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About SickKids

September 5, 2014

SickKids contributes to first International Standards to assess fetal growth and newborn size worldwide

The first international standards to assess fetal growth and newborn size worldwide were published in The Lancet today. The standards were developed by the INTERGROWTH 21st Project, a collaboration of over 300 clinicians and researchers from 27 institutions across the world, including The Hospital for Sick Children (SickKids) in Toronto. The six-year landmark project was funded by the Bill & Melinda Gates Foundation.

Global Child Health

The international standards – one for the growing fetus and the other for newborns – provide  doctors and midwives with clinical tools that can be incorporated immediately into practice during pregnancy and at birth. Investigators used the same conceptual approach, study design and instrument measures as the World Health Organization (WHO) did in developing the existing International Growth Standards for children between ages 0 and 5.  Hence, health practitioners can now monitor growth “from the womb to the school” worldwide in the same way. 

The INTERGROWTH-21st Project studied all pregnant women who delivered in selected urban areas in Brazil, China, India, Kenya, Italy, Oman, the UK and the USA where mothers received evidence-based health care and where the environmental and nutritional constraints on growth were minimal. From the total population, healthy, well-nourished women with problem-free pregnancies were enrolled to construct the standards.

The study is unique because it encompasses whole populations and involves large numbers of mothers and babies, with training, research methodology, equipment and quality control standardized across all study sites. At birth, the length, weight and head circumference of almost 60,000 babies were measured. The growth of almost 4,500 of these babies was monitored from early pregnancy to birth using a range of ultrasound measurements (e.g. head and abdominal circumferences).

“These new standards for fetal growth and newborn size, and standardized methods for comparing length/height and head circumference for gestational age are the best ways to compare populations across the globe,” said Professor Zulfiqar Bhutta, Co-Director of the SickKids Centre for Global Child Health, one of the senior authors and Chair of the Study Steering Committee. “We hope their widespread use, in combination with the existing WHO Child Standards, will contribute to improved birth outcomes and reduced perinatal mortality and morbidity worldwide.”

The new international fetal and newborn growth standards describe how babies in the womb should grow when they are provided with good health care and nutrition, and are living in a healthy environment. These are reliable tools to recognize inadequate growth that can be applied to the 120 million babies born every year in the world. In addition, more infants in developed regions may be diagnosed at birth as overweight and treated earlier to prevent chronic diseases later in life. Researchers now need to work with clinicians at regional, national and international levels to introduce the new tools into practice around the world.

To access the Lancet papers, visit: