Postnatal Prediction of Gestational Age Using Newborn Fetal Hemoglobin Levels

Kumanan Wilson; Steven Hawken; Malia S Q Murphy; Katherine M Atkinson; Beth K Potter; Ann Sprague; Mark Walker; Pranesh Chakraborty; Julian Little

doi:10.1016/j.ebiom.2016.11.032

Postnatal Prediction of Gestational Age Using Newborn Fetal Hemoglobin Levels

EBioMedicine. 2017 Feb:15:203-209. doi: 10.1016/j.ebiom.2016.11.032. Epub 2016 Dec 1.

Authors

Kumanan Wilson¹, Steven Hawken², Malia S Q Murphy³, Katherine M Atkinson⁴, Beth K Potter⁵, Ann Sprague⁶, Mark Walker⁷, Pranesh Chakraborty⁸, Julian Little⁵

Affiliations

¹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Institute of Clinical Evaluative Sciences, uOttawa Site, Ottawa, Ontario, Canada.
² Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Institute of Clinical Evaluative Sciences, uOttawa Site, Ottawa, Ontario, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
³ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁴ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
⁵ School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁶ Better Outcomes Registry & Network, Ottawa, Ontario, Canada.
⁷ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Better Outcomes Registry & Network, Ottawa, Ontario, Canada; Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁸ Better Outcomes Registry & Network, Ottawa, Ontario, Canada; Newborn Screening Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

Abstract

Introduction: In many parts of the developing world procurement of antenatal gestational age estimates is not possible, challenging provision of appropriate perinatal care. This study aimed to develop a model for postnatal gestational age estimation utilizing measures of the newborn hemoglobin levels and other metabolic analyte data derived from newborn blood spot samples.

Methods: We conducted a retrospective cohort analysis of 159,215 infants born January 2012-December 2014 in Ontario, Canada. Multivariable linear and logistic regression analyses were used to evaluate the precision of developed models.

Results: Models derived from a combination of hemoglobin ratios and birthweight were more precise at predicting gestational age (RMSE1·23weeks) than models limited to birthweight (RMSE1·34). Models including birthweight, hemoglobin, TSH and 17-OHP levels were able to accurately estimate gestational age to ±2weeks in 95·3% of the cohort and discriminate ≤34 versus >34 (c-statistic, 0·98). This model also performed well in small for gestational age infants (c-statistic, 0·998).

Discussion: The development of a point-of-care mechanism to allow widespread implementation of postnatal gestational age prediction tools that make use of hemoglobin or non-mass spectromietry-derived metabolites could serve areas where antenatal gestational age dating is not routinely available.

Keywords: Gestational age; Metabolomics; Newborn screening; Prediction modelling; Preterm birth.

MeSH terms

Birth Weight
Female
Fetal Hemoglobin*
Gestational Age*
Humans
Infant, Newborn
Models, Statistical
Neonatal Screening*
Ontario
Point-of-Care Systems
Population Surveillance*
Pregnancy
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity

Substances

Fetal Hemoglobin