Measurement error, microcephaly prevalence and implications for Zika: an analysis of Uruguay perinatal data.
Zika virus infection
bias
gestational age
head circumference
microcephaly
Journal
Archives of disease in childhood
ISSN: 1468-2044
Titre abrégé: Arch Dis Child
Pays: England
ID NLM: 0372434
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
04
06
2019
revised:
11
11
2019
accepted:
21
11
2019
pubmed:
15
12
2019
medline:
31
7
2020
entrez:
15
12
2019
Statut:
ppublish
Résumé
The Zika virus outbreak has drawn attention to microcephaly, whose definition is based on head circumference measuring below a percentile or number of SDs below the mean. The objective of this analysis was to assess how differences in measurement precision might affect prevalence and trends of microcephaly. Data from all births in Uruguay during 2010-2015 were obtained from the Perinatal Information System. The prevalence of births with microcephaly was calculated based on head circumference measurement at birth applying the INTERGROWTH-21 Rounding and digit preference was observed: 74% of head circumference measurements were reported as a whole centimetre value. The prevalence of births varied substantially by the criterion used to define microcephaly (<3 SD, <2 SD, <3rd percentile for gestational age) and could be halved or doubled based on adding or subtracting a half-centimetre from all reported head circumference measurements. If 4 days were added to gestational age calculations, rather than using completed gestational weeks (without days) for gestational age reporting, the prevalence was 1.7-2 times higher. Rounding in measurement of head circumference and reporting preferences of gestational age may have contributed to a lower prevalence of microcephaly than expected in this population. Differences in head circumference measurement protocols and gestational age dating have the potential to affect the prevalence of babies reported with microcephaly, and this limitation should be acknowledged when interpreting head circumference data collected for surveillance.
Sections du résumé
BACKGROUND AND OBJECTIVE
The Zika virus outbreak has drawn attention to microcephaly, whose definition is based on head circumference measuring below a percentile or number of SDs below the mean. The objective of this analysis was to assess how differences in measurement precision might affect prevalence and trends of microcephaly.
METHODS
Data from all births in Uruguay during 2010-2015 were obtained from the Perinatal Information System. The prevalence of births with microcephaly was calculated based on head circumference measurement at birth applying the INTERGROWTH-21
RESULTS
Rounding and digit preference was observed: 74% of head circumference measurements were reported as a whole centimetre value. The prevalence of births varied substantially by the criterion used to define microcephaly (<3 SD, <2 SD, <3rd percentile for gestational age) and could be halved or doubled based on adding or subtracting a half-centimetre from all reported head circumference measurements. If 4 days were added to gestational age calculations, rather than using completed gestational weeks (without days) for gestational age reporting, the prevalence was 1.7-2 times higher.
DISCUSSION
Rounding in measurement of head circumference and reporting preferences of gestational age may have contributed to a lower prevalence of microcephaly than expected in this population. Differences in head circumference measurement protocols and gestational age dating have the potential to affect the prevalence of babies reported with microcephaly, and this limitation should be acknowledged when interpreting head circumference data collected for surveillance.
Identifiants
pubmed: 31836636
pii: archdischild-2019-317678
doi: 10.1136/archdischild-2019-317678
pmc: PMC7450538
mid: NIHMS1552327
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
428-432Subventions
Organisme : Intramural CDC HHS
ID : CC999999
Pays : United States
Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Am J Obstet Gynecol. 2018 Feb;218(2S):S641-S655.e28
pubmed: 29275821
BMJ. 2016 Sep 13;354:i4721
pubmed: 27623840
Biomedica. 2018 Aug 01;38(0):127-134
pubmed: 30184373
J Trop Pediatr. 2017 Dec 1;63(6):495-498
pubmed: 28335029
MMWR Morb Mortal Wkly Rep. 2017 Oct 20;66(41):1089-1099
pubmed: 29049277
Am J Obstet Gynecol. 2002 Dec;187(6):1660-6
pubmed: 12501080
J Perinat Med. 2017 Apr 1;45(3):305-308
pubmed: 27219097
Am J Obstet Gynecol. 2018 Aug;219(2):187.e1-187.e20
pubmed: 29738748
Glob Health Sci Pract. 2017 Dec 28;5(4):686-696
pubmed: 29284702
Trends Parasitol. 2016 Jul;32(7):508-511
pubmed: 27105931
PLoS One. 2017 Sep 21;12(9):e0185263
pubmed: 28934352
Arch Dis Child. 1976 Aug;51(8):624-7
pubmed: 962373
Pediatrics. 2018 Feb;141(2):
pubmed: 29305391
Lancet. 2016 Aug 27;388(10047):891-7
pubmed: 27372398
J Pediatr. 1978 Jul;93(1):120-2
pubmed: 650322
JAMA Pediatr. 2017 Mar 1;171(3):288-295
pubmed: 27812690
MMWR Morb Mortal Wkly Rep. 2017 Feb 10;66(5):125-129
pubmed: 28182608
Vaccine. 2017 Dec 4;35(48 Pt A):6472-6482
pubmed: 29150052
JAMA. 2017 Jan 3;317(1):59-68
pubmed: 27960197
Lancet. 2014 Sep 6;384(9946):857-68
pubmed: 25209487
Lancet. 2016 Feb 13;387(10019):621-4
pubmed: 26864961
Travel Med Infect Dis. 2017 Mar - Apr;16:52-57
pubmed: 28342826
BMJ. 2017 Nov 21;359:j5018
pubmed: 29162597
Paediatr Perinat Epidemiol. 2019 Jul;33(4):286-290
pubmed: 31347726
MMWR Morb Mortal Wkly Rep. 2018 Aug 10;67(31):858-867
pubmed: 30091967