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Am J Perinatol
DOI: 10.1055/a-2677-6720
Original Article

Growth Velocity and Sonographic Estimation of Birth Weight Among Low-Risk Pregnancies

Katherine L. Grantz 
1   Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Madeleine St. Ville
2   Biostatistics and Bioinformatics Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Jessica Gleason 
1   Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Dian He
1   Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
3   The Prospective Group, Inc., Fairfax, Virginia
,
William A. Grobman
4   Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
,
Daniel Skupski
5   Department of Obstetrics and Gynecology, New York Presbyterian Queens, Flushing, New York
,
Roger B. Newman
6   Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
,
John Owen
7   Department of Obstetrics and Gynecology, University of Alabama, Birmingham, Alabama
,
Edward K. Chien
8   Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio
,
Angela C. Ranzini
9   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The MetroHealth System/Case Western Reserve University, Cleveland, Ohio
,
Sungduk Kim
10   Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
,
Paul S. Albert
10   Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
,
Jagteshwar Grewal
11   Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Zhen Chen
2   Biostatistics and Bioinformatics Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
› Author Affiliations
Funding This research was supported, in part, by the Intramural Research Program of the National Institutes of Health; and, in part, with Federal funds for the NICHD Fetal Growth Studies – Singletons (contract numbers: HHSN275200800013C, HHSN275200800002I, HHSN27500006, HHSN275200800003IC, HHSN275200800014C, HHSN275200800012C, HHSN275200800028C, and HHSN275201000009C). The contributions of the NIH author(s) were made as part of their official duties as NIH federal employees, are in compliance with agency policy requirements, and are considered Works of the United States Government. However, the findings and conclusions presented in this paper are those of the authors and do not necessarily reflect the views of the NIH or the U.S. Department of Health and Human Services.
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Abstract

Objective

This study aimed to examine whether the addition of fetal growth velocities, based on serial scans, compared with estimated fetal weight (EFW) alone, improves the prediction accuracy of birth weight (BW).

Study Design

From the prospective National Institute for Child Health and Human Development Fetal Growth Studies, Singletons (2009–2013) that recruited women at low-risk for aberrant fetal growth, we included 2,397 participants with two to five ultrasounds between 15 and 41 weeks. Fetal growth velocity (V) was calculated between successive visits. Linear regression estimated the relationship between EFW and BW: non-V model, absent all growth velocities, included EFW at visit 5, interval from visit 5 to delivery, their cubic polynomials, and delivery gestational age; all-V model added all available velocities between research visits (i.e., V2 + V3 + V4 + V5) to the non-V model; single-V model added only the velocity between visits 4 and 5.

Results

Non-V performed the worst, with the highest mean absolute error of 197 g and the lowest R 2, 0.63. The two best performing models were all-V and single-V, with the lowest mean absolute error (192 g for both), the highest R 2 of 0.65 (for both), and the greatest proportion of predicted BWs within 10% of actual BW (84.7% for both).

Conclusion

Integrating fetal growth velocities into BW estimating formulas improved BW prediction accuracy, which has the potential to guide clinical intervention decisions that rely on EFW.

Key Points

  • Decreasing the BW prediction error is essential.

  • Single EFW assessment to predict BW is standard.

  • Adding third-trimester growth velocity improved accuracy.

  • Growth velocities also improved small- and large-for-gestational age predictions.

  • These improvements reach a population level.

Keywords

birth weight - estimated fetal weight - fetal growth velocity - large for gestational age - small for gestational age

Note

The study was registered at ClinicalTrials.gov (identifiers: NCT00912132 and NCT03266198).


Authors' Contributions

K.L.G.: Conceptualization, data curation, investigation, project administration, resources, and writing—original draft preparation. M.S.V.: Writing—review and editing. J.G.: Data curation and writing—review and editing. D.H.: Data curation, formal analysis, methodology, and writing—review and editing. W.A.G., D.S., R.B.N., J.O., E.K.C., and A.C.R.: Funding acquisition, investigation, and writing—review and editing. S.K. and P.S.A.: Investigation, resources, and writing—review and editing. J.G.: Funding acquisition, investigation, project administration, resources, and writing—review and editing. Z.C.: Conceptualization, formal analysis, methodology, and writing—review and editing.


Supplementary Material



Publication History

Received: 22 May 2025

Accepted: 05 August 2025

Accepted Manuscript online:
07 August 2025

Article published online:
21 August 2025

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