Antenatal detection of large-for-gestational-age fetuses following implementation of the Growth Assessment Protocol: secondary analysis of a randomised control trial.

Relph, S; Vieira, MC; Copas, A; Winsloe, C; Coxon, K; Alagna, A; Briley, A; Johnson, M; Page, L; Peebles, D; Shennan, A; Thilaganathan, B; Marlow, N; Lees, C; Lawlor, DA; Khalil, A; Sandall, J; Pasupathy, D; DESiGN trial team,

Antenatal detection of large-for-gestational-age fetuses following implementation of the Growth Assessment Protocol: secondary analysis of a randomised control trial.

Relph, S Vieira, MC Copas, A Winsloe, C Coxon, K Alagna, A Briley, A Johnson, M Page, L Peebles, D Shennan, A Thilaganathan, B Marlow, N Lees, C Lawlor, DA Khalil, A Sandall, J

Pasupathy, D DESiGN trial team,

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Publisher:: WILEY
Publication Type:: Journal Article
Citation:: BJOG, 2023, 130, (10), pp. 1167-1176
Issue Date:: 2023-09

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Field	Value	Language
dc.contributor.author	Relph, S
dc.contributor.author	Vieira, MC
dc.contributor.author	Copas, A
dc.contributor.author	Winsloe, C
dc.contributor.author	Coxon, K
dc.contributor.author	Alagna, A
dc.contributor.author	Briley, A
dc.contributor.author	Johnson, M
dc.contributor.author	Page, L
dc.contributor.author	Peebles, D
dc.contributor.author	Shennan, A
dc.contributor.author	Thilaganathan, B
dc.contributor.author	Marlow, N
dc.contributor.author	Lees, C
dc.contributor.author	Lawlor, DA
dc.contributor.author	Khalil, A
dc.contributor.author	Sandall, J https://orcid.org/0000-0003-2000-743X
dc.contributor.author	Pasupathy, D
dc.contributor.author	DESiGN trial team,
dc.date.accessioned	2023-10-04T02:36:38Z
dc.date.available	2023-02-24
dc.date.available	2023-10-04T02:36:38Z
dc.date.issued	2023-09
dc.identifier.citation	BJOG, 2023, 130, (10), pp. 1167-1176
dc.identifier.issn	1470-0328
dc.identifier.issn	1471-0528
dc.identifier.uri	http://hdl.handle.net/10453/172458
dc.description.abstract	OBJECTIVE: To determine whether the Growth Assessment Protocol (GAP) affects the antenatal detection of large for gestational age (LGA) or maternal and perinatal outcomes amongst LGA babies. DESIGN: Secondary analysis of a pragmatic open randomised cluster control trial comparing the GAP with standard care. SETTING: Eleven UK maternity units. POPULATION: Pregnant women and their LGA babies born at ≥36+0 weeks of gestation. METHODS: Clusters were randomly allocated to GAP implementation or standard care. Data were collected from electronic patient records. Trial arms were compared using summary statistics, with unadjusted and adjusted (two-stage cluster summary approach) differences. MAIN OUTCOME MEASURES: Rate of detection of LGA (estimated fetal weight on ultrasound scan above the 90th centile after 34+0 weeks of gestation, defined by either population or customised growth charts), maternal and perinatal outcomes (e.g. mode of birth, postpartum haemorrhage, severe perineal tears, birthweight and gestational age, neonatal unit admission, perinatal mortality, and neonatal morbidity and mortality). RESULTS: A total of 506 LGA babies were exposed to GAP and 618 babies received standard care. There were no significant differences in the rate of LGA detection (GAP 38.0% vs standard care 48.0%; adjusted effect size -4.9%; 95% CI -20.5, 10.7; p = 0.54), nor in any of the maternal or perinatal outcomes. CONCLUSIONS: The use of GAP did not change the rate of antenatal ultrasound detection of LGA when compared with standard care.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	WILEY
dc.relation.ispartof	BJOG
dc.relation.isbasedon	10.1111/1471-0528.17453
dc.rights	info:eu-repo/semantics/openAccess
dc.rights	This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited
dc.subject	11 Medical and Health Sciences
dc.subject.classification	Obstetrics & Reproductive Medicine
dc.subject.classification	3215 Reproductive medicine
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Infant
dc.subject.mesh	Female
dc.subject.mesh	Pregnancy
dc.subject.mesh	Humans
dc.subject.mesh	Gestational Age
dc.subject.mesh	Birth Weight
dc.subject.mesh	Perinatal Mortality
dc.subject.mesh	Parturition
dc.subject.mesh	Fetus
dc.subject.mesh	Randomized Controlled Trials as Topic
dc.subject.mesh	Fetus
dc.subject.mesh	Humans
dc.subject.mesh	Birth Weight
dc.subject.mesh	Gestational Age
dc.subject.mesh	Pregnancy
dc.subject.mesh	Parturition
dc.subject.mesh	Infant
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Female
dc.subject.mesh	Randomized Controlled Trials as Topic
dc.subject.mesh	Perinatal Mortality
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Infant
dc.subject.mesh	Female
dc.subject.mesh	Pregnancy
dc.subject.mesh	Humans
dc.subject.mesh	Gestational Age
dc.subject.mesh	Birth Weight
dc.subject.mesh	Perinatal Mortality
dc.subject.mesh	Parturition
dc.subject.mesh	Fetus
dc.subject.mesh	Randomized Controlled Trials as Topic
dc.title	Antenatal detection of large-for-gestational-age fetuses following implementation of the Growth Assessment Protocol: secondary analysis of a randomised control trial.
dc.type	Journal Article
utslib.citation.volume	130
utslib.location.activity	England
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Midwifery
utslib.copyright.status	open_access	*
dc.date.updated	2023-10-04T02:36:37Z
pubs.issue	10
pubs.publication-status	Published
pubs.volume	130
utslib.citation.issue	10

Abstract:

OBJECTIVE: To determine whether the Growth Assessment Protocol (GAP) affects the antenatal detection of large for gestational age (LGA) or maternal and perinatal outcomes amongst LGA babies. DESIGN: Secondary analysis of a pragmatic open randomised cluster control trial comparing the GAP with standard care. SETTING: Eleven UK maternity units. POPULATION: Pregnant women and their LGA babies born at ≥36+0 weeks of gestation. METHODS: Clusters were randomly allocated to GAP implementation or standard care. Data were collected from electronic patient records. Trial arms were compared using summary statistics, with unadjusted and adjusted (two-stage cluster summary approach) differences. MAIN OUTCOME MEASURES: Rate of detection of LGA (estimated fetal weight on ultrasound scan above the 90th centile after 34+0 weeks of gestation, defined by either population or customised growth charts), maternal and perinatal outcomes (e.g. mode of birth, postpartum haemorrhage, severe perineal tears, birthweight and gestational age, neonatal unit admission, perinatal mortality, and neonatal morbidity and mortality). RESULTS: A total of 506 LGA babies were exposed to GAP and 618 babies received standard care. There were no significant differences in the rate of LGA detection (GAP 38.0% vs standard care 48.0%; adjusted effect size -4.9%; 95% CI -20.5, 10.7; p = 0.54), nor in any of the maternal or perinatal outcomes. CONCLUSIONS: The use of GAP did not change the rate of antenatal ultrasound detection of LGA when compared with standard care.

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http://hdl.handle.net/10453/172458