title: Optimal fetal growth: a misconception?
abstract: Alterations in fetal growth trajectory, either in terms of individual organs or the fetal body, constitute part of a suite of adaptive responses that the fetus can make to a developmental challenge such as inadequate nutrition. Nonetheless, despite substantial changes in nutrition in many countries over recent centuries, mean birthweight has changed relatively little. Low birthweight is recognized as a risk factor for later noncommunicable disease, although the developmental origins of such risk are graded across the full range of fetal growth and birthweight. Many parental and environmental factors, some biological and some cultural, can influence fetal growth, and these should not be viewed as abnormal. We argue that the suggestion of establishing a universal standard for optimal fetal growth ignores the breadth of these normal fetal responses. It may influence practice adversely, through incorrect estimation of gestational age and unnecessary elective deliveries. It raises ethical as well as practical issues.
authors.affiliation: Institute of Developmental Sciences and National Institute for Health Research Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton, Southampton, United Kingdom. Electronic address: M.Hanson@soton.ac.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Hanson
authors.affiliation: Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Torvid
authors.initials: T
authors.lastname: Kiserud
authors.affiliation: Department of Obstetrics, University Medical Center Utrecht, Lundlaan, Utrecht, The Netherlands.
authors.forename: Gerard H A
authors.initials: GH
authors.lastname: Visser
authors.affiliation: University College London Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London Medical School Building, London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Brocklehurst
authors.affiliation: Department of History and Centre for Global Health Studies, University of Sussex, Brighton, United Kingdom.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
mesh_terms: D001724:Birth Weight / Q000502:physiology*; D005260:Female; D047109:Fetal Development / Q000502:physiology*; D005317:Fetal Growth Retardation / Q000503:physiopathology*; D048070:Fetal Nutrition Disorders / Q000503:physiopathology*; D005865:Gestational Age; D057238:Growth Charts; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D012016:Reference Values
keywords: fetal growth trajectory; inadequate nutrition; low birthweight