Can the date of last menstrual period be trusted in the first trimester? Comparisons of gestational age measures from a prospective cohort study in six low-income to middle-income countries
Waldemar A Carlo,
Archana Patel,
Sowmya R Rao,
Patricia L Hibberd,
Fabian Esamai,
Antoinette Tshefu Kitoto,
Robert L Goldenberg,
Elizabeth McClure,
Sarah Saleem,
Elwyn Chomba,
Sherri Bucher,
Carla M Bann,
Richard Derman,
Nancy F Krebs,
Adrien Lokangaka,
Melissa Bauserman,
Lester Figueroa,
Marion Koso-Thomas,
Vanessa R Thorsten,
Shivaprasad Goudar
Affiliations
Waldemar A Carlo
14 Division of Neonatology, University of Alabama at Birmingham Department of Pediatrics, Birmingham, Alabama, USA
Archana Patel
1 Lata Medical Research Foundation, Nagpur, Nagpur, Maharashtra, India
Sowmya R Rao
4 School of Public Health, Boston University, Boston, Massachusetts, USA
Patricia L Hibberd
4 School of Public Health, Boston University, Boston, Massachusetts, USA
Fabian Esamai
9 Alupe University College, Busia, Western Kenya, Kenya
Antoinette Tshefu Kitoto
5 School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
Robert L Goldenberg
12 School of Medicine, Columbia University, New York, New York, USA
Elizabeth McClure
3 Statistics Division, RTI International, Research Triangle Park, North Carolina, USA
Sarah Saleem
11 Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
Elwyn Chomba
13 University of Zambia University Teaching Hospital, Lusaka, Lusaka, Zambia
Sherri Bucher
10 Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
Carla M Bann
3 Statistics Division, RTI International, Research Triangle Park, North Carolina, USA
Richard Derman
16 Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Nancy F Krebs
8 School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
Adrien Lokangaka
5 School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
Melissa Bauserman
6 School of Medicine, University of North Carolina, Chapel Hill, Carolina, USA
Lester Figueroa
7 Institute of Nutrition of Central America and Panama, Guatemala, Guatemala, Guatemala
Marion Koso-Thomas
17 Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
Vanessa R Thorsten
3 Statistics Division, RTI International, Research Triangle Park, North Carolina, USA
Shivaprasad Goudar
15 Women`s and Children`s Health Research Unit, J N Medical College Belagavi, Belagavi, Karnataka, India
Objectives We examined gestational age (GA) estimates for live and still births, and prematurity rates based on last menstrual period (LMP) compared with ultrasonography (USG) among pregnant women at seven sites in six low-resource countries.Design Prospective cohort studySetting and participants This study included data from the Global Network’s population-based Maternal and Newborn Health Registry which follows pregnant women in six low-income and middle-income countries (Democratic Republic of the Congo, Guatemala, India, Kenya, Pakistan and Zambia). Participants in this analysis were 42 803 women, including their 43 230 babies, who registered for the study in their first trimester based on GA estimated either by LMP or USG and had a live or stillbirth with an estimated GA of 20–42 weeks.Outcome measures GA was estimated in weeks and days based on LMP and/or USG. Prematurity was defined as GA of 20 weeks+0 days through 36 weeks+6 days, calculated by both USG and LMP.Results Overall, average GA varied ≤1 week between LMP and USG. Mean GA for live births by LMP was lower than by USG (adjusted mean difference (95% CI) = −0.23 (–0.29 to –0.17) weeks). Among stillbirths, a higher GA was estimated by LMP than USG (adjusted mean difference (95% CI)= 0.42 (0.11 to 0.72) weeks). Preterm birth rates for live births were significantly higher when dated by LMP (adjusted rate difference (95% CI)= 4.20 (3.56 to 4.85)). There was no significant difference in preterm birth rates for stillbirths.Conclusion The small differences in GA for LMP versus USG in the Guatemalan and Indian sites suggest that LMP may be a useful alternative to USG for GA dating during the first trimester until availability of USG improves in those areas. Further research is needed to assess LMP for first-trimester GA dating in other regions with limited access to USG.Trial registration number NCT01073475.
