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The first international standards setting out how babies should grow if their mothers have adequate health, nutrition, medical care and socioeconomic status, have been developed by a global team led by scientists from Oxford University.
The standards spell out the desirable pattern of healthy growth for all babies everywhere, regardless of their ethnicity or country of birth.
They provide 3rd, 10th, 50th, 90th and 97th centile curves for the growth of a baby during pregnancy (as measured by ultrasound) and for a baby's size at birth according to gestational age (weight, length and head circumference).
The standards mean it will be possible to detect underweight and overweight babies early in life no matter where in the world they are born.
Senior author Professor José Villar of Oxford University, claims that the huge improvement in health care that the international standards will bring is ‘unprecedented’. He said: “Being able to identify millions of additional undernourished babies at birth provides an opportunity for them to receive nutritional support and targeted treatment, without which close to five per cent are likely to die in their first year or develop severe, long-term health problems.”
Professor Stephen Kennedy of Oxford University, one of the senior authors of the study, added: “We now need to work with politicians and clinicians at regional, national and international levels to introduce the new tools into practice around the world.”
The international standards – one for the growing fetus and the other for newborns – have been published in two papers in the medical journal The Lancet. They were developed as part of the INTERGROWTH-21st Project, funded by the Bill & Melinda Gates Foundation, which took over 300 clinicians and researchers from 27 institutions across the world six years to complete.
Poor growth in the womb resulting in small size at birth is associated with illness and death in infancy and childhood. It also impacts on adult health with increased risks of diabetes, high blood pressure and cardiovascular disease. Smaller babies result in substantial costs for health services and they are a significant economic burden on society as a whole.
Professor Zulfiqar Bhutta, from The Aga Khan University in Karachi, Pakistan, and the Hospital for Sick Children in Toronto and chair of the INTERGROWTH-21st Project Steering Committee, said he hoped widespread use of the standards “will contribute to improved birth outcomes and reduced perinatal mortality and morbidity worldwide”.
Being born overweight is also a worsening problem, particularly in developed and emerging countries, as a result of rising maternal obesity rates due to overnutrition. Overweight babies are at increased risk of diabetes and high blood pressure later in life.
Introducing the standards in developed countries “will lead to more infants being diagnosed at birth as overweight and treated earlier to prevent chronic diseases later in life,” according to Dr Julian Robinson of Harvard Medical School.
At present, over 100 different, locally produced, growth charts are used around the world to assess fetal growth and newborn size. These only describe how babies grew in a particular population or region at a given time. International standards, on the other hand, describe what can be achieved with optimally healthy growth.