Fetal growth, typically measured as birth weight-for-gestational-age, predicts morbidity, survival, and long-term health outcomes in children and their mothers. Physicians typically use percentile thresholds (for example, the 10th or 90th percentile) from population-based reference charts to identify at-risk infants who may have had restricted or excessive fetal growth. Children identified as being small or large for their gestational age often need more care and careful monitoring during early life.  Previous birth weight charts however, suffer for two reasons. First, they may not reflect the current socio-demographic composition of the United States. And, second, they rely on very uncertain estimates of gestational age, from maternal reports of their last menstrual period. This subjective dating method is often less accurate than obstetric estimates based on ultrasound measurements, menstrual history and laboratory values. Given these concerns, we need a new and improved obstetric-estimate-based reference birth weight-at-gestational age.
In our latest study, we have created an updated birth weight reference for both clinicians and researchers using the most recent and nationally representative data on birth weight and obstetric estimates of gestational age. We used publicly available birth certificate data on over 3 million live births from 2017 to develop reference percentile curves and gestational age-specific cutpoints for male and female infants as well as for first-, second- and third-or-more-born infants. This data had the more precise obstetric measures and was more representative of the entire US population. We also created a simple and easy to use online tool for both clinicians and researchers to quickly calculate measures of birth size, tailored to their specific needs. To give an example, a female infant born at 3000 grams (~6 pounds, 9 ounces) at 38 weeks’ gestation would be in the 35th percentile using our updated reference. The same infant, however, would be classified in the 29th percentile using an older reference that was based on live births in 1999‒2000. How should these results be used? We expect clinicians to be able to use the percentile thresholds from the updated reference to identify at-risk infants in need of additional monitoring or care. Researchers may also use the reference to derive continuous measures of birth size for studies examining predictors of fetal growth or relationships of fetal growth with later health outcomes. Previously published birth weight references, such as those by Oken et al, have been readily adopted in clinical settings. For example, Massachusetts General Hospital in Boston currently uses the “Oken reference” as a growth standard for all fetal ultrasounds. We hope that this updated reference will have a similar uptake.
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Have you ever wondered what you can do to reduce your risk of developing Alzheimer’s disease? A healthy diet may be one important way in which you can lower your risk.
Countries around the world – from small nations like Fiji and Vanuatu to huge ones like India and Mexico – are increasingly implementing taxes on sugar-sweetened beverages (SSBs) in an effort to improve diet quality and reduce rates of chronic disease. SSBs, which include sodas, iced teas, energy drinks, and other beverages with added sugar, are an understandable target for an excise tax; they are strongly associated with poor health outcomes (such as obesity, diabetes, and dental caries), and they consist of “empty calories” that reduce feelings of satiety. While the U.S. isn’t one of the 30+ countries to levy an SSB tax, several US cities have now done so. And, results are coming in.
“Breakfast is the most important meal of the day.” We’ve all heard (and likely repeated) this age-old phrase. Despite saying it, however, some of us might not live by it. Maybe we’re running late in the morning, or we think skipping it benefits our waistlines. Or perhaps some of us think this is one of those baseless statements well-meaning people make.
Regardless of the reason, some of us are habitual breakfast skippers. It turns out, it’s not doing us any favors, especially for those of us who live with diabetes.
Childhood allergic disease is a significant public health problem, with over half of school-age children showing sensitization to allergens, and approximately 10% with asthma. Childhood asthma is responsible for more hospitalizations and emergency room visits than any other childhood disease in the U.S. While a child’s early life experience may influence his or her risk, susceptibility to allergies and asthma likely begins even before birth.
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