Development and assessment of population specific fetal growth references

最佳的胎儿生长被认为是终身健康的基本基础;生长限制 胎儿过度生长与婴儿、儿童和成人的发病率和死亡率有关。识别 早期胎儿生长异常，足以允许临床干预和减轻相关的母体 新生儿的风险取决于是否有合适的生长图表来比较胎儿的生物特征 测量.有两个最近公布的胎儿生长标准（旨在代表最佳的 增长）;一个由INTERGROWTH-21和另一个由世界卫生组织（世卫组织）。的疑问 然而，基于显著的 根据种族的胎儿生长的变化和使用来自 健康的妇女，在最佳条件下，谁可能不代表更广泛的怀孕人口。 针对这一辩论，本提案旨在为萨摩亚人制定胎儿生长参考标准， 正常生长，因此可以避免生长限制和 与标准相关的胎儿过度生长。到目前为止，太平洋岛民，包括萨摩亚人， 尽管在构建公开的增长图表方面表现明显，但其代表性极其不足 与美国一般人群相比，围产期结局较差。 我们的具体目标是：（1）为萨摩亚人制定和验证具体人口增长参考数据; (2)（a）将萨摩亚特有的胎儿生长参考与世卫组织和INTERGROWTH-21进行比较 标准和（B）解释生长图表之间的任何系统差异;和（3）比较 萨摩亚特定胎儿生长参照WHO和INTERGROWTH-21的诊断能力 围产期和儿童期肥胖结果的标准。 这项提案的创新之处在于我们把重点放在太平洋岛民身上，事实上，我们将 是最早测试最近公布的世卫组织标准的诊断和预测能力的国家之一， 传统上代表性不足的人口群体，以及我们对预测围产期和儿童期的关注- 使用胎儿生长参考的肥胖相关结果。虽然胎儿的生长和以后的发育 心脏代谢风险是公认的，很少有研究探讨胎儿生长轨迹的效用， 潜在的生物标志物为以后的代谢风险。我们希望建立一个种族特异性的胎儿生长模型 参考，以改善胎儿生长异常的临床检测，允许早期管理，因此 改善萨摩亚人的围产期结果。此外，儿童肥胖风险的检测增加， 允许早期预防性干预，将对这一人群的公共卫生产生重大影响。

Optimal fetal growth is recognized as the basic foundation for lifelong health; both growth restriction and excess fetal growth are associated with infant, child, and adult morbidity and mortality. Identifying abnormal fetal growth early enough to allow for clinical intervention and mitigation of the associated maternal and neonatal risk depends on the availability of appropriate growth charts with which to compare fetal biometric measurements. There have been two recently published fetal growth standards (designed to represent optimal growth); one by INTERGROWTH-21st and another by the World Health Organization (WHO). Questions have been raised, however, about their applicability and clinical utility for all population groups based on marked variation in fetal growth according to ethnicity and the creation of the standards using measurements from healthy women, in optimal conditions, who may be unrepresentative of the broader pregnant population. Responding to this debate, this proposal aims to develop fetal growth references for Samoans, which reflect usual growth and may therefore avoid some of the potential misclassification of both growth restriction and excess fetal growth associated with the standards. Until now, Pacific Islanders, including Samoans, have been extremely underrepresented in the construction of publicly available growth charts despite their markedly poorer perinatal outcomes compared with the general US population. Our specific aims are: (1) to develop and validate population-specific growth references for Samoans; (2) to (a) compare the Samoan-specific fetal growth references against the WHO and INTERGROWTH-21st standards and (b) explain any systematic differences between growth charts; and (3) to compare the diagnostic ability of the Samoan-specific fetal growth references against the WHO and INTERGROWTH-21st standards for perinatal and childhood obesity outcomes. The innovation in this proposal lies in our focus on a Pacific Islander population, the fact that we will be among the first to test the diagnostic and predictive ability of the very recently published WHO standards in a traditionally underrepresented population group, and our focus on predicting both perinatal and childhood- obesity related outcomes using fetal growth references. While the connection between fetal growth and later cardiometabolic risk is well established, few studies have explored the utility of fetal growth trajectories as a potential biomarker for later metabolic risk. We expect the construction of an ethnicity-specific fetal growth reference to improve clinical detection of fetal growth abnormalities, allow earlier management, and therefore improve perinatal outcomes among Samoans. In addition, increased detection of childhood-obesity risk, allowing for early preventative intervention, stands to have a significant public health impact for this population.