Downloadable Resources

The Distribution of Clinical Phenotypes of Preterm Birth Syndrome: Implications for Prevention

Preterm birth has been difficult to study and prevent because of its complex syndromic nature. The INTERGROWTH-21st Project presents a new approach to this problem. This paper explains the results of the first application of a prototype classification system for preterm birth based on twelve phenotypes, using data from the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. http://archpedi.jamanetwork.com/article.aspx?articleid=2050591

The INTERGROWTH-21st Project Neurodevelopment Package: A Novel Method for the Multi-Dimensional Assessment of Neurodevelopment in Pre-School Age Children

The INTERGROWTH-21st Neurodevelopment Package is a multi-dimensional instrument measuring early childhood development (ECD). Its developmental approach may be useful to those involved in large-scale ECD research and surveillance efforts. This paper describes neurodevelopment tools for preschoolers and the systematic approach leading to the development of the Package. The Package measures vision; cortical auditory processing; and cognition, language skills, behavior, motor skills, and attention in 35-45 minutes. Sleep-wake patterns are also assessed. Tablet-based applications with integrated quality checks and automated, wireless electroencephalography make the Package easy to administer in the field by non-specialist staff. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0113360

WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6–9-year-old children from school year 2007/2008 to school year 2009/2010

The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010. Changes in BMI and prevalence of overweight over a two-year period varied significantly among European countries. It may be that countries with higher prevalence of overweight in COSI Round 1 have implemented interventions to try to remedy this situation.

International standards for early fetal size and pregnancy dating based on ultrasound measurement of crown-rump length in the first trimester

The INTERGROWTH-21st Project has produced the first, international standards for relating fetal crown-rump length to gestational age. 

International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project

These international anthropometric standards were developed to assess newborn size in routine clinical practice that are intended to complement the WHO Child Growth Standards and allow comparisons across multiethnic populations.

International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project

Using the same methods and conceptual approach as the WHO child growth standards, the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project developed international growth and size standards for fetuses for clinical interpretation of routinely taken ultrasound measurements and for comparisons across populations.

The association between obesity and blood pressure in Thai public school children

The prevalence of obesity has substantially increased in the past 3 decades in both developed and developing countries and may lead to an increase in high blood pressure (BP) at an early age. This study aimed to determine the prevalence of obesity and its association with blood pressure among primary school children in central Thailand. Obesity among school children was positively associated with higher BP. Prevention of childhood obesity should be strengthened to prevent the risk of early high BP including cardiovascular risk factors.

The likeness of fetal growth and newborn size across non-isolated populations in the INTERGROWTH-21st Project: the Fetal Growth Longitudinal Study and Newborn Cross-Sectional Study

Large differences exist in size at birth and in rates of impaired fetal growth worldwide. The relative effects of nutrition, disease, the environment, and genetics on these differences are often debated. In clinical practice, various references are often used to assess fetal growth and newborn size across populations and ethnic origins, whereas international standards for assessing growth in infants and children have been established. In the INTERGROWTH-21^st Project, our aim was to assess fetal growth and newborn size in eight geographically defined urban populations in which the health needs of mothers were met and adequate antenatal care was provided. Through the Fetal Growth Longitudinal Study and Newborn Cross-Sectional Study, data showed that fetal growth and newborn length are similar across diverse georgraphical settings when mothers' nutritional and health needs are met, and environmental constraints on growth are low. The findings for birthlength are in strong agreement with the WHO Multicentre Growth Reference Study (MGRS). These results provide the conceptual frame to create international standards for growth from conception to newborn baby, which will extend the present infant to childhood WHO MGRS standards. Download the PDF of the article here

Consumption of sweet foods and mammographic breast density: a cross-sectional study

The increasing consumption of sugar worldwide seems to lead to several health problems, including some types of cancer. This study examined the association of sweet foods and drinks intake with mammographic density among 776 premenopausal and 779 postmenopausal women recruited at mammography. The results suggest that an increase in sweet foods or sugar-sweetened beverage intake is associated with higher mammographic density.

INTERGROWTH-21st Study Forms

All of the forms that the INTERGROWTH-21^st Project used to implement their studies can be downloaded here.

Novel biomarkers for predicting intrauterine growth restriction: a systematic review and meta-analysis

Several biomarkers for predicting intrauterine growth restriction (IUGR) have been proposed in recent years. However, the predictive performance of these biomarkers has not been systematically evaluated. This objective of this paper is to determine the predictive accuracy of novel biomarkers for IUGR in women with singleton gestations. http://www.ncbi.nlm.nih.gov/pubmed/23398929

Intra- and interobserver variability in fetal ultrasound measurements

This paper assess the intra- and interobserver variability of fetal biometry measurements throughout pregnancy. Authors concluded that although intra- and interobserver variability increases with advancing gestation when expressed in milimeters, both are constant as a percentage of the fetal dimensions or when reported as a Z-score. Thus, measurement variability should be considered when interpreting fetal growth rates.  http://www.ncbi.nlm.nih.gov/pubmed/22535628

The preterm birth syndrome: issues to consider in creating a classification system

A comprehensive classification system for preterm birth requires expanded gestational boundaries that recognize the early origins of preterm parturition and emphasize fetal maturity over fetal age. This paper explores the issues to consider in creating a classification system for preterm birth syndrome. http://www.ncbi.nlm.nih.gov/pubmed/22177186

Symposium on Maternal and Child Health and Nutrition in Emerging Markets: Report

The University of Oxford's Emerging Markets Symposium convened a gathering of health and nutrition experts, leading economists, and policymakers to discuss actionable priorities for improving maternal and child health and nutrition in emerging market countries. Universal adoption of the INTERGROWTH-21^st Project's new global indicators at birth to capture differences in population-level nutritional and environmental exposures during pregnancy was one of their recommendations. http://ems.gtc.ox.ac.uk/sites/ems.gtc.ox.ac.uk/files/findings_and_recommendations_ems2014.pdf

The evidence-based management of Postpartum Haemorrhage

Source: The Nuffield Department of Obstetrics and Gynaecology at the University of Oxford and the Geneva Foundation for Medical Education and Research Language: English, Spanish, Russian Overview: This course provides key information on postpartum hemorrhage for health care professionals. It covers basic clinical issues, as well as background information, such as the global burden of postpartum hemorrhage.The course is accompanied by key articles and documents for further reading. Certification is available to those who qualify.

The evidence-based management of Pre-Eclampsia and Eclampsia

Source: The Nuffield Department of Obstetrics and Gynaecology at the University of Oxford and the Geneva Foundation for Medical Education and Research Language: English, Spanish Overview: Course content includes both a basic module covering critical recommendations on prevention and treatment of pre-eclampsia/eclampsia (PE/E) for those unfamiliar with PE/E, and an advanced version for users interested in learning the evidence behind the recommendations, and is accompanied by key articles and documents for further reading. Certification is available to those who qualify.

Translating research into practice: the introduction of the INTERGROWTH-21st package of clinical standards, tools and guidelines into policies, programmes and services

This paper describes the approach to translating the findings, tools and resources generated by the INTERGROWTH-21^st Project into practice. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12416/abstract

A rapid questionnaire assessment of environmental exposures to pregnant women in the INTERGROWTH-21st Project

Impaired fetal growth and preterm birth are the leading causes of neonatal and infant mortality worldwide and there is a growing scientific literature suggesting that environmental exposures during pregnancy may play a causal role in these outcomes. This paper describes the creation of a global tool for screening pregnant women for environmental exposures in the Fetal Growth Longitudinal Study, a component of the INTERGROWTH-21^st Project. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12430/abstract

Implementation of the INTERGROWTH-21st Project in the United States

This paper describes the implementation of the INTERGROWTH-21^st Project in Seattle, USA. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12126/abstract

Implementation of the INTERGROWTH-21st Project in the UK

This paper describes the implementation of the INTERGROWTH-21^st Project in Oxford, UK. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12033/abstract