Relationship Between Foot Length and Gestational Age in Pakistan

Shiyam Sunder Tikmani, Sana Roujani, Syed Iqbal Azam, Haleema Yasmin, Khadija Bano, Saleem Jessani, Sayyeda Reza, Elizabeth M. McClure, Robert L. Goldenberg, Sarah Saleem

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Preterm births have a high risk of mortality. Therefore, knowledge of the gestational age (GA) at birth is crucial to guide the appropriate management of a newborn. Common methods for estimating GA such as the last menstrual period, ultrasonography, and post-natal Ballard scoring have some limitations. This study aimed to determine the relationship between foot length and GA to develop and validate an equation for predicting GA of Pakistani newborns. We conducted a prospective study in a large obstetric hospital in Pakistan. Data for this analysis were extracted from the hospital files of eligible women by trained study midwives. Midwives were also trained in performing the Ballard examination and taking foot length using a disposable measuring tape within an hour of the birth. The GA was calculated using an android-based GA calculator. Simple and multiple linear regression were used to construct predicting equations for GA. Both the foot length and GA were available for 1542 cases. The median GA was 34.5 (IQR 4.7) weeks and the median foot length was 7 cm (IQR 1.4). There was a positive linear relationship between foot length and GA (r2 81.7%, P-value <.001). Stratified analysis showed an r2 of 81.7% for males and 81.6% for females. The r2 for stillbirths was 84.1% and, 82.3% for live births. The r2 for macerated stillbirths was 88.6% and 90.6% for fresh stillbirths. In resource poor settings, the use of foot length can estimate GA in both live births and stillbirths and can easily identify preterm infants.

Original languageEnglish
JournalGlobal Pediatric Health
Publication statusPublished - 2020


  • Ballard scoring
  • foot length
  • gestational age
  • last menstrual period


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