DESiGN: Detection of small for gestational age fetus (SGA)
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.
This study wanted to find out if the Growth Assessment Protocol (GAP) program helps in identifying babies who are smaller than expected (small for gestational age, or SGA) using ultrasound scans. The GAP program trains staff, uses growth charts personalised to each pregnant person and looks at how well hospitals and units are doing when they use it.
The results of the study showed that there was no difference in finding small for gestational age babies between hospitals using the GAP program and those that didn't. The research also pointed out that the GAP program is often used differently in different hospitals, making it difficult to compare how effective it is.
More information
Why do we need this research?
Finding out if a baby is smaller than expected in the womb is important because some of these babies may have health problems that could put them at increased risk of stillbirth, and so they need to be monitored more closely than usual. By finding better ways to spot small for gestational age babies, monitoring can be started sooner which could lower the risk of stillbirth occurring.
What were the aims of this study?
The study aimed to see whether the GAP program helped in identifying small for gestational age babies in the womb, taking into account the cost of the program and how it is actually used by staff in maternity units.
What did the researchers do?
The researchers compared maternity units in hospitals which did and did not use the GAP program. They looked at 11,096 births with the GAP program (across 5 hospitals) and 13,810 births with standard care without the GAP program (across 6 hospitals). They checked for differences in how well small for gestational age babies were identified from ultrasound scans, how the GAP program was practically used in different hospitals, and the costs involved with running the program.
What did the study find?
The study found that using the GAP program did not make it any easier to identify small for gestational age babies using ultrasound scans, compared to scans done as part of standard care with non-personalised growth charts. It was clear that different hospitals used the GAP program in different ways, which might have affected these results and points to inconsistencies in care. Future studies should look at how the program is used with set guidelines to help make better policies for improving the care of pregnant women and their babies.
Additional information:
Lead researcher – Dr. Dharmintra Pasupathy
Institution – King's College London
Funder – Sands, Guys and St Thomas’s, Tommy’s
Funding amount: £40,000
Duration – 2016 - 2022
Publications:
Relph, S. et al. (2020) ‘Costing the impact of interventions during pregnancy in the UK: a systematic review of economic evaluations’, BMJ Open, 10(10), p. e040022. Available at: https://doi.org/10.1136/bmjopen-2020-040022.
Relph, S. et al. (2021) ‘Using electronic patient records to assess the effect of a complex antenatal intervention in a cluster randomised controlled trial-data management experience from the DESiGN Trial team’, Trials, 22(1), p. 195. Available at: https://doi.org/10.1186/s13063-021-05141-8.
Vieira, M.C. et al. (2019) ‘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, 20(1), p. 154. Available at: https://doi.org/10.1186/s13063-019-3242-6.
Vieira, M.C. et al. (2022) ‘Evaluation of the Growth Assessment Protocol (GAP) for antenatal detection of small for gestational age: The DESiGN cluster randomised trial’, PLOS Medicine, 19(6), p. e1004004. Available at: https://doi.org/10.1371/journal.pmed.1004004.