DESiGN: Detection of small for gestational age fetus (SGA) - A cluster randomised controlled trial to evaluate the effect of the Growth Assessment Protocol (GAP) on perinatal outcomes.

This research looked at how well we can identify babies who are smaller than expected (small for gestational age, or SGA) using the Growth Assessment Protocol (GAP) programme.

Most SGA babies are healthy, but some are small because of a health issue, and these babies are at risk if they aren’t monitored closely. If we find better ways of identifying SGA babies, we could potentially reduce the risk of stillbirth.

GAP is a programme that involves training staff, using growth charts based on characteristics of the mother and baby (customised charts) and which are linked to care guidelines, and checking and comparing the performance of hospitals and units using it.


What the researchers did:

The DESiGN study compared what happens in units and hospitals that do and do not use GAP. It investigated whether using GAP improves the detection of SGA babies. The researchers also looked at the cost of using GAP and how GAP is used in maternity units.


What the study found:

DESiGN found that there was no difference in the detection of SGA babies via ultrasound scans between hospitals that use the GAP programme and those that do not. The study also highlighted the fact that the GAP programme is often implemented differently across the hospitals which use it.  


Additional information:

Lead researcher: Dr Dharmintra Pasupathy, Senior Clinical Lecturer and Consultant in Maternal & Fetal Medicine and Perinatal Epidemiology in the Department of Women and Children's Health, King's College London

Sum awarded: £40,000

Other funders: Guys and St Thomas’s; Tommy’s

Duration of study: 2 years, ending 2018



Relph, Sophie, et al. “Costing the Impact of Interventions during Pregnancy in the UK: A Systematic Review of Economic Evaluations.” BMJ Open, vol. 10, no. 10, Oct. 2020, p. e040022,

Vieira, Matias C., et al. “The DESiGN Trial (DEtection of Small for Gestational Age Neonate), Evaluating the Effect of the Growth Assessment Protocol (GAP): Study Protocol for a Randomised Controlled Trial.” Trials, vol. 20, no. 1, Mar. 2019, p. 154,

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