title: Individualized norms of optimal fetal growth: fetal growth potential.
abstract: OBJECTIVE
  To demonstrate that individualized optimal fetal growth norms, accounting for physiologic and pathologic determinants of fetal growth, better identify normal and abnormal outcomes of pregnancy than existing methods.
  
  
  METHODS
  In a prospective cohort of 38,033 singleton pregnancies, we identified 9,818 women with a completely normal outcome of pregnancy and characterized the physiologic factors affecting birth weight using multivariable regression. We used those physiologic factors to individually predict optimal growth trajectory and its variation, growth potential, for each fetus in the entire cohort. By comparing actual birth weight with growth potential, population, ultrasound, and customized norms, we calculated for each fetus achieved percentiles, by each norm. We then compared proportions of pregnancies classified as normally grown, between 10th and 90th percentile, or aberrantly grown, outside this interval, by growth potential and traditional norms, in 14,229 complicated pregnancies, 1,518 pregnancies with diabetes or hypertensive disorders, and 1,347 pregnancies with neonatal complications.
  
  
  RESULTS
  Nineteen physiologic factors, associated with maternal characteristics and early placental function, were identified. Growth potential norms correctly classified significantly more pregnancies than population, ultrasound, or customized norms in complicated pregnancies (26.4% compared with 18.3%, 18.7%, 22.8%, respectively, all P<.05), pregnancies with diabetes or hypertensive disorders (37.3% compared with 23.0%, 28.0%, 34.0%, respectively, all P<.05) and neonatal complications (33.3% compared with 19.7%, 24.9%, 29.8%, respectively, all P<.05).
  
  
  CONCLUSIONS
  Growth potential norms based on the physiologic determinants of birth weight are a better discriminator of aberrations of fetal growth than traditional norms.
  
  
  METHODS
  II.
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas 77555, USA. rkbukows@utmb.edu
authors.forename: Radek
authors.initials: R
authors.lastname: Bukowski
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Uchida
authors.forename: Gordon C S
authors.initials: GC
authors.lastname: Smith
authors.forename: Fergal D
authors.initials: FD
authors.lastname: Malone
authors.forename: Robert H
authors.initials: RH
authors.lastname: Ball
authors.forename: David A
authors.initials: DA
authors.lastname: Nyberg
authors.forename: Christine H
authors.initials: CH
authors.lastname: Comstock
authors.forename: Gary D V
authors.initials: GD
authors.lastname: Hankins
authors.forename: Richard L
authors.initials: RL
authors.lastname: Berkowitz
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Gross
authors.forename: Lorraine
authors.initials: L
authors.lastname: Dugoff
authors.forename: Sabrina D
authors.initials: SD
authors.lastname: Craigo
authors.forename: Ilan E
authors.initials: IE
authors.lastname: Timor
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Carr
authors.forename: Honor M
authors.initials: HM
authors.lastname: Wolfe
authors.forename: Mary E
authors.initials: ME
authors.lastname: D'Alton
mesh_terms: D000328:Adult; D001724:Birth Weight; D006063:Chorionic Gonadotropin / Q000097:blood; D004964:Estriol / Q000097:blood; D005260:Female; D047109:Fetal Development / Q000502:physiology*; D005865:Gestational Age; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000503:physiopathology; D007265:Inhibins / Q000097:blood; D010925:Placental Function Tests; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000503:physiopathology; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis; D011446:Prospective Studies; D012016:Reference Values; D016216:Ultrasonography, Prenatal
chemical_list: D006063:Chorionic Gonadotropin; C422362:inhibin A; D007265:Inhibins; D011266:Pregnancy-Associated Plasma Protein-A; D004964:Estriol