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Comparison of first trimester dating methods for gestational age estimation and their implication on preterm birth classification in a North Indian cohort
Date Issued
01-12-2021
Author(s)
Vijayram, Ramya
Damaraju, Nikhita
Xavier, Ashley
Desiraju, Bapu Koundinya
Thiruvengadam, Ramachandran
Misra, Sumit
Chopra, Shilpa
Khurana, Ashok
Wadhwa, Nitya
Bal, Vineeta
Bhatnagar, Shinjini
Das, Bhabatosh
Dash, Mahadev
Kshetrapal, Pallavi
Natchu, Uma Chandra Mouli
Rath, Satyajit
Sachdeva, Kanika
Sharma, Dharmendra
Singh, Amanpreet
Sopory, Shailaja
Maitra, Arindam
Majumder, Partha P.
Mukherjee, Souvik
Maiti, Tushar K.
Bahl, Monika
Bansal, Shubra
Mehta, Umesh
Sharma, Sunita
Sindhu, Brahmdeep
Arya, Sugandha
Bharti, Rekha
Chellani, Harish
Mittal, Pratima
Garg, Anju
Ramji, Siddharth
Tripathi, Reva
Goyal, Alpesh
Gupta, Yashdeep
Hari, Smriti
Tandon, Nikhil
Gupta, Rakesh
Salunke, Dinakar M.
Nair, G. Balakrish
Kang, Gagandeep
Indian Institute of Technology, Madras
Indian Institute of Technology, Madras
Abstract
Background: Different formulae have been developed globally to estimate gestational age (GA) by ultrasonography in the first trimester of pregnancy. In this study, we develop an Indian population-specific dating formula and compare its performance with published formulae. Finally, we evaluate the implications of the choice of dating method on preterm birth (PTB) rate. This study’s data was from GARBH-Ini, an ongoing pregnancy cohort of North Indian women to study PTB. Methods: Comparisons between ultrasonography-Hadlock and last menstrual period (LMP) based dating methods were made by studying the distribution of their differences by Bland-Altman analysis. Using data-driven approaches, we removed data outliers more efficiently than by applying clinical parameters. We applied advanced machine learning algorithms to identify relevant features for GA estimation and developed an Indian population-specific formula (Garbhini-GA1) for the first trimester. PTB rates of Garbhini-GA1 and other formulae were compared by estimating sensitivity and accuracy. Results: Performance of Garbhini-GA1 formula, a non-linear function of crown-rump length (CRL), was equivalent to published formulae for estimation of first trimester GA (LoA, − 0.46,0.96 weeks). We found that CRL was the most crucial parameter in estimating GA and no other clinical or socioeconomic covariates contributed to GA estimation. The estimated PTB rate across all the formulae including LMP ranged 11.27–16.50% with Garbhini-GA1 estimating the least rate with highest sensitivity and accuracy. While the LMP-based method overestimated GA by 3 days compared to USG-Hadlock formula; at an individual level, these methods had less than 50% agreement in the classification of PTB. Conclusions: An accurate estimation of GA is crucial for the management of PTB. Garbhini-GA1, the first such formula developed in an Indian setting, estimates PTB rates with higher accuracy, especially when compared to commonly used Hadlock formula. Our results reinforce the need to develop population-specific gestational age formulae.
Volume
21