Development and assessment of population specific fetal growth references

最佳的胎儿生长被认为是终生健康的基本基础；同时限制生长 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 胎儿发育异常的时间足够早，可以进行临床干预和缓解相关的母体 新生儿的风险取决于是否有合适的生长曲线来比较胎儿的生物特征。 测量。最近公布了两个胎儿生长标准(旨在代表最佳 增长)；一个由共生--第21届，另一个由世界卫生组织(世卫组织)提供。问题有 然而，关于它们对基于标记的所有人群组的适用性和临床实用性提出了建议 不同种族胎儿生长的差异以及使用以下测量方法创建的标准 处于最佳状态的健康妇女，她们可能不能代表更广泛的怀孕人口。 作为对这场辩论的回应，这项提案旨在为萨摩亚人制定胎儿发育参考，这些参考反映了 正常增长，因此可能会避免一些潜在的错误分类，既有生长限制，也有 胎儿生长过快与标准有关。到目前为止，包括萨摩亚人在内的太平洋岛民一直 在构建公开可用的增长图表方面代表性极低，尽管他们明显 与美国总体人口相比，围产期结局更差。 我们的具体目标是：(1)为萨摩亚人制定和验证特定于人口的增长参考； (2)(A)将萨摩亚特有的胎儿生长参考与世界卫生组织和共生组织-21进行比较 标准和(B)解释增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考值与WHO和共生-21的诊断能力 围产期和儿童期肥胖结局标准。 这项提案的创新之处在于我们专注于太平洋岛民人口，我们将 最早测试最近发布的世卫组织标准的诊断和预测能力的公司之一 传统上代表不足的人口群体，以及我们对围产期和儿童期预测的重点- 使用胎儿生长参考的肥胖相关结果。而胎儿发育和后来的关系 心脏代谢风险是公认的，很少有研究探索胎儿生长轨迹作为 未来代谢风险的潜在生物标记物。我们希望建造一个特定种族的胎儿生长发育 参考文献，以改进胎儿生长异常的临床检测，允许早期处理，因此 改善萨摩亚人的围产儿结局。此外，增加了对儿童肥胖风险的检测， 允许及早进行预防性干预，势必对这一人群的公共健康产生重大影响。

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.