units. Population: Pregnant women and their LGA babies born at ≥36+0 weeks of gestation. Methods: Clusters were randomly allocated to GAP implementation or standard care. Data were collected from electronic patient records. Trial arms were compared using summary statistics, with unadjusted and adjusted (two-stage cluster summary approach) differences. Main outcome measures: Rate of detection of LGA (estimated fetal weight on ultrasound scan above the 90th centile after 34+0 weeks of gestation, defined by either population or customised growth charts), maternal and perinatal outcomes (e.g. mode of birth, postpartum haemorrhage, severe perineal tears, birthweight and gestational age, neonatal unit admission, perinatal mortality, and neonatal morbidity and mortality). Results: A total of 506 LGA babies were exposed to GAP and 618 babies received standard care. There were no significant differences in the rate of LGA detection (GAP 38.0% vs standard care 48.0%; adjusted effect size −4.9%; 95% CI −20.5, 10.7; p = 0.54), nor in any of the maternal or perinatal outcomes. Conclusions: The use of GAP did not change the rate of antenatal ultrasound detection of LGA when compared with standard care.
KW - antenatal screening
KW - big baby
KW - Growth Assessment Protocol
KW - large for gestational age
UR - http://www.scopus.com/inward/record.url?scp=85151728549&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.17453
DO - 10.1111/1471-0528.17453
M3 - Article
C2 - 36999234
AN - SCOPUS:85151728549
SN - 1470-0328
VL - 130
SP - 1167
EP - 1176
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 10
ER -