Using Amanhi-Act Cohorts For External Validation Of Iowa New-Born Metabolic Profiles Based Models For Postnatal Gestational Age Estimation

Sunil Sazawal, Kelli K. Ryckman, Harshita Mittal, Rasheda Khanam, Imran Nisar, Elizabeth Jasper, Elizabeth Jasper, Usma Mehmood, Sayan Das, Bruce Bedell, Nabidul Haque Chowdhury, Amina Barkat, Arup Dutta, Saikat Deb, Salahuddin Ahmed, Farah Khalid, Rubhana Raqib, Muhammad Ilyas, Ambreen Nizar, Said Mohammed AliAlexander Manu, Sachiyo Yoshida, Abdullah H. Baqui, Fyezah Jehan, Usha Dhingra, Rajiv Bahl

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Background Globally, 15 million infants are born preterm and another 23.2 million infants are born small for gestational age (SGA). Determining burden of preterm and SGA births, is essential for effective planning, modification of health policies and targeting interventions for reducing these outcomes for which accurate estimation of gestational age (GA) is crucial. Early pregnancy ultrasound measurements, last menstrual period and post-natal neonatal examinations have proven to be not feasible or inaccurate. Proposed algorithms for GA estimation in western populations, based on routine new-born screening, though promising, lack validation in developing country settings. We evaluated the hypothesis that models developed in USA, also predicted GA in cohorts of South Asia (575) and Sub-Saharan Africa (736) with same precision. Methods Dried heel prick blood spots collected 24-72 hours after birth from 1311 new-borns, were analysed for standard metabolic screen. Regression algorithm based, GA estimates were computed from metabolic data and compared to first trimester ultrasound validated, GA estimates (gold standard). Results Overall Algorithm (metabolites + birthweight) estimated GA to within an average deviation of 1.5 weeks. The estimated GA was within the gold standard estimate by 1 and 2 weeks for 70.5% and 90.1% new-borns respectively. Inclusion of birthweight in the metabolites model improved discriminatory ability of this method, and showed promise in identifying preterm births. Receiver operating characteristic (ROC) curve analysis estimated an area under curve of 0.86 (conservative bootstrap 95% confidence interval (CI) = 0.83 to 0.89); P < 0.001) and Youden Index of 0.58 (95% CI = 0.51 to 0.64) with a corresponding sensitivity of 80.7% and specificity of 77.6%. Conclusion Metabolic gestational age dating offers a novel means for accurate population-level gestational age estimates in LMIC settings and help preterm birth surveillance initiatives.

Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalJournal of Global Health
Publication statusPublished - 2021


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