Global growth standards for healthier mothers and newborns
The INTERGROWTH-21st Project forms part of our department's Global Health theme and is led jointly by Professor José Villar.
Interested in this research?
The INTERGROWTH-21st Project
Why this project is important?
Millions of preventable newborn deaths occur as a result of preterm birth or poor intrauterine growth.
International growth standards are needed to measure and improve maternal and newborn clinical care and compare outcomes across populations. While the WHO Child Growth Standards provide a way to monitor the growth of infants and children, the fetal and newborn counterpart had been missing.
Developing international standards for fetal and newborn growth can help healthcare professionals identify babies with growth problems and support evidence-based evaluation of growth and nutritional status.
How the INTERGROWTH-21ST PROJECT can help
INTERGROWTH-21st is an international, multidisciplinary research network dedicated to improving perinatal health through the development of fetal and newborn growth standards.
The project studied growth, health, nutrition and neurodevelopment from early pregnancy through infancy, involving nearly 60,000 mothers and babies across eight urban areas in Brazil, China, India, Italy, Kenya, Oman, the UK and USA.
By developing international, evidence-based growth standards, INTERGROWTH-21st provides tools to identify babies with growth problems, compare outcomes across populations and support continuity of care.
The Truth About Babies - The Creation of the INTERGROWTH-21st Standards
The International Fetal and Newborn Growth Consortium for the 21st Century, or INTERGROWTH-21st, is a global, multidisciplinary network of more than 300 researchers and clinicians from 27 institutions in 18 countries worldwide.
Our research
The INTERGROWTH-21st studies
We implemented three population-based studies using standardized methods, and clinical and research protocols. We gathered a rich body of data on health, growth and nutrition from pregnancy to early infancy from close to 60,000 women and newborns across five continents, making the INTERGROWTH-21st Project the largest collaborative venture in the field of perinatal health research to-date.
Primary data were collected on a population-based sample of healthy pregnant women. The tools describe how fetuses and newborns should grow in all countries rather than the more limited objective of past growth references which describe how they have grown at specific times and locations. This allows for evidence-based evaluation of nutritional status at birth and measurement of the impact of preventive and treatment interventions in the community.
Recruitment for the first phase of the study took place between April 27th, 2009 and March 2nd, 2014 in eight geographically distinct urban areas where environmental, nutritional and social constraints on fetal growth were minimal.
The areas were Pelotas (Brazil), Turin (Italy), Muscat (Oman), Oxford (UK), Seattle (USA), Shunyi County, Beijing (China), the central area of Nagpur (India) and the Parklands suburb of Nairobi (Kenya).
What did INTERGROWTH-21st find?
The principal finding was that fetal skeletal growth and newborn size at birth are strikingly similar around the world when maternal health, social and nutritional conditions are optimal, and women have access to evidence-based care.
These landmark observations led to the publication of the first international early pregnancy dating standards, fetal growth standards, and newborn size at birth standards for gestational age and sex.
The findings have substantial public health significance for fetal growth and perinatal outcomes, with the potential to improve the quality of obstetric and newborn care around the world and the recognition of babies with growth problems.
The ability to recognise the earliest faltering of linear growth, or stunting, could enable more effective and timely interventions, avoiding the potential for metabolic problems and obesity associated with rapid catch-up growth.
The impact of our work
INTERGROWTH-21st fills critical gaps in the understanding of human growth and development. Its international, prescriptive standards provide a platform for interventions that aim to improve the quality of healthcare provided to mothers and newborns.
The INTERGROWTH-21st Project provides:
- new evidence-based tools to identify babies with growth problems in utero;
- a common method for quantifying and comparing the prevalence of nutritional deficiencies in populations at birth; and
- an evidence-based method for monitoring the postnatal growth of preterm infants.
It is estimated that each year an additional 13 million newborns worldwide will be identified as undernourished using the INTERGROWTH-21st standards compared with previous practice.
In collaboration with the Maternal Health Task Force, Harvard School of Public Health, the project aims to position INTERGROWTH-21st at the centre of global conversations about maternal and newborn health in ways that are relevant to healthcare professionals, researchers and policymakers.
INTERGROWTH-21st Growth Standards App
The INTERGROWTH-21st Growth Standards App brings internationally validated fetal, newborn and preterm postnatal growth standards together in a user-friendly digital platform.
The latest version enables healthcare professionals to assess and monitor growth from pregnancy through early infancy, including fetal biometry and estimated fetal weight, newborn size at birth, and postnatal growth for preterm infants.
The app supports longitudinal patient tracking and standardised centile plotting, with charts available to download for clinical documentation and research. In-app translation is also available in French, Spanish and European and Brazilian Portuguese, supporting wider use by healthcare professionals internationally.
The INTERGROWTH-21st Growth Standards App is freely available on phones, tablets and computers.
iOS
Download on the App Store.
Android
Get it on Google Play.
Continuing the research: INTERBIO-21st
The INTERBIO-21st Study is an extension to the INTERGROWTH-21st Project.
The study aims to improve the phenotypic characterisation of fetal growth restriction/small for gestational age (FGR/SGA) and preterm birth syndromes at molecular, biochemical and clinical levels, so as to develop better strategies to correct the effects of an adverse intrauterine environment.
Neurodevelopmental follow-up of babies from the INTERGROWTH-21st study and its extension, INTERBIO-21st, are currently ongoing.
Useful links
Global Health theme
The Nuffield Department of Women's and Reproductive Health manages over 30 research groups that fall within either Global Health, Cancer, Maternal & Fetal Health; Big data; and Reproductive Medicine & Genetics.
INTERGROWTH-21st study
Explore further information and resources from the INTERGROWTH-21st Project.
Worldwide research centres
Find contact details for the research centres involved in the project and learn more about the study structure and committees.
Key publications
The distribution of clinical phenotypes of preterm birth syndrome: implications for prevention.
Journal article
Barros FC. et al, (2015), JAMA Pediatr, 169, 220 - 229
The likeness of fetal growth and newborn size across non-isolated populations in the INTERGROWTH-21st Project: the Fetal Growth Longitudinal Study and Newborn Cross-Sectional Study.
Journal article
Villar J. et al, (2014), Lancet Diabetes Endocrinol, 2, 781 - 792
International Normative Charts for Twin Weight, Length, and Head Circumference at Birth, By Gestational Age and Sex: The Twin Neonatal Cross-Sectional Study of the INTERGROWTH-21st Project.
Journal article
Giuliani F. et al, (2026), Twin Res Hum Genet, 1 - 16
International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project.
Journal article
Papageorghiou AT. et al, (2014), Lancet, 384, 869 - 879
Pregnancy: impact of maternal nutrition on intrauterine fetal growth.
Journal article
Yogev Y. and Hiersch L., (2014), World Rev Nutr Diet, 109, 101 - 108
The research team
-
Stephen Kennedy
Professor Emeritus
-
José Villar
Professor of Perinatal Medicine & Co-Director of the Oxford Maternal and Perinatal Health Institute (OMPHI).
-
Aris Papageorghiou
Professor of Fetal Medicine and Director of Research of the Oxford Maternal and Perinatal Health Institute (OMPHI).
-
Leila Cheikh Ismail
Director of Field Studies (OMPHI), Project Leader (INTERGROWTH-21st)
-
Jane Hirst
Visiting Professor in Global Women's Health
-
Adele Winsey
Executive Manager to the INTERGROWTH-21st Project Secretariat
How can you help?
You can support the ongoing work of the Intergrowth-21st project through donations, collaborations and research support. If you wish to support our work, please contact our team.