Open Access Study protocol

WHO multicentre study for the development of growth standards from fetal life to childhood: the fetal component

Mario Merialdi1, Mariana Widmer1*, Ahmet Metin Gülmezoglu1, Hany Abdel-Aleem2, George Bega3, Alexandra Benachi4, Guillermo Carroli5, Jose Guilherme Cecatti6, Anke Diemert7, Rogelio Gonzalez8, Kurt Hecher7, Lisa N Jensen12, Synnøve L Johnsen9, Torvid Kiserud9, Alka Kriplani10, Pisake Lumbiganon11, Ann Tabor12, Sameera A Talegawkar13, Antoinette Tshefu14, Daniel Wojdyla5 and Lawrence Platt15

Author Affiliations

1 UNDP/UNFPA/UNICEF/WHO/WORLD BANK Special Programme of Research, Development and Research Training in Human Reproduction; Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

2 Assiut University, Assiut, Egypt

3 Thomas Jefferson University, Philadelphia, PA, USA

4 Hôpital Antoine Béclère, Université Paris Sud, Paris, France

5 Centro Rosarino de Estudios Perinatales, Rosario, Argentina

6 University of Campinas, Campinas, Brazil

7 University Medical Center, Hamburg, Germany

8 Pontificia Universidad Católica de Chile, Santiago, Chile

9 University of Bergen, Bergen, Norway

10 All India Institute of Medical of Sciences, New Delhi, India

11 Khon Kaen University, Khon Kaen, Thailand

12 Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

13 Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

14 University of Kinshasa, Kinshasa, Democratic Republic of Congo

15 Center for Fetal Medicine, Los Angeles, USA

For all author emails, please log on.

BMC Pregnancy and Childbirth 2014, 14:157  doi:10.1186/1471-2393-14-157

Published: 2 May 2014



In 2006 WHO presented the infant and child growth charts suggested for universal application. However, major determinants for perinatal outcomes and postnatal growth are laid down during antenatal development. Accordingly, monitoring fetal growth in utero by ultrasonography is important both for clinical and scientific reasons. The currently used fetal growth references are derived mainly from North American and European population and may be inappropriate for international use, given possible variances in the growth rates of fetuses from different ethnic population groups. WHO has, therefore, made it a high priority to establish charts of optimal fetal growth that can be recommended worldwide.


This is a multi-national study for the development of fetal growth standards for international application by assessing fetal growth in populations of different ethnic and geographic backgrounds. The study will select pregnant women of high-middle socioeconomic status with no obvious environmental constraints on growth (adequate nutritional status, non-smoking), and normal pregnancy history with no complications likely to affect fetal growth. The study will be conducted in centres from ten developing and industrialized countries: Argentina, Brazil, Democratic Republic of Congo, Denmark, Egypt, France, Germany, India, Norway, and Thailand. At each centre, 140 pregnant women will be recruited between 8 + 0 and 12 + 6 weeks of gestation. Subsequently, visits for fetal biometry will be scheduled at 14, 18, 24, 28, 32, 36, and 40 weeks (+/− 1 week) to be performed by trained ultrasonographers.

The main outcome of the proposed study will be the development of fetal growth standards (either global or population specific) for international applications.


The data from this study will be incorporated into obstetric practice and national health policies at country level in coordination with the activities presently conducted by WHO to implement the use of the Child Growth Standards.

Fetal growth; Child development; Ultrasound; Growth standards