The assessment of gestational age: A comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa 11 Medical and Health Sciences 1114 Paediatrics and Reproductive Medicine

Holger Unger, Kamala Thriemer, Benedikt Ley, Halidou Tinto, Maminata Traoré, Innocent Valea, Harry Tagbor, Gifty Antwi, Prosper Gbekor, Michael Nambozi, Jean Bertin Bukasa Kabuya, Modest Mulenga, Victor Mwapasa, Gertrude Chapotera, Mwayiwawo Madanitsa, Stephen Rulisa, Maaike De Crop, Yves Claeys, Raffaella Ravinetto, Umberto D'Alessandro

Research output: Contribution to journalArticleResearchpeer-review

3 Downloads (Pure)

Abstract

Background: Determining gestational age in resource-poor settings is challenging because of limited availability of ultrasound technology and late first presentation to antenatal clinic. Last menstrual period (LMP), symphysio-pubis fundal height (SFH) and Ballard Score (BS) at delivery are therefore often used. We assessed the accuracy of LMP, SFH, and BS to estimate gestational age at delivery and preterm birth compared to ultrasound (US) using a large dataset derived from a randomized controlled trial in pregnant malaria patients in four African countries.

Methods: Mean and median gestational age for US, LMP, SFH and BS were calculated for the entire study population and stratified by country. Correlation coefficients were calculated using Pearson's rho, and Bland Altman plots were used to calculate mean differences in findings with 95% limit of agreements. Sensitivity, specificity, positive predictive value and negative predictive value were calculated considering US as reference method to identify term and preterm babies.

Results: A total of 1630 women with P. falciparum infection and a gestational age > 24 weeks determined by ultrasound at enrolment were included in the analysis. The mean gestational age at delivery using US was 38.7 weeks (95%CI: 38.6-38.8), by LMP, 38.4 weeks (95%CI: 38.0-38.9), by SFH, 38.3 weeks (95%CI: 38.2-38.5), and by BS 38.0 weeks (95%CI: 37.9-38.1) (p < 0.001). Correlation between US and any of the other three methods was poor to moderate. Sensitivity and specificity to determine prematurity were 0.63 (95%CI 0.50-0.75) and 0.72 (95%CI, 0.66-0.76) for LMP, 0.80 (95%CI 0.74-0.85) and 0.74 (95%CI 0.72-0.76) for SFH and 0.42 (95%CI 0.35-0.49) and 0.77 (95%CI 0.74-0.79) for BS.

Conclusions: In settings with limited access to ultrasound, and in women who had been treated with P. falciparum malaria, SFH may be the most useful antenatal tool to date a pregnancy when women present first in second and third trimester. The Ballard postnatal maturation assessment has a limited role and lacks precision. Improving ultrasound facilities and skills, and early attendance, together with the development of new technologies such as automated image analysis and new postnatal methods to assess gestational age, are essential for the study and management of preterm birth in low-income settings.

Original languageEnglish
Article number12
JournalBMC Pregnancy and Childbirth
Volume19
Issue number1
DOIs
Publication statusPublished - 8 Jan 2019

Fingerprint

Pubic Bone
Reproductive Medicine
Africa South of the Sahara
Malaria
Gestational Age
Pediatrics
Pregnancy
Health
Premature Birth
Technology
Sensitivity and Specificity
Falciparum Malaria
Third Pregnancy Trimester
Second Pregnancy Trimester
Randomized Controlled Trials
Infection
Population

Cite this

Unger, Holger ; Thriemer, Kamala ; Ley, Benedikt ; Tinto, Halidou ; Traoré, Maminata ; Valea, Innocent ; Tagbor, Harry ; Antwi, Gifty ; Gbekor, Prosper ; Nambozi, Michael ; Kabuya, Jean Bertin Bukasa ; Mulenga, Modest ; Mwapasa, Victor ; Chapotera, Gertrude ; Madanitsa, Mwayiwawo ; Rulisa, Stephen ; De Crop, Maaike ; Claeys, Yves ; Ravinetto, Raffaella ; D'Alessandro, Umberto. / The assessment of gestational age : A comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa 11 Medical and Health Sciences 1114 Paediatrics and Reproductive Medicine. In: BMC Pregnancy and Childbirth. 2019 ; Vol. 19, No. 1.
@article{f1007d6f923c48919da599179cf3c6ff,
title = "The assessment of gestational age: A comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa 11 Medical and Health Sciences 1114 Paediatrics and Reproductive Medicine",
abstract = "Background: Determining gestational age in resource-poor settings is challenging because of limited availability of ultrasound technology and late first presentation to antenatal clinic. Last menstrual period (LMP), symphysio-pubis fundal height (SFH) and Ballard Score (BS) at delivery are therefore often used. We assessed the accuracy of LMP, SFH, and BS to estimate gestational age at delivery and preterm birth compared to ultrasound (US) using a large dataset derived from a randomized controlled trial in pregnant malaria patients in four African countries. Methods: Mean and median gestational age for US, LMP, SFH and BS were calculated for the entire study population and stratified by country. Correlation coefficients were calculated using Pearson's rho, and Bland Altman plots were used to calculate mean differences in findings with 95{\%} limit of agreements. Sensitivity, specificity, positive predictive value and negative predictive value were calculated considering US as reference method to identify term and preterm babies. Results: A total of 1630 women with P. falciparum infection and a gestational age > 24 weeks determined by ultrasound at enrolment were included in the analysis. The mean gestational age at delivery using US was 38.7 weeks (95{\%}CI: 38.6-38.8), by LMP, 38.4 weeks (95{\%}CI: 38.0-38.9), by SFH, 38.3 weeks (95{\%}CI: 38.2-38.5), and by BS 38.0 weeks (95{\%}CI: 37.9-38.1) (p < 0.001). Correlation between US and any of the other three methods was poor to moderate. Sensitivity and specificity to determine prematurity were 0.63 (95{\%}CI 0.50-0.75) and 0.72 (95{\%}CI, 0.66-0.76) for LMP, 0.80 (95{\%}CI 0.74-0.85) and 0.74 (95{\%}CI 0.72-0.76) for SFH and 0.42 (95{\%}CI 0.35-0.49) and 0.77 (95{\%}CI 0.74-0.79) for BS. Conclusions: In settings with limited access to ultrasound, and in women who had been treated with P. falciparum malaria, SFH may be the most useful antenatal tool to date a pregnancy when women present first in second and third trimester. The Ballard postnatal maturation assessment has a limited role and lacks precision. Improving ultrasound facilities and skills, and early attendance, together with the development of new technologies such as automated image analysis and new postnatal methods to assess gestational age, are essential for the study and management of preterm birth in low-income settings.",
keywords = "Ballard score, Gestational age, Last menstrual period, Low income country, Methods, Pregnancy, Symphysio-pubis fundal height, Ultrasound",
author = "Holger Unger and Kamala Thriemer and Benedikt Ley and Halidou Tinto and Maminata Traor{\'e} and Innocent Valea and Harry Tagbor and Gifty Antwi and Prosper Gbekor and Michael Nambozi and Kabuya, {Jean Bertin Bukasa} and Modest Mulenga and Victor Mwapasa and Gertrude Chapotera and Mwayiwawo Madanitsa and Stephen Rulisa and {De Crop}, Maaike and Yves Claeys and Raffaella Ravinetto and Umberto D'Alessandro",
year = "2019",
month = "1",
day = "8",
doi = "10.1186/s12884-018-2128-z",
language = "English",
volume = "19",
journal = "BMC Pregnancy and Childbirth",
issn = "1471-2393",
publisher = "BioMed Central",
number = "1",

}

Unger, H, Thriemer, K, Ley, B, Tinto, H, Traoré, M, Valea, I, Tagbor, H, Antwi, G, Gbekor, P, Nambozi, M, Kabuya, JBB, Mulenga, M, Mwapasa, V, Chapotera, G, Madanitsa, M, Rulisa, S, De Crop, M, Claeys, Y, Ravinetto, R & D'Alessandro, U 2019, 'The assessment of gestational age: A comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa 11 Medical and Health Sciences 1114 Paediatrics and Reproductive Medicine' BMC Pregnancy and Childbirth, vol. 19, no. 1, 12. https://doi.org/10.1186/s12884-018-2128-z

The assessment of gestational age : A comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa 11 Medical and Health Sciences 1114 Paediatrics and Reproductive Medicine. / Unger, Holger; Thriemer, Kamala; Ley, Benedikt; Tinto, Halidou; Traoré, Maminata; Valea, Innocent; Tagbor, Harry; Antwi, Gifty; Gbekor, Prosper; Nambozi, Michael; Kabuya, Jean Bertin Bukasa; Mulenga, Modest; Mwapasa, Victor; Chapotera, Gertrude; Madanitsa, Mwayiwawo; Rulisa, Stephen; De Crop, Maaike; Claeys, Yves; Ravinetto, Raffaella; D'Alessandro, Umberto.

In: BMC Pregnancy and Childbirth, Vol. 19, No. 1, 12, 08.01.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - The assessment of gestational age

T2 - A comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa 11 Medical and Health Sciences 1114 Paediatrics and Reproductive Medicine

AU - Unger, Holger

AU - Thriemer, Kamala

AU - Ley, Benedikt

AU - Tinto, Halidou

AU - Traoré, Maminata

AU - Valea, Innocent

AU - Tagbor, Harry

AU - Antwi, Gifty

AU - Gbekor, Prosper

AU - Nambozi, Michael

AU - Kabuya, Jean Bertin Bukasa

AU - Mulenga, Modest

AU - Mwapasa, Victor

AU - Chapotera, Gertrude

AU - Madanitsa, Mwayiwawo

AU - Rulisa, Stephen

AU - De Crop, Maaike

AU - Claeys, Yves

AU - Ravinetto, Raffaella

AU - D'Alessandro, Umberto

PY - 2019/1/8

Y1 - 2019/1/8

N2 - Background: Determining gestational age in resource-poor settings is challenging because of limited availability of ultrasound technology and late first presentation to antenatal clinic. Last menstrual period (LMP), symphysio-pubis fundal height (SFH) and Ballard Score (BS) at delivery are therefore often used. We assessed the accuracy of LMP, SFH, and BS to estimate gestational age at delivery and preterm birth compared to ultrasound (US) using a large dataset derived from a randomized controlled trial in pregnant malaria patients in four African countries. Methods: Mean and median gestational age for US, LMP, SFH and BS were calculated for the entire study population and stratified by country. Correlation coefficients were calculated using Pearson's rho, and Bland Altman plots were used to calculate mean differences in findings with 95% limit of agreements. Sensitivity, specificity, positive predictive value and negative predictive value were calculated considering US as reference method to identify term and preterm babies. Results: A total of 1630 women with P. falciparum infection and a gestational age > 24 weeks determined by ultrasound at enrolment were included in the analysis. The mean gestational age at delivery using US was 38.7 weeks (95%CI: 38.6-38.8), by LMP, 38.4 weeks (95%CI: 38.0-38.9), by SFH, 38.3 weeks (95%CI: 38.2-38.5), and by BS 38.0 weeks (95%CI: 37.9-38.1) (p < 0.001). Correlation between US and any of the other three methods was poor to moderate. Sensitivity and specificity to determine prematurity were 0.63 (95%CI 0.50-0.75) and 0.72 (95%CI, 0.66-0.76) for LMP, 0.80 (95%CI 0.74-0.85) and 0.74 (95%CI 0.72-0.76) for SFH and 0.42 (95%CI 0.35-0.49) and 0.77 (95%CI 0.74-0.79) for BS. Conclusions: In settings with limited access to ultrasound, and in women who had been treated with P. falciparum malaria, SFH may be the most useful antenatal tool to date a pregnancy when women present first in second and third trimester. The Ballard postnatal maturation assessment has a limited role and lacks precision. Improving ultrasound facilities and skills, and early attendance, together with the development of new technologies such as automated image analysis and new postnatal methods to assess gestational age, are essential for the study and management of preterm birth in low-income settings.

AB - Background: Determining gestational age in resource-poor settings is challenging because of limited availability of ultrasound technology and late first presentation to antenatal clinic. Last menstrual period (LMP), symphysio-pubis fundal height (SFH) and Ballard Score (BS) at delivery are therefore often used. We assessed the accuracy of LMP, SFH, and BS to estimate gestational age at delivery and preterm birth compared to ultrasound (US) using a large dataset derived from a randomized controlled trial in pregnant malaria patients in four African countries. Methods: Mean and median gestational age for US, LMP, SFH and BS were calculated for the entire study population and stratified by country. Correlation coefficients were calculated using Pearson's rho, and Bland Altman plots were used to calculate mean differences in findings with 95% limit of agreements. Sensitivity, specificity, positive predictive value and negative predictive value were calculated considering US as reference method to identify term and preterm babies. Results: A total of 1630 women with P. falciparum infection and a gestational age > 24 weeks determined by ultrasound at enrolment were included in the analysis. The mean gestational age at delivery using US was 38.7 weeks (95%CI: 38.6-38.8), by LMP, 38.4 weeks (95%CI: 38.0-38.9), by SFH, 38.3 weeks (95%CI: 38.2-38.5), and by BS 38.0 weeks (95%CI: 37.9-38.1) (p < 0.001). Correlation between US and any of the other three methods was poor to moderate. Sensitivity and specificity to determine prematurity were 0.63 (95%CI 0.50-0.75) and 0.72 (95%CI, 0.66-0.76) for LMP, 0.80 (95%CI 0.74-0.85) and 0.74 (95%CI 0.72-0.76) for SFH and 0.42 (95%CI 0.35-0.49) and 0.77 (95%CI 0.74-0.79) for BS. Conclusions: In settings with limited access to ultrasound, and in women who had been treated with P. falciparum malaria, SFH may be the most useful antenatal tool to date a pregnancy when women present first in second and third trimester. The Ballard postnatal maturation assessment has a limited role and lacks precision. Improving ultrasound facilities and skills, and early attendance, together with the development of new technologies such as automated image analysis and new postnatal methods to assess gestational age, are essential for the study and management of preterm birth in low-income settings.

KW - Ballard score

KW - Gestational age

KW - Last menstrual period

KW - Low income country

KW - Methods

KW - Pregnancy

KW - Symphysio-pubis fundal height

KW - Ultrasound

UR - http://www.scopus.com/inward/record.url?scp=85059796053&partnerID=8YFLogxK

U2 - 10.1186/s12884-018-2128-z

DO - 10.1186/s12884-018-2128-z

M3 - Article

VL - 19

JO - BMC Pregnancy and Childbirth

JF - BMC Pregnancy and Childbirth

SN - 1471-2393

IS - 1

M1 - 12

ER -