Maternal nutritional screening and risk of small‐for‐gestational‐age birth in Vietnamese pregnancies: A prospective comparison of the
FIGO
nutrition checklist, pre‐pregnancy
Thi Thu Lieu Nguyen, Phuong Thao Nguyen, Vinh An Pham, Toan Anh Ngo, Quang Dung Nguyen Abstract
Background
Vietnam bears a substantial burden of small‐for‐gestational‐age (SGA) births, contributing to neonatal mortality, stunting, and long‐term developmental impairment. In Southeast Asia, practical nutritional screening tools that predict objectively defined neonatal growth outcomes are poorly evaluated. We aimed to compare the predictive validity of the International Federation of Gynecology and Obstetrics (FIGO) Nutrition Checklist, pre‐pregnancy body mass index, and mid‐upper arm circumference (MUAC) for SGA birth outcomes in pregnant Vietnamese women and to identify the FIGO checklist items most strongly associated with distinct SGA phenotypes.
Methods
In this hospital‐based cross‐sectional study with prospective ascertainment of neonatal outcomes, 818 mother–newborn pairs were enrolled at a national tertiary obstetric center in Hanoi, Vietnam, between June and December 2024. FIGO score (0–9), pre‐pregnancy body mass index, and MUAC were assessed at the antenatal birth registration visit (mean gestational age 36.1 weeks). SGA‐weight and SGA‐length were classified independently as birth weight or birth length below the sex‐ and gestational‐age‐specific 10th percentile using INTERGROWTH‐21st Newborn Size Standards. Predictive performance was evaluated using area under the receiver operating characteristic curve (AUC) with DeLong pairwise comparisons, and multivariable logistic regression with bootstrap confidence intervals (1000 resamples).
Results
SGA‐weight occurred in 81 neonates (9.9%) and SGA‐length in 39 (4.8%). The FIGO score demonstrated a significantly higher AUC than MUAC for SGA‐length (0.706 [95% confidence interval (CI) 0.627–0.785] vs. 0.564 [95% CI 0.465–0.662]; ΔAUC +0.142 [+0.023 to +0.261]; P = 0.028); no significant pairwise differences were observed for SGA‐weight. FIGO at‐risk status (score <5) was independently associated with SGA‐weight (adjusted odds ratio 3.46 [95% CI 1.17–10.24]; P = 0.025) and SGA‐length (adjusted odds ratio 4.03 [95% CI 1.03–15.84]; P = 0.046). Pre‐pregnancy underweight was also independently associated with both outcomes. Fish intake and folate supplementation showed SGA‐length–specific associations, whereas fruit/vegetable intake and reduced packaged snack consumption were associated with both SGA phenotypes.
Conclusion
The FIGO Nutrition Checklist demonstrated superior predictive validity over MUAC for impaired fetal linear growth and provided independent risk identification beyond anthropometric indicators alone. Its item‐level specificity for SGA‐length implicates chronic micronutrient inadequacy in fetal linear growth restriction in this population. Integration of the FIGO Nutrition Checklist into routine antenatal care is supported by this evidence and should be prioritized in Southeast Asian obstetric settings, with cultural adaptation needed for populations with low whole‐grain consumption.