SEARCHCOHORTobstetrics and gynecology, epidemiology

cohort·obstetrics and gynecology, epidemiology, pediatrics, public health, observational study·PMC10514667

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

BMJ Open · 20 authors, 17 centres

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TL;DR

The study found that average differences between methods were small overall, but LMP dating led to significantly higher preterm birth rates for live births in some regions.

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The study compared gestational age (GA) estimates and preterm birth rates calculated by last menstrual period (LMP) versus ultrasonography (USG). Results showed that the average GA difference between LMP and USG was generally less than one week. For live births, the mean GA by LMP was 0.23 weeks lower than by USG, and the preterm birth rate was significantly higher when dated by LMP, with an adjusted rate difference of 4.20. For stillbirths, LMP estimated a higher GA than USG, but there was no significant difference in preterm birth rates. Limitations include that only about 45% of enrollees registered in the first trimester, and three sites had limited data for direct comparisons.

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cohort

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obstetrics and gynecology

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ORIGINAL PAPER

PMC10514667

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

BMJ Open

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ABSTRACT

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 study Setting 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 .

CITATION EXPORT

Archana Patel, Carla M Bann, Vanessa R Thorsten et al.. 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. BMJ Open. (2023). https://doi.org/10.1136/bmjopen-2022-067470

AUTHORS

20 · 17 CENTRES

Archana Patel, Carla M Bann, Vanessa R Thorsten, Sowmya R Rao, Adrien Lokangaka, Antoinette Tshefu Kitoto, Melissa Bauserman, Lester Figueroa, Nancy F Krebs, Fabian Esamai, Sherri Bucher, Sarah Saleem, Robert L Goldenberg, Elwyn Chomba, Waldemar A Carlo, Shivaprasad Goudar, Richard Derman, Marion Koso-Thomas, Elizabeth McClure, Patricia L Hibberd

1 Lata Medical Research Foundation, Nagpur, Nagpur, Maharashtra, India
2 Datta Meghe Institute of Medical Sciences, Wardha, India
3 Statistics Division, RTI International, Research Triangle Park, North Carolina, USA
4 School of Public Health, Boston University, Boston, Massachusetts, USA
5 School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
6 School of Medicine, University of North Carolina, Chapel Hill, Carolina, USA
7 Institute of Nutrition of Central America and Panama, Guatemala, Guatemala, Guatemala
8 School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
9 Alupe University College, Busia, Western Kenya, Kenya
10 Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
11 Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
12 School of Medicine, Columbia University, New York, New York, USA
13 University of Zambia University Teaching Hospital, Lusaka, Lusaka, Zambia
14 Division of Neonatology, University of Alabama at Birmingham Department of Pediatrics, Birmingham, Alabama, USA
15 Women's and Children's Health Research Unit, J N Medical College Belagavi, Belagavi, Karnataka, India
16 Thomas Jefferson University, Philadelphia, Pennsylvania, USA
17 Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA