title: WHO Child Growth Standards Are Often Incorrectly Applied to Children Born Preterm in Epidemiologic Research.
abstract: In epidemiologic research, there is no standard approach for accounting for gestational age (GA) at birth when interpreting postnatal anthropometric data in analyses of cohorts that include children born preterm (CBP). A scoping review was conducted to describe analytical approaches to account for GA at birth when applying the WHO Growth Standards (WHO-GS) to anthropometric data in epidemiologic studies. We searched PubMed, Scopus, MEDLINE, Embase, and Web of Science for studies that applied WHO-GS, included CBP in the study population, had access to data within 1 mo of age, and were published between 2006 and 2015 in English. Of the 80 included studies that used the WHO-GS, 80% (64 of 80) included all children regardless of GA, whereas 20% (16 of 80) restricted analyses that used WHO-GS to term-born children. Among the 64 studies that included all children, 53 (83%) used chronological age and 11 (17%) used corrected age for CBP. Of the 53 studies that used chronological age, 12 (23%) excluded data that were likely contributed by CBP (e.g., very low birth weight or extremely low outlying z scores) and 19 (36%) adjusted for or stratified by GA at birth in regression analyses. In summary, researchers commonly apply WHO-GS to CBP, usually based on chronological age. Methodologic challenges of analyzing data from CBP in the application of WHO-GS were rarely explicitly addressed. Further efforts are required to establish acceptable approaches to account for heterogeneity in GA at birth in the analysis of post-term anthropometric data in epidemiologic research.
authors.affiliation: Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Canada; and.
authors.forename: Nandita
authors.initials: N
authors.lastname: Perumal
authors.affiliation: Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Canada; and.
authors.forename: Michelle F
authors.initials: MF
authors.lastname: Gaffey
authors.affiliation: Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Canada; Dalla Lana School of Public Health and Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada.
authors.forename: Diego G
authors.initials: DG
authors.lastname: Bassani
authors.affiliation: Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Canada; and Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada daniel.roth@sickkids.ca.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Roth
mesh_terms: D000886:Anthropometry; D002657:Child Development; D016208:Databases, Factual; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D016032:Randomized Controlled Trials as Topic; D012016:Reference Values; D014944:World Health Organization
keywords: World Health Organization Growth Standards (WHO-GS); gestational age; growth; infants; pediatrics; preterm birth; review