INTERGROWTH‐21st: a new paradigm for fetal growth in the 21stcentury

Key contentThere are currently more than 100 different population‐based and customised charts in use, hence definitions of small‐for‐gestational‐age (SGA) are inconsistent.Over 130 countries have adopted the World Health Organization Child Growth Standards. These standards recognise that all children can achieve similar growth if environment, nutrition and health are optimal.The INTERGROWTH‐21stProject was a large‐scale, multicountry study that measured fetal growth of babies in utero and at birth in mothers in whom environmental, social, medical and pregnancy conditions were optimal.International standards for fetal measurement and the assessment of newborn size at birth will enable continuity of measurement from the pregnancy to childhood.Learning objectivesUnderstand that 97% of variation in fetal growth is caused by factors unrelated to ethnicity.When conditions for growth are optimal, fetal growth is strikingly similar around the world.Ethical issuesConsider poor fetal growth as a human rights issue: what is the legacy for individuals and societies where undernutrition has occurred in the first 1000 days of life?Recognise that, as obstetricians, we have a duty to help the most disadvantaged. The practice of ‘customising’ for ethnicity could normalise suboptimal growth.