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The Journal of Health, Population and Nutrition
ISSN: 1606-0997
EISSN: 1606-0997
Vol. 35, No. 1, 2016, pp. 1-9
Bioline Code: hn16021
Full paper language: English
Document type: Research Article
Document available free of charge

The Journal of Health, Population and Nutrition, Vol. 35, No. 1, 2016, pp. 1-9

 en A home calendar and recall method of last menstrual period for estimating gestational age in rural Bangladesh: a validation study
Gernand, Alison D.; Paul, Rina Rani; Ullah, Barkat; Taher, Muhammad A.; Witter, Frank R.; Wu, Lee; Labrique, Alain B.; West Jr., Keith P. & Christian, Parul


Background: The best method of gestational age assessment is by ultrasound in the first trimester; however, this method is impractical in large field trials in rural areas. Our objective was to assess the validity of gestational age estimated from prospectively collected date of last menstrual period (LMP) using crown-rump length (CRL) measured in early pregnancy by ultrasound.
Methods: As part of a large, cluster-randomized, controlled trial in rural Bangladesh, we collected dates of LMP by recall and as marked on a calendar every 5 weeks in women likely to become pregnant. Among those with a urinetest confirmed pregnancy, a subset with gestational age of <15 weeks (n = 353) were enrolled for ultrasound follow-up to measure CRL. We compared interview-assessed LMP with CRL gestational age estimates and classification of preterm, term, and post-term births.
Results: LMP-based gestational age was higher than CRL by a mean (SD) of 2.8 (10.7) days; differences varied by maternal education and preterm birth (P < 0.05). Lin’s concordance correlation coefficient was good at ultrasound [0.63 (95 % CI 0.56, 0.69)] and at birth [0.77 (95 % CI 0.73, 0.81)]. Validity of classifying preterm birth was high but post-term was lower, with specificity of 96 and 89 % and sensitivity of 86 and 67 %, respectively. Results were similar by parity.
Conclusions: Prospectively collected LMP provided a valid estimate of gestational age and preterm birth in a rural, low-income setting and may be a suitable alternative to ultrasound in programmatic settings and large field trials.
Trial registration: NCT00860470

Last menstrual period; Ultrasound; Validation; Bangladesh; Gestational age; Crown-rump length

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