Developing Universally-applicable Growth Standards: Emerging Findings on the First 1,000 Days of Life From the INTERGROWTH-21st Project

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By: Alison Chatfield, Project Manager, Maternal Health Task Force, Women and Health Initiative

The first 1,000 days of life is well-established as a critical time for the interconnected health of the mother-baby pair, as well as for the individual needs of both.  Yet the divide between maternal and newborn health remains persistent in policy, programs and, most importantly, in practice.

An international group of researchers across five continents has responded to this challenge through a collaborative effort to improve our understandings of human growth.

The evidence collected by the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) Project, led by the University of Oxford’s Maternal and Perinatal Health Institute, will inform the world’s first universally-applicable standards for measuring fetal, newborn and preterm growth.

Why growth?  “Low-weight newborns (newborns weighing 2000-2499 grams) are 2.8 times more likely to die during the neonatal period than those weighing more than 2499 grams at birth,” Zulfiqar Bhutta writes.  “A major limitation in our understanding of the significance of low birth weight and various connotations of the condition is the lack of standardized patterns of intrauterine growth.”

Current fetal, newborn and preterm growth charts were developed based on descriptions of how babies grew in a small cohort of American babies in the 1970s.  The INTERGROWTH-21st Consortium recognizes that existing benchmarks are increasingly irrelevant, and is gathering evidence to fill this gap and produce the world’s first universally-applicable growth standards.

Like the Multicentre Growth Reference Study before it, the INTERGROWTH-21st Project is racially and ethnically inclusive.  Participant mothers are non-smokers, receive adequate antenatal care and nutrition throughout pregnancy, and they all breastfeed their infants.  The resulting evidence will inform a standard based on how babies grow when given an optimal start to life.

The results of the INTERGROWTH-21st Project will (a) contribute to the evidence base on maternal, newborn and preterm health and nutrition, and (b) provide frontline healthcare professionals with decision-making tools that will improve the quality of care when it matters most to the health of mothers and newborns.  Translating this research into practice “may help us to reduce the millions of stillbirths and deaths in infancy that are attributable to poor growth,” says Professor Sir Sabaratnam Arulkumaran, President of FIGO.

For further reading, the BJOG: An International Journal of Gynaecology and Obstetrics has released a special supplement on the INTERGROWTH-21st Project’s methodology and implementation narratives from the study sites in Brazil, China, India, Italy, Kenya, Oman, the UK and the US.

Resources on Perinatal Health can be found on the MHTF’s newest Topic page.  If you have suggestions for additions or changes to the Topic page, or ideas for additional blog posts on Perinatal Health, let us know!