A detailed description of the entry criteria and definitions has been published previously. This resulted in a group of educated, affluent, clinically healthy women, with adequate nutritional status, who by definition were at a low risk of FGR and preterm birth. 12 At each study site, we recruited women with no clinically relevant obstetrical, gynecologic, or medical history, who initiated antenatal care <14 +0 weeks’ gestation by menstrual dates and met the entry criteria of optimal health, nutrition, education, and socioeconomic status. INTERGROWTH-21 st was a multicenter, population-based project carried out between 20 in 8 delimited urban areas: Pelotas, Brazil Turin, Italy Muscat, Oman Oxford, United Kingdom Seattle, WA Shunyi County, a suburban district of the Beijing municipality, China the central area of the city of Nagpur (Central Nagpur), Maharashtra, India and the Parklands suburb of Nairobi, Kenya. The app is freely available with the other INTERGROWTH-21 st tools at. We also provide an easy-to-use application (app) that enables assessment of velocity increment and conditional velocity for fetal head circumference (HC), biparietal diameter (BPD), occipitofrontal diameter (OFD), abdominal circumference (AC), and femur length (FL) ( ). Thus, to complement the existing international INTERGROWTH-21 st Fetal Growth ( Distance) Standards, 12 we present here international Fetal Growth ( Velocity Increment and Conditional Velocity) Standards, based on the same serial ultrasound measures obtained from the FGLS cohort. To illustrate the point, poor placental nutrient transfer in the second trimester of pregnancy leads to early-onset fetal growth restriction (FGR) including impaired skeletal growth, 16 whereas in later pregnancy, it leads to the depletion of fetal fat stores. 15 It should, therefore, be self-evident that the concept of the differential growth velocity of fetal structures is in conflict with the practice of using single summary indicators of fetal growth, such as estimated fetal weight (EFW). 12, 13, 14 However, the use of such distance growth charts in clinical practice may not be sufficient to identify fetuses at a risk of adverse outcomes because (1) actual rates of skeletal and organ growth differ across time, and (2) insults at different time points during pregnancy almost certainly have differential effects on the growth and development of the skeleton and individual organs. ![]() To our knowledge, the only published international fetal growth charts that conform completely to the WHO prescriptive recommendations are those constructed using data from the INTERGROWTH-21 st Fetal Growth Longitudinal Study (FGLS). 5, 8, 9, 10 Charts should conform to the recommendations of the World Health Organization (WHO) for monitoring human growth and be based on the prescriptive approach, that is, they should be international standards, derived from healthy populations that have minimal nutritional, environmental, or socioeconomic constraints on growth. 3, 7 Specific charts for each objective should be purposely derived from several anthropometric measures obtained longitudinally from the same fetuses and expressed as distance or velocity measures. ![]() In contrast, growth is a change in a measure per unit of time-hence, a dynamic process. 3, 4, 5, 6 Size is an individual measure taken at a specific point in time repeated size measures represent distant variations in size. However, size and growth are not synonymous terms-a fact that is frequently ignored or misunderstood. They perfectly complement our existing fetal growth standards (distance), which are already being used clinically in many settings. These standards may be valuable if one wants to study the pathophysiology of fetal growth comprehensively.
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