Customised Growth Charts

All babies are made to measure as mums’ bodies are unique. For example, European mums have bigger babies than Asian mums, and taller mums have bigger babies than smaller mums. Because all babies are different it is important that we take this into account when monitoring babies’ growth during pregnancy.

Customised growth charts are generated using software which takes into account a mum’s ethnicity, weight, height and how many babies she has had to produce an individualised growth chart for midwives to use in the antenatal notes.

To calculate whether a baby born was growth restricted, use this handy GROW centile calculator.

We have teamed up with The Perinatal Institute, a not-for-profit organisation enhancing the safety and quality of maternity care. They are a qualified provider of maternity support services, including education and training in:

• Fetal Growth Assessment
• Standardised Maternity Records

The Perinatal Institute was set up in 2000 to take action on the fact that West Midlands stillbirths had been consistently above the national average for over 50 years. From 2002 they introduced customised growth charts and GROW training in West Midlands maternity units, reducing stillbirth rates in the area by nearly 40 per cent in a decade. Customised growth charts are now used in the majority of maternity units across the UK. Software, training and audit tools are available to all hospitals through the Growth Assessment Protocol (GAP), and GAP e-learning is free to NHS staff through Health Education England’s e-LfH platform. Upcoming GAP training days listed are on the Perinatal Institute’s diary page, so please make sure your hospital doesn’t miss out on their vital education.

Customised assessment of birthweight and fetal growth has been recommended by the RCOG since 2002, and is now the national standard: NHS England’s Saving Babies’ Lives Care Bundle (version 3, Element 2) requires every trust to use customised growth charts for fetal growth surveillance, and a 2024 NHS England national patient safety alert reinforced that the correct customised chart must be used for every pregnancy. The Perinatal Institute’s GAP care pathway is aligned with and complementary to the Care Bundle, and their latest GROW 2.0 software provides the chart electronically, with automatic plotting, risk assessment and audit built in.

In July 2013, The Perinatal Institute received the Award for Clinical Leadership at the prestigious Patient Safety Awards 2013. It was awarded in recognition of the Institute’s ground breaking work on ‘Reducing stillbirths through improved antenatal identification of pregnancies at risk due to fetal growth problems’ and then in 2015 received the BMJ Clinical Leadership Team of the Year with the judges commenting the GAP programme offered: “A fully delivered programme of national and international scope saving a significant number of lives and sorrow; achieved with quiet, relentless, determined leadership across a complex network of healthcare provision.”

Stillbirth rates in England fell consistently for nine years, reaching their lowest recorded point of 3.8 per 1,000 births in 2020 – a 29% reduction on the 2000-09 average, the equivalent of over 1,000 babies’ lives saved every year. Although the rate rose during the pandemic, it has been falling again since. Research now shows clearly what works: a ten-year, unit-level analysis found the steepest falls in stillbirth occurred in trusts that fully implemented the GAP programme and achieved the highest detection rates of growth-restricted babies.

A special thank you to The Perinatal Institute.