Assessing first trimester growth: the influence of ethnic background and maternal age
Identifieur interne : 001111 ( Istex/Corpus ); précédent : 001110; suivant : 001112Assessing first trimester growth: the influence of ethnic background and maternal age
Auteurs : Cecilia Bottomley ; Anneleen Daemen ; Faizah Mukri ; Aris T. Papageorghiou ; Emma Kirk ; Anne Pexsters ; Bart De Moor ; Dirk Timmerman ; Tom BourneSource :
- Human Reproduction [ 0268-1161 ] ; 2009-02.
Abstract
BACKGROUND First trimester growth restriction may predict miscarriage or adverse outcome later in the pregnancy, but determinants of early growth are not well described. Our objective was to examine factors influencing fetal and gestational sac size in the first trimester. METHODS Prospective observational study of 1828 singleton pregnancies before 12 weeks gestation. Maternal characteristics (ethnicity, maternal age, obstetric history, abdominal pain and vaginal bleeding), crown rump length (CRL) and mean gestational sac diameter (MSD) were recorded. A stepwise linear mixed effects analysis was performed to determine factors influencing rate of change in CRL and MSD. RESULTS 1063 scans, in 464 women, were included. Rate of increase in CRL was higher in women of black ethnic origin (P = 0.0261) compared with white, and increased with advancing maternal age (P = 0.0046). Maternal age also influenced MSD: older women had gestational sacs which were 0.118 mm larger for each one year increase in maternal age (P = 0.0073). Bleeding, pain and prior obstetric history did not influence CRL or MSD. CONCLUSIONS Rate of increase in CRL was greater in fetuses of black versus white women and increased with advancing maternal age. As CRL is used to date pregnancies, and this influences further growth assessment, consideration should be given to the use of individualized growth charts which take account of maternal factors found to influence first trimester growth.
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DOI: 10.1093/humrep/den389
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Papageorghiou</name><affiliation><mods:affiliation>Early Pregnancy and Gynaecological Ultrasound Unit, Department of Obstetrics and Gynaecology, St George's, University of London, Third Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's, University of London, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Kirk, Emma" sort="Kirk, Emma" uniqKey="Kirk E" first="Emma" last="Kirk">Emma Kirk</name><affiliation><mods:affiliation>Imperial College London, The Hammersmith Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Pexsters, Anne" sort="Pexsters, Anne" uniqKey="Pexsters A" first="Anne" last="Pexsters">Anne Pexsters</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="De Moor, Bart" sort="De Moor, Bart" uniqKey="De Moor B" first="Bart" last="De Moor">Bart De Moor</name><affiliation><mods:affiliation>Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Timmerman, Dirk" sort="Timmerman, Dirk" uniqKey="Timmerman D" first="Dirk" last="Timmerman">Dirk Timmerman</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Bourne, Tom" sort="Bourne, Tom" uniqKey="Bourne T" first="Tom" last="Bourne">Tom Bourne</name><affiliation><mods:affiliation>Imperial College London, The Hammersmith Hospital, London, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:8E7DFA51958A8F4DF583DE6A7DE3CB9631412879</idno><date when="2009" year="2009">2009</date><idno type="doi">10.1093/humrep/den389</idno><idno type="url">https://api.istex.fr/document/8E7DFA51958A8F4DF583DE6A7DE3CB9631412879/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001111</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Assessing first trimester growth: the influence of ethnic background and maternal age</title><author><name sortKey="Bottomley, Cecilia" sort="Bottomley, Cecilia" uniqKey="Bottomley C" first="Cecilia" last="Bottomley">Cecilia Bottomley</name><affiliation><mods:affiliation>Early Pregnancy and Gynaecological Ultrasound Unit, Department of Obstetrics and Gynaecology, St George's, University of London, Third Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: ceciliabottomley@doctors.org.uk</mods:affiliation></affiliation></author><author><name sortKey="Daemen, Anneleen" sort="Daemen, Anneleen" uniqKey="Daemen A" first="Anneleen" last="Daemen">Anneleen Daemen</name><affiliation><mods:affiliation>Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Mukri, Faizah" sort="Mukri, Faizah" uniqKey="Mukri F" first="Faizah" last="Mukri">Faizah Mukri</name><affiliation><mods:affiliation>Early Pregnancy and Gynaecological Ultrasound Unit, Department of Obstetrics and Gynaecology, St George's, University of London, Third Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK</mods:affiliation></affiliation></author><author><name sortKey="Papageorghiou, Aris T" sort="Papageorghiou, Aris T" uniqKey="Papageorghiou A" first="Aris T." last="Papageorghiou">Aris T. Papageorghiou</name><affiliation><mods:affiliation>Early Pregnancy and Gynaecological Ultrasound Unit, Department of Obstetrics and Gynaecology, St George's, University of London, Third Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's, University of London, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Kirk, Emma" sort="Kirk, Emma" uniqKey="Kirk E" first="Emma" last="Kirk">Emma Kirk</name><affiliation><mods:affiliation>Imperial College London, The Hammersmith Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Pexsters, Anne" sort="Pexsters, Anne" uniqKey="Pexsters A" first="Anne" last="Pexsters">Anne Pexsters</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="De Moor, Bart" sort="De Moor, Bart" uniqKey="De Moor B" first="Bart" last="De Moor">Bart De Moor</name><affiliation><mods:affiliation>Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Timmerman, Dirk" sort="Timmerman, Dirk" uniqKey="Timmerman D" first="Dirk" last="Timmerman">Dirk Timmerman</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Bourne, Tom" sort="Bourne, Tom" uniqKey="Bourne T" first="Tom" last="Bourne">Tom Bourne</name><affiliation><mods:affiliation>Imperial College London, The Hammersmith Hospital, London, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Human Reproduction</title><idno type="ISSN">0268-1161</idno><idno type="eISSN">1460-2350</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2009-02">2009-02</date><biblScope unit="volume">24</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="284">284</biblScope><biblScope unit="page" to="290">290</biblScope></imprint><idno type="ISSN">0268-1161</idno></series><idno type="istex">8E7DFA51958A8F4DF583DE6A7DE3CB9631412879</idno><idno type="DOI">10.1093/humrep/den389</idno><idno type="ArticleID">den389</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0268-1161</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">BACKGROUND First trimester growth restriction may predict miscarriage or adverse outcome later in the pregnancy, but determinants of early growth are not well described. Our objective was to examine factors influencing fetal and gestational sac size in the first trimester. METHODS Prospective observational study of 1828 singleton pregnancies before 12 weeks gestation. Maternal characteristics (ethnicity, maternal age, obstetric history, abdominal pain and vaginal bleeding), crown rump length (CRL) and mean gestational sac diameter (MSD) were recorded. A stepwise linear mixed effects analysis was performed to determine factors influencing rate of change in CRL and MSD. RESULTS 1063 scans, in 464 women, were included. Rate of increase in CRL was higher in women of black ethnic origin (P = 0.0261) compared with white, and increased with advancing maternal age (P = 0.0046). Maternal age also influenced MSD: older women had gestational sacs which were 0.118 mm larger for each one year increase in maternal age (P = 0.0073). Bleeding, pain and prior obstetric history did not influence CRL or MSD. CONCLUSIONS Rate of increase in CRL was greater in fetuses of black versus white women and increased with advancing maternal age. As CRL is used to date pregnancies, and this influences further growth assessment, consideration should be given to the use of individualized growth charts which take account of maternal factors found to influence first trimester growth.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>Cecilia Bottomley</name><affiliations><json:string>Early Pregnancy and Gynaecological Ultrasound Unit, Department of Obstetrics and Gynaecology, St George's, University of London, Third Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK</json:string><json:string>E-mail: ceciliabottomley@doctors.org.uk</json:string></affiliations></json:item><json:item><name>Anneleen Daemen</name><affiliations><json:string>Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Leuven, Belgium</json:string></affiliations></json:item><json:item><name>Faizah Mukri</name><affiliations><json:string>Early Pregnancy and Gynaecological Ultrasound Unit, Department of Obstetrics and Gynaecology, St George's, University of London, Third Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK</json:string></affiliations></json:item><json:item><name>Aris T. Papageorghiou</name><affiliations><json:string>Early Pregnancy and Gynaecological Ultrasound Unit, Department of Obstetrics and Gynaecology, St George's, University of London, Third Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK</json:string><json:string>Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's, University of London, London, UK</json:string></affiliations></json:item><json:item><name>Emma Kirk</name><affiliations><json:string>Imperial College London, The Hammersmith Hospital, London, UK</json:string></affiliations></json:item><json:item><name>Anne Pexsters</name><affiliations><json:string>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</json:string></affiliations></json:item><json:item><name>Bart De Moor</name><affiliations><json:string>Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Leuven, Belgium</json:string></affiliations></json:item><json:item><name>Dirk Timmerman</name><affiliations><json:string>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</json:string></affiliations></json:item><json:item><name>Tom Bourne</name><affiliations><json:string>Imperial College London, The Hammersmith Hospital, London, UK</json:string><json:string>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>fetal growth</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>age</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>ethnicity</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>first trimester</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>ultrasound</value></json:item></subject><articleId><json:string>den389</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>BACKGROUND First trimester growth restriction may predict miscarriage or adverse outcome later in the pregnancy, but determinants of early growth are not well described. Our objective was to examine factors influencing fetal and gestational sac size in the first trimester. METHODS Prospective observational study of 1828 singleton pregnancies before 12 weeks gestation. Maternal characteristics (ethnicity, maternal age, obstetric history, abdominal pain and vaginal bleeding), crown rump length (CRL) and mean gestational sac diameter (MSD) were recorded. A stepwise linear mixed effects analysis was performed to determine factors influencing rate of change in CRL and MSD. RESULTS 1063 scans, in 464 women, were included. Rate of increase in CRL was higher in women of black ethnic origin (P = 0.0261) compared with white, and increased with advancing maternal age (P = 0.0046). Maternal age also influenced MSD: older women had gestational sacs which were 0.118 mm larger for each one year increase in maternal age (P = 0.0073). Bleeding, pain and prior obstetric history did not influence CRL or MSD. CONCLUSIONS Rate of increase in CRL was greater in fetuses of black versus white women and increased with advancing maternal age. As CRL is used to date pregnancies, and this influences further growth assessment, consideration should be given to the use of individualized growth charts which take account of maternal factors found to influence first trimester growth.</abstract><qualityIndicators><score>7.34</score><pdfVersion>1.2</pdfVersion><pdfPageSize>612.283 x 790.866 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>1474</abstractCharCount><pdfWordCount>4628</pdfWordCount><pdfCharCount>27817</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>226</abstractWordCount></qualityIndicators><title>Assessing first trimester growth: the influence of ethnic background and maternal age</title><genre><json:string>research-article</json:string></genre><host><volume>24</volume><publisherId><json:string>humrep</json:string></publisherId><pages><last>290</last><first>284</first></pages><issn><json:string>0268-1161</json:string></issn><issue>2</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1460-2350</json:string></eissn><title>Human Reproduction</title></host><categories><wos><json:string>OBSTETRICS & GYNECOLOGY</json:string><json:string>REPRODUCTIVE BIOLOGY</json:string></wos></categories><publicationDate>2009</publicationDate><copyrightDate>2009</copyrightDate><doi><json:string>10.1093/humrep/den389</json:string></doi><id>8E7DFA51958A8F4DF583DE6A7DE3CB9631412879</id><score>0.23751307</score><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/8E7DFA51958A8F4DF583DE6A7DE3CB9631412879/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/8E7DFA51958A8F4DF583DE6A7DE3CB9631412879/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/8E7DFA51958A8F4DF583DE6A7DE3CB9631412879/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Assessing first trimester growth: the influence of ethnic background and maternal age</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Oxford University Press</publisher><availability><p>The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissionsoxfordjournals.org</p></availability><date>2008-12-02</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Assessing first trimester growth: the influence of ethnic background and maternal age</title><author xml:id="author-1"><persName><forename type="first">Cecilia</forename><surname>Bottomley</surname></persName><email>ceciliabottomley@doctors.org.uk</email><affiliation>Early Pregnancy and Gynaecological Ultrasound Unit, Department of Obstetrics and Gynaecology, St George's, University of London, Third Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK</affiliation></author><author xml:id="author-2"><persName><forename type="first">Anneleen</forename><surname>Daemen</surname></persName><affiliation>Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Leuven, Belgium</affiliation></author><author xml:id="author-3"><persName><forename type="first">Faizah</forename><surname>Mukri</surname></persName><affiliation>Early Pregnancy and Gynaecological Ultrasound Unit, Department of Obstetrics and Gynaecology, St George's, University of London, Third Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK</affiliation></author><author xml:id="author-4"><persName><forename type="first">Aris T.</forename><surname>Papageorghiou</surname></persName><affiliation>Early Pregnancy and Gynaecological Ultrasound Unit, Department of Obstetrics and Gynaecology, St George's, University of London, Third Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK</affiliation><affiliation>Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's, University of London, London, UK</affiliation></author><author xml:id="author-5"><persName><forename type="first">Emma</forename><surname>Kirk</surname></persName><affiliation>Imperial College London, The Hammersmith Hospital, London, UK</affiliation></author><author xml:id="author-6"><persName><forename type="first">Anne</forename><surname>Pexsters</surname></persName><affiliation>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</affiliation></author><author xml:id="author-7"><persName><forename type="first">Bart</forename><surname>De Moor</surname></persName><affiliation>Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Leuven, Belgium</affiliation></author><author xml:id="author-8"><persName><forename type="first">Dirk</forename><surname>Timmerman</surname></persName><affiliation>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</affiliation></author><author xml:id="author-9"><persName><forename type="first">Tom</forename><surname>Bourne</surname></persName><affiliation>Imperial College London, The Hammersmith Hospital, London, UK</affiliation><affiliation>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</affiliation></author></analytic><monogr><title level="j">Human Reproduction</title><idno type="pISSN">0268-1161</idno><idno type="eISSN">1460-2350</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2009-02"></date><biblScope unit="volume">24</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="284">284</biblScope><biblScope unit="page" to="290">290</biblScope></imprint></monogr><idno type="istex">8E7DFA51958A8F4DF583DE6A7DE3CB9631412879</idno><idno type="DOI">10.1093/humrep/den389</idno><idno type="ArticleID">den389</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2008-12-02</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>BACKGROUND First trimester growth restriction may predict miscarriage or adverse outcome later in the pregnancy, but determinants of early growth are not well described. Our objective was to examine factors influencing fetal and gestational sac size in the first trimester. METHODS Prospective observational study of 1828 singleton pregnancies before 12 weeks gestation. Maternal characteristics (ethnicity, maternal age, obstetric history, abdominal pain and vaginal bleeding), crown rump length (CRL) and mean gestational sac diameter (MSD) were recorded. A stepwise linear mixed effects analysis was performed to determine factors influencing rate of change in CRL and MSD. RESULTS 1063 scans, in 464 women, were included. Rate of increase in CRL was higher in women of black ethnic origin (P = 0.0261) compared with white, and increased with advancing maternal age (P = 0.0046). Maternal age also influenced MSD: older women had gestational sacs which were 0.118 mm larger for each one year increase in maternal age (P = 0.0073). Bleeding, pain and prior obstetric history did not influence CRL or MSD. CONCLUSIONS Rate of increase in CRL was greater in fetuses of black versus white women and increased with advancing maternal age. As CRL is used to date pregnancies, and this influences further growth assessment, consideration should be given to the use of individualized growth charts which take account of maternal factors found to influence first trimester growth.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>fetal growth</term></item><item><term>age</term></item><item><term>ethnicity</term></item><item><term>first trimester</term></item><item><term>ultrasound</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2008-12-02">Created</change><change when="2009-02">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/8E7DFA51958A8F4DF583DE6A7DE3CB9631412879/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="publisher-id">humrep</journal-id><journal-id journal-id-type="hwp">humrep</journal-id><journal-title>Human Reproduction</journal-title><issn pub-type="ppub">0268-1161</issn><issn pub-type="epub">1460-2350</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1093/humrep/den389</article-id><article-id pub-id-type="publisher-id">den389</article-id><article-categories><subj-group subj-group-type="heading"><subject>ORIGINAL ARTICLES</subject><subj-group><subject>Early pregnancy</subject></subj-group></subj-group></article-categories><title-group><article-title>Assessing first trimester growth: the influence of ethnic background and maternal age</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bottomley</surname><given-names>Cecilia</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="corresp" rid="cor1">6</xref></contrib><contrib contrib-type="author"><name><surname>Daemen</surname><given-names>Anneleen</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Mukri</surname><given-names>Faizah</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Papageorghiou</surname><given-names>Aris T.</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Kirk</surname><given-names>Emma</given-names></name><xref ref-type="aff" rid="af4">4</xref></contrib><contrib contrib-type="author"><name><surname>Pexsters</surname><given-names>Anne</given-names></name><xref ref-type="aff" rid="af5">5</xref></contrib><contrib contrib-type="author"><name><surname>De Moor</surname><given-names>Bart</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Timmerman</surname><given-names>Dirk</given-names></name><xref ref-type="aff" rid="af5">5</xref></contrib><contrib contrib-type="author"><name><surname>Bourne</surname><given-names>Tom</given-names></name><xref ref-type="aff" rid="af4">4</xref><xref ref-type="aff" rid="af5">5</xref></contrib></contrib-group><aff id="af1"><label>1</label><addr-line>Early Pregnancy and Gynaecological Ultrasound Unit, Department of Obstetrics and Gynaecology</addr-line>, <institution>St George's, University of London</institution>, <addr-line>Third Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE</addr-line>, <country>UK</country></aff><aff id="af2"><label>2</label><addr-line>Department of Electrical Engineering (ESAT)</addr-line>, <institution>Katholieke Universiteit Leuven</institution>, <addr-line>Leuven</addr-line>, <country>Belgium</country></aff><aff id="af3"><label>3</label><addr-line>Fetal Medicine Unit, Department of Obstetrics and Gynaecology</addr-line>, <institution>St George's, University of London</institution>, <addr-line>London</addr-line>, <country>UK</country></aff><aff id="af4"><label>4</label><addr-line>Imperial College London</addr-line>, <institution>The Hammersmith Hospital</institution>, <addr-line>London</addr-line>, <country>UK</country></aff><aff id="af5"><label>5</label><addr-line>Department of Obstetrics and Gynaecology</addr-line>, <institution>University Hospitals, KU Leuven</institution>, <addr-line>Leuven</addr-line>, <country>Belgium</country></aff><author-notes><corresp id="cor1"><label>6</label>Correspondence address. Tel: <phone>+44-79-8593-7833</phone>; Fax: <fax>+44-20-8725-0094</fax>; E-mail: <email>ceciliabottomley@doctors.org.uk</email></corresp></author-notes><pub-date pub-type="ppub"><month>2</month><year>2009</year></pub-date><pub-date pub-type="epub"><day>2</day><month>12</month><year>2008</year></pub-date><volume>24</volume><issue>2</issue><fpage>284</fpage><lpage>290</lpage><history><date date-type="received"><day>13</day><month>5</month><year>2008</year></date><date date-type="rev-recd"><day>22</day><month>9</month><year>2008</year></date><date date-type="accepted"><day>25</day><month>9</month><year>2008</year></date></history><copyright-statement>© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org</copyright-statement><copyright-year>2009</copyright-year><abstract><sec><title>BACKGROUND</title><p>First trimester growth restriction may predict miscarriage or adverse outcome later in the pregnancy, but determinants of early growth are not well described. Our objective was to examine factors influencing fetal and gestational sac size in the first trimester.</p></sec><sec><title>METHODS</title><p>Prospective observational study of 1828 singleton pregnancies before 12 weeks gestation. Maternal characteristics (ethnicity, maternal age, obstetric history, abdominal pain and vaginal bleeding), crown rump length (CRL) and mean gestational sac diameter (MSD) were recorded. A stepwise linear mixed effects analysis was performed to determine factors influencing rate of change in CRL and MSD.</p></sec><sec><title>RESULTS</title><p>1063 scans, in 464 women, were included. Rate of increase in CRL was higher in women of black ethnic origin (<italic>P</italic> = 0.0261) compared with white, and increased with advancing maternal age (<italic>P</italic> = 0.0046). Maternal age also influenced MSD: older women had gestational sacs which were 0.118 mm larger for each one year increase in maternal age (<italic>P</italic> = 0.0073). Bleeding, pain and prior obstetric history did not influence CRL or MSD.</p></sec><sec><title>CONCLUSIONS</title><p>Rate of increase in CRL was greater in fetuses of black versus white women and increased with advancing maternal age. As CRL is used to date pregnancies, and this influences further growth assessment, consideration should be given to the use of individualized growth charts which take account of maternal factors found to influence first trimester growth.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>fetal growth</kwd><kwd>age</kwd><kwd>ethnicity</kwd><kwd>first trimester</kwd><kwd>ultrasound</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Assessing first trimester growth: the influence of ethnic background and maternal age</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Assessing first trimester growth: the influence of ethnic background and maternal age</title></titleInfo><name type="personal"><namePart type="given">Cecilia</namePart><namePart type="family">Bottomley</namePart><affiliation>Early Pregnancy and Gynaecological Ultrasound Unit, Department of Obstetrics and Gynaecology, St George's, University of London, Third Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK</affiliation><affiliation>E-mail: ceciliabottomley@doctors.org.uk</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anneleen</namePart><namePart type="family">Daemen</namePart><affiliation>Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Faizah</namePart><namePart type="family">Mukri</namePart><affiliation>Early Pregnancy and Gynaecological Ultrasound Unit, Department of Obstetrics and Gynaecology, St George's, University of London, Third Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Aris T.</namePart><namePart type="family">Papageorghiou</namePart><affiliation>Early Pregnancy and Gynaecological Ultrasound Unit, Department of Obstetrics and Gynaecology, St George's, University of London, Third Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK</affiliation><affiliation>Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's, University of London, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Emma</namePart><namePart type="family">Kirk</namePart><affiliation>Imperial College London, The Hammersmith Hospital, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anne</namePart><namePart type="family">Pexsters</namePart><affiliation>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Bart</namePart><namePart type="family">De Moor</namePart><affiliation>Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Dirk</namePart><namePart type="family">Timmerman</namePart><affiliation>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Tom</namePart><namePart type="family">Bourne</namePart><affiliation>Imperial College London, The Hammersmith Hospital, London, UK</affiliation><affiliation>Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2009-02</dateIssued><dateCreated encoding="w3cdtf">2008-12-02</dateCreated><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>BACKGROUND First trimester growth restriction may predict miscarriage or adverse outcome later in the pregnancy, but determinants of early growth are not well described. Our objective was to examine factors influencing fetal and gestational sac size in the first trimester. METHODS Prospective observational study of 1828 singleton pregnancies before 12 weeks gestation. Maternal characteristics (ethnicity, maternal age, obstetric history, abdominal pain and vaginal bleeding), crown rump length (CRL) and mean gestational sac diameter (MSD) were recorded. A stepwise linear mixed effects analysis was performed to determine factors influencing rate of change in CRL and MSD. RESULTS 1063 scans, in 464 women, were included. Rate of increase in CRL was higher in women of black ethnic origin (P = 0.0261) compared with white, and increased with advancing maternal age (P = 0.0046). Maternal age also influenced MSD: older women had gestational sacs which were 0.118 mm larger for each one year increase in maternal age (P = 0.0073). Bleeding, pain and prior obstetric history did not influence CRL or MSD. CONCLUSIONS Rate of increase in CRL was greater in fetuses of black versus white women and increased with advancing maternal age. As CRL is used to date pregnancies, and this influences further growth assessment, consideration should be given to the use of individualized growth charts which take account of maternal factors found to influence first trimester growth.</abstract><subject><genre>Keywords</genre><topic>fetal growth</topic><topic>age</topic><topic>ethnicity</topic><topic>first trimester</topic><topic>ultrasound</topic></subject><relatedItem type="host"><titleInfo><title>Human Reproduction</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0268-1161</identifier><identifier type="eISSN">1460-2350</identifier><identifier type="PublisherID">humrep</identifier><identifier type="PublisherID-hwp">humrep</identifier><part><date>2009</date><detail type="volume"><caption>vol.</caption><number>24</number></detail><detail type="issue"><caption>no.</caption><number>2</number></detail><extent unit="pages"><start>284</start><end>290</end></extent></part></relatedItem><identifier type="istex">8E7DFA51958A8F4DF583DE6A7DE3CB9631412879</identifier><identifier type="DOI">10.1093/humrep/den389</identifier><identifier type="ArticleID">den389</identifier><accessCondition type="use and reproduction" contentType="copyright">The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. 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