A home calendar and recall method of last menstrual period for estimating gestational age in rural Bangladesh: a validation study

Alison D. Gernand, Rina Rani Paul, Barkat Ullah, Muhammad A. Taher, Frank R Witter, Lee Shu Fune Wu, Alain B Labrique, Keith West, Parul S Christian

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Abstract

BACKGROUND: The best method of gestational age assessment is by ultrasound in the first trimester; however, this method is impractical in large field trials in rural areas. Our objective was to assess the validity of gestational age estimated from prospectively collected date of last menstrual period (LMP) using crown-rump length (CRL) measured in early pregnancy by ultrasound. METHODS: As part of a large, cluster-randomized, controlled trial in rural Bangladesh, we collected dates of LMP by recall and as marked on a calendar every 5 weeks in women likely to become pregnant. Among those with a urine-test confirmed pregnancy, a subset with gestational age of <15 weeks (n = 353) were enrolled for ultrasound follow-up to measure CRL. We compared interview-assessed LMP with CRL gestational age estimates and classification of preterm, term, and post-term births. RESULTS: LMP-based gestational age was higher than CRL by a mean (SD) of 2.8 (10.7) days; differences varied by maternal education and preterm birth (P < 0.05). Lin's concordance correlation coefficient was good at ultrasound [0.63 (95 % CI 0.56, 0.69)] and at birth [0.77 (95 % CI 0.73, 0.81)]. Validity of classifying preterm birth was high but post-term was lower, with specificity of 96 and 89 % and sensitivity of 86 and 67 %, respectively. Results were similar by parity. CONCLUSIONS: Prospectively collected LMP provided a valid estimate of gestational age and preterm birth in a rural, low-income setting and may be a suitable alternative to ultrasound in programmatic settings and large field trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT00860470.

Original languageEnglish (US)
Number of pages1
JournalJournal of health, population, and nutrition
Volume35
Issue number1
StatePublished - Oct 21 2016

Fingerprint

Bangladesh
Validation Studies
gestational age
Crown-Rump Length
Gestational Age
rump
premature birth
Premature Birth
field experimentation
methodology
pregnancy
Term Birth
Pregnancy Tests
First Pregnancy Trimester
parity (reproduction)
Parity
rural areas
Calendars
interviews
education

Keywords

  • Bangladesh
  • Crown-rump length
  • Gestational age
  • Last menstrual period
  • Ultrasound
  • Validation

ASJC Scopus subject areas

  • Food Science
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

Cite this

@article{74c07378ec594ab390fa8b3a4c941a99,
title = "A home calendar and recall method of last menstrual period for estimating gestational age in rural Bangladesh: a validation study",
abstract = "BACKGROUND: The best method of gestational age assessment is by ultrasound in the first trimester; however, this method is impractical in large field trials in rural areas. Our objective was to assess the validity of gestational age estimated from prospectively collected date of last menstrual period (LMP) using crown-rump length (CRL) measured in early pregnancy by ultrasound. METHODS: As part of a large, cluster-randomized, controlled trial in rural Bangladesh, we collected dates of LMP by recall and as marked on a calendar every 5 weeks in women likely to become pregnant. Among those with a urine-test confirmed pregnancy, a subset with gestational age of <15 weeks (n = 353) were enrolled for ultrasound follow-up to measure CRL. We compared interview-assessed LMP with CRL gestational age estimates and classification of preterm, term, and post-term births. RESULTS: LMP-based gestational age was higher than CRL by a mean (SD) of 2.8 (10.7) days; differences varied by maternal education and preterm birth (P < 0.05). Lin's concordance correlation coefficient was good at ultrasound [0.63 (95 {\%} CI 0.56, 0.69)] and at birth [0.77 (95 {\%} CI 0.73, 0.81)]. Validity of classifying preterm birth was high but post-term was lower, with specificity of 96 and 89 {\%} and sensitivity of 86 and 67 {\%}, respectively. Results were similar by parity. CONCLUSIONS: Prospectively collected LMP provided a valid estimate of gestational age and preterm birth in a rural, low-income setting and may be a suitable alternative to ultrasound in programmatic settings and large field trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT00860470.",
keywords = "Bangladesh, Crown-rump length, Gestational age, Last menstrual period, Ultrasound, Validation",
author = "Gernand, {Alison D.} and Paul, {Rina Rani} and Barkat Ullah and Taher, {Muhammad A.} and Witter, {Frank R} and Wu, {Lee Shu Fune} and Labrique, {Alain B} and Keith West and Christian, {Parul S}",
year = "2016",
month = "10",
day = "21",
language = "English (US)",
volume = "35",
journal = "Journal of Health, Population and Nutrition",
issn = "1606-0997",
publisher = "International Center for Diarrhoeal Disease Research",
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TY - JOUR

T1 - A home calendar and recall method of last menstrual period for estimating gestational age in rural Bangladesh

T2 - a validation study

AU - Gernand, Alison D.

AU - Paul, Rina Rani

AU - Ullah, Barkat

AU - Taher, Muhammad A.

AU - Witter, Frank R

AU - Wu, Lee Shu Fune

AU - Labrique, Alain B

AU - West, Keith

AU - Christian, Parul S

PY - 2016/10/21

Y1 - 2016/10/21

N2 - BACKGROUND: The best method of gestational age assessment is by ultrasound in the first trimester; however, this method is impractical in large field trials in rural areas. Our objective was to assess the validity of gestational age estimated from prospectively collected date of last menstrual period (LMP) using crown-rump length (CRL) measured in early pregnancy by ultrasound. METHODS: As part of a large, cluster-randomized, controlled trial in rural Bangladesh, we collected dates of LMP by recall and as marked on a calendar every 5 weeks in women likely to become pregnant. Among those with a urine-test confirmed pregnancy, a subset with gestational age of <15 weeks (n = 353) were enrolled for ultrasound follow-up to measure CRL. We compared interview-assessed LMP with CRL gestational age estimates and classification of preterm, term, and post-term births. RESULTS: LMP-based gestational age was higher than CRL by a mean (SD) of 2.8 (10.7) days; differences varied by maternal education and preterm birth (P < 0.05). Lin's concordance correlation coefficient was good at ultrasound [0.63 (95 % CI 0.56, 0.69)] and at birth [0.77 (95 % CI 0.73, 0.81)]. Validity of classifying preterm birth was high but post-term was lower, with specificity of 96 and 89 % and sensitivity of 86 and 67 %, respectively. Results were similar by parity. CONCLUSIONS: Prospectively collected LMP provided a valid estimate of gestational age and preterm birth in a rural, low-income setting and may be a suitable alternative to ultrasound in programmatic settings and large field trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT00860470.

AB - BACKGROUND: The best method of gestational age assessment is by ultrasound in the first trimester; however, this method is impractical in large field trials in rural areas. Our objective was to assess the validity of gestational age estimated from prospectively collected date of last menstrual period (LMP) using crown-rump length (CRL) measured in early pregnancy by ultrasound. METHODS: As part of a large, cluster-randomized, controlled trial in rural Bangladesh, we collected dates of LMP by recall and as marked on a calendar every 5 weeks in women likely to become pregnant. Among those with a urine-test confirmed pregnancy, a subset with gestational age of <15 weeks (n = 353) were enrolled for ultrasound follow-up to measure CRL. We compared interview-assessed LMP with CRL gestational age estimates and classification of preterm, term, and post-term births. RESULTS: LMP-based gestational age was higher than CRL by a mean (SD) of 2.8 (10.7) days; differences varied by maternal education and preterm birth (P < 0.05). Lin's concordance correlation coefficient was good at ultrasound [0.63 (95 % CI 0.56, 0.69)] and at birth [0.77 (95 % CI 0.73, 0.81)]. Validity of classifying preterm birth was high but post-term was lower, with specificity of 96 and 89 % and sensitivity of 86 and 67 %, respectively. Results were similar by parity. CONCLUSIONS: Prospectively collected LMP provided a valid estimate of gestational age and preterm birth in a rural, low-income setting and may be a suitable alternative to ultrasound in programmatic settings and large field trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT00860470.

KW - Bangladesh

KW - Crown-rump length

KW - Gestational age

KW - Last menstrual period

KW - Ultrasound

KW - Validation

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