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Cite this page: Hill, M.A. (2020, August 7) Embryology Birth-Weight. Retrieved from


Birth weight and subsequent blood pressure: a meta-analysis

Arch Cardiovasc Dis. 2012 Feb;105(2):99-113. Epub 2012 Feb 14.

Mu M, Wang SF, Sheng J, Zhao Y, Li HZ, Hu CL, Tao FB. Source School of Public Health, Anhui Medical University, Hefei, China.


Hypertension is becoming an important health problem in many countries. The 'small baby syndrome hypothesis' suggests that an inverse linear relationship exists between birth weight and later risk of hypertension; however, this relationship is under debate. We conducted a meta-analysis to examine the association between birth weight and subsequent blood pressure. Among 78 studies reporting on the association between birth weight and subsequent blood pressure, 20 articles (reporting 27 original studies) were eligible for inclusion. Low birth weight (< 2500 g) compared with birth weight greater than 2500 g was associated with an increased risk of hypertension (odds ratio [OR] 1.21; 95% confidence interval [CI] 1.13, 1.30); high birth weight (> 4000 g) compared with birth weight less than 4000 g was associated with a decreased risk of hypertension (OR 0.78; 95% CI 0.71, 0.86). When low birth weight (< 2500 g) was compared with birth weight greater than 2500 g, mean systolic blood pressure (SBP) increased by 2.28 mmHg (95% CI 1.24, 3.33); when high birth weight (> 4000 g) was compared with birth weight less than 4000 g, mean SBP decreased by 2.08 mmHg (95% CI -2.98, -1.17). These findings indicate that there is an inverse linear association between birth weight and later risk of hypertension, and that this association primarily exists between birth weight and SBP. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

PMID 22424328


Birth-weight prediction by two- and three-dimensional ultrasound imaging

Ultrasound Obstet Gynecol. 2010 Apr;35(4):426-33.

Bennini JR, Marussi EF, Barini R, Faro C, Peralta CF. Source Department of Obstetrics and Gynecology, Center for Integral Assistance to Women's Health, State University of Campinas Medical School, Campinas, Brazil.


OBJECTIVES: To compare the accuracies of birth-weight predicting models derived from two-dimensional (2D) ultrasound parameters and from total fetal thigh volumes measured by three-dimensional (3D) ultrasound imaging; and to compare the performances of these formulae with those of previously published equations.

METHODS: A total of 210 patients were evaluated to create a formula-generating group (n = 150) and a prospective-validation group (n = 60). Polynomial regression analysis was performed on the first group to generate one equation based on 2D ultrasound measurements, one based on fetal thigh volume measured by the multiplanar technique (ThiM) and one based on fetal thigh volume obtained by the Virtual Organ Computer-aided AnaLysis (VOCAL()) method (ThiV). Paired-samples t-tests with Bonferroni adjustments were used to compare the performances of these equations in the formula-finding and the prospective-validation groups. The same approach was used to compare the accuracies of the new 2D and 3D formulae with those of both original and modified 2D equations from previous publications, as well as the 3D model reported by Chang et al.

RESULTS: The formulae with the best fit for the prediction of birth weight were: estimated fetal weight (EFW) = - 562.824 + 11.962x AC x FDL + 0.009 x BPD(2)x AC(2) (where AC is abdominal circumference, FDL is femur diaphysis length and BPD is biparietal diameter), EFW = 1033.286 + 12.733 x ThiM, and EFW = 1025.383 + 12.775 x ThiV. For both the formula-generating and the prospective-validation groups, there were no significant differences between the accuracies of the new 2D and 3D models in the prediction of birth weight. When applied to our population, the performances of the modified and original versions of the previously published 2D equations and the performance of the original 3D formula reported by Chang et al. were all significantly worse than our models.

CONCLUSIONS: We believe that the greatest sources of discrepancy in estimation of birth weight are the phenotypic differences among patients used to create each of the formulae mentioned in this study. Our data reinforce the need for customized birth-weight prediction formulae, regardless of whether 2D or 3D measurements are employed.

Copyright 2009 ISUOG. Published by John Wiley & Sons, Ltd.

PMID 20069666

Estimate of birth weight using two- and three-dimensional ultrasonography

Rev Assoc Med Bras. 2010 Mar-Apr;56(2):204-8.

(Article in Portuguese)

Nardozza LM, Araújo Junior E, Vieira MF, Rolo LC, Moron AF. Source Departamento de Obstetrícia, Universidade Federal de São Paulo- Escola Paulista de Medicina - UNIFESP-EPM, São Paulo, SP. Abstract OBJECTIVE: Assess and compare accuracy of birth weight prediction using a combination of two-dimensional (abdominal circumference - AC and femur length - FL) and three-dimensional parameters (fetal arm -VolArm and thigh -VolTh volumes).

METHODS: A cross sectional study was carried out involving 78 singleton, live, euploid fetuses without structural malformations born within 48 hours after ultrasonography. VolArm and VolTh were obtained by three-dimensional ultrasound using the multiplanar mode at 5 mm intervals. AC and FL were measured by two-dimensional ultrasound. Linear and polynomial regressions were calculated to determine the best formula to predict birth weight using VolArm, VolTh , CA and FL. ANOVA was used to compare errors in birth weight prediction using this formula and those obtained using the Shepard and Hadlock formulae.

RESULTS: The best formula for prediction of birth weight was a simple linear regression (Weight = -1486.1 + 60.5AC + 140.57FL + 16.6VolArm + 4.8VolTh), R2= 0.932. The error (E), absolute error (AE), percent error (PE) and absolute percent error (APE) for this new formula were 0 g, 0.2%, 112.2 g and 3.7%. This new formula had smaller E, AE, PE and APE than the Shepard formula and smaller AE and APE than Hadlock s formula.

CONCLUSION: A formula using VolArm, VolTh, AC and FL was more accurate for prediction of birth weight than formulae using only two-dimensional parameters.

PMID 20498996


A comparison of customized and population-based birth-weight standards: the influence of gestational age

Eur J Obstet Gynecol Reprod Biol. 2009 Sep;146(1):41-5. Epub 2009 Jul 5.

Hemming K, Hutton JL, Bonellie S. Source Department of Public Health, University of Birmingham, Birmingham B15 2TT, UK.


OBJECTIVES: We examined how customized birth-weight standards compare to population birth-weight references at term (> or =37 weeks), nearly term (34-36 weeks), moderately preterm (32-33 weeks) and for the very preterm births (28-31 weeks), with respect to perinatal mortality. STUDY DESIGN: Data from the national Swedish Medical Births Register for the years 1992-2001, consisting of a total of 783,303 singletons born at or after 28 completed gestational weeks. Infants were classified as small for gestational age (SGA, <10th centile) according to a conventional population based birth-weight reference and a customized standard. Risk ratios (RR) for still birth and neonatal death were compared between standards by prematurity of the birth. Diagnostic performance measures of specificity, sensitivity and positive and negative predictive values were also evaluated. RESULTS: More than half, 59% (209), of the 355 infants still-born between 28 and 31 weeks gestation were classified as SGA by the customized standard, but only 23% (80), were so classified as SGA by the population reference. However, only 14% (95%CI 13-16) of the 1461 very preterm infants classified as SGA by the customized standard were still-born, compared to 23% (95%CI 19-28) of the 348 infants classified as SGA by the population reference. Therefore, the relative risk of still birth for those classified as SGA by the customized standard is lower, 2.02 (95%CI: 1.65, 2.46), than for the population reference 2.64 (95%CI: 2.11, 3.30). Similar results were observed for the risk of neonatal death. For term weeks, customized standards showed stronger relationships than population references (RR: 4.30 (95%CI 3.82, 4.84) vs. 4.00 (95%CI 3.55, 4.51) for still births). CONCLUSIONS: Customized standards categorize a higher absolute number of preterm infants who are still-born as SGA. However, infants classified as SGA by population references are at higher risk of perinatal mortality than infants classified as SGA by customized standards.

PMID 19581044

New fetal weight estimation models using fractional limb volume

Ultrasound Obstet Gynecol. 2009 Nov;34(5):556-65.

Lee W, Balasubramaniam M, Deter RL, Yeo L, Hassan SS, Gotsch F, Kusanovic JP, Gonçalves LF, Romero R. Source Division of Fetal Imaging, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073-6769, USA. Abstract OBJECTIVES: The main goal of this study was to determine the accuracy and precision of new fetal weight estimation models, based on fractional limb volume and conventional two-dimensional (2D) sonographic measurements during the second and third trimesters of pregnancy.

METHODS: A prospective cross-sectional study of 271 fetuses was performed using three-dimensional ultrasonography to extract standard measurements-biparietal diameter (BPD), abdominal circumference (AC) and femoral diaphysis length (FDL)-plus fractional arm volume (AVol) and fractional thigh volume (TVol) within 4 days of delivery. Weighted multiple linear regression analysis was used to develop 'modified Hadlock' models and new models using transformed predictors that included soft tissue parameters for estimating birth weight. Estimated and observed birth weights were compared using mean percent difference (systematic weight estimation error) and the SD of the percent differences (random weight estimation error). The proportion of newborns with estimated birth weight within 5 or 10% of actual birth weight were compared using McNemar's test.

RESULTS: Birth weights in the study group ranged from 235 to 5790 g, with equal proportions of male and female infants. Six new fetal weight estimation models were compared with the results for modified Hadlock models with sample-specific coefficients. All the new models were very accurate, with mean percent differences that were not significantly different from zero. Model 3 (which used the natural logarithms of BPD, AC and AVol) and Model 6 (which used the natural logarithms of BPD, AC and TVol) provided the most precise weight estimations (random error = 6.6% of actual birth weight) as compared with 8.5% for the best original Hadlock model and 7.6% for a modified Hadlock model using sample-specific coefficients. Model 5 (which used the natural logarithms of AC and TVol) classified an additional 9.1% and 8.3% of the fetuses within 5% and 10% of actual birth weight and Model 6 classified an additional 7.3% and 4.1% of infants within 5% and 10% of actual birth weight.

CONCLUSION: The precision of fetal weight estimation can be improved by adding fractional limb volume measurements to conventional 2D biometry. New models that consider fractional limb volume may offer novel insight into the contribution of soft tissue development to weight estimation.

Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.

PMID 19725080

Sonographic fetal weight estimation in prolonged pregnancy: comparative study of two- and three-dimensional methods

Ultrasound Obstet Gynecol. 2009 Mar;33(3):295-300.

Lindell G, Marsál K. Source Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund, Sweden. Abstract OBJECTIVES: To compare two-dimensional (2D) and three-dimensional (3D) ultrasound techniques, including volumetry of fetal thigh, for fetal weight (FW) estimation in prolonged pregnancy, and to develop a new FW estimation formula.

METHODS: This prospective comparative study initially included 176 pregnant women. FW estimation was performed at >or= 287 days of gestation within <or= 4 days of delivery. Fetal head, abdomen and femur were measured using 2D ultrasound techniques, and fetal thigh volume was estimated using 3D techniques. The formula of Persson and Weldner (2D) was compared with two 3D formulae published by Lee and colleagues. In a subgroup of 63 fetuses, volumetry of the abdomen was performed and a new formula was developed; this formula was tested prospectively, along with the previously published formulae, on a further 50 women (Test Group).

RESULTS: In the initial group of 176 pregnancies, the SD of the mean percentage error (MPE) was 6.3% for both the 2D Persson and Weldner formula and for the better performing 3D formula of Lee et al., but the MPE of this Lee formula differed significantly from zero. Significantly more FW estimations were within +/- 10% of the birth weight when the 2D formula was used than when the 3D formulae were applied. The new formula gave a SD of MPE of 5.6% when applied to the data from which it was derived. In the Test Group, the SD of MPE was similar for the 2D formula, the second formula of Lee et al. and the new formula, with values of 7.0, 7.0 and 7.1, respectively, but only the Persson and Weldner formula showed a MPE that did not differ significantly from zero.

CONCLUSIONS: FW in prolonged pregnancies can be estimated using 2D sonography with the same accuracy as with 3D sonography. 3D ultrasound techniques require technically advanced and expensive equipment, special operator training and skills, and are time consuming. It does not seem reasonable to abandon the 2D ultrasound methods in favor of 3D ultrasound imaging for FW estimation.

(c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.

PMID 19180582


Quantitative standards for fetal and neonatal autopsy

Am J Clin Pathol. 2006 Aug;126(2):256-65.

Archie JG, Collins JS, Lebel RR. Source Office of Epidemiology, Greenwood Genetic Center, Greenwood, SC, USA.


Growth curves are essential for determining whether growth parameters lie within normal ranges. In the case of fetal and neonatal autopsy, relevant data are scattered across many publications, and few sources examine a large enough sample to be considered definitive. To ameliorate these inadequacies, regressions were created incorporating data from multiple sources both to increase accuracy and to condense available data into a single standard. When measurements were not well studied, the best available published standards are given. These regressions provide a valuable tool for clinicians who need to understand the significance of measurements obtained during autopsy.

PMID 16891202

Supplementary Data


Age terminology during the perinatal period

Pediatrics. 2004 Nov;114(5):1362-4.

Engle WA; American Academy of Pediatrics Committee on Fetus and Newborn.


Consistent definitions to describe the length of gestation and age in neonates are needed to compare neurodevelopmental, medical, and growth outcomes. The purposes of this policy statement are to review conventional definitions of age during the perinatal period and to recommend use of standard terminology including gestational age, postmenstrual age, chronological age, corrected age, adjusted age, and estimated date of delivery.

PMID 15520122


World Health Organization, Low Birth Weight: A tabulation of available information, WHO/MCH/92.2, World Health Organization, Geneva, and UNICEF, New York, 1992.