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Gestational dating by metabolic profile at birth: a California cohort study
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Accurate gestational dating is a critical component of obstetric and newborn care. In the absence of early ultrasound, many clinicians rely on less accurate measures, such as last menstrual period or symphysis-fundal height during pregnancy, or Dubowitz scoring or the Ballard or New Ballard method at birth. These measures often underestimate or overestimate gestational age and can lead to misclassification of babies as born preterm, which has both short- and long-term clinical care and public health implications.
We sought to evaluate whether metabolic markers in newborns measured as part of routine screening for treatable inborn errors of metabolism can be used to develop a population-level metabolic gestational dating algorithm that is robust despite intrauterine growth restriction and can be used when fetal ultrasound dating is not available. We used multivariate backward stepwise regression to test for associations and linear discriminate analyses to create a linear function for PTB and to assign a specific week of gestation.
We used sensitivity, specificity, and positive predictive value to evaluate the performance of linear functions. Along with birthweight and infant age at test, we included 35 of the 51 metabolic markers measured in the final multivariate model comparing PTBs and term births. Dating by metabolic profile may be useful in instances where there is no fetal ultrasound due to lack of availability or late entry into care. Accurate gestational dating is also important for establishing population-level rates of preterm birth PTB.
Measuring and tracking this rate across time is essential for establishing baselines and for resource planning aimed at reducing these outcomes and their associated burden within and across populations. While first-trimester ultrasound is recognized as the best method to establish gestational age for most pregnancies, ultrasound dating becomes less reliable as gestation progresses.
As such, prenatal ultrasound is not available in some rural and low- and middle-income country settings.
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Read terms. Pettker, MD; James D. Goldberg, MD; and Yasser Y. This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. As soon as data from the last menstrual period, the first accurate ultrasound examination, or both are obtained, the gestational age and the estimated due date EDD should be determined, discussed with the patient, and documented clearly in the medical record.
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Methods for Estimating the Due Date
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