NHS Maternity Safety Alert Issued on Fetal Growth Charts

What Parents and Professionals Need to Know

NHS England has issued a national maternity safety alert advising NHS Trusts to stop using INTERGROWTH EFW charts for fetal growth surveillance during pregnancy.

This alert follows growing evidence that the use of INTERGROWTH EFW charts has contributed to missed detection of fetal growth restriction, placing babies at increased risk of stillbirth.

MAMA Academy welcomes this alert. For many months, we have been campaigning alongside the Perinatal Institute and other partners to highlight the importance of accurate, evidence-based fetal growth monitoring as a cornerstone of safer pregnancy care.

 

Why Was This Safety Alert Issued?

Evidence reviewed by NHS England has shown that INTERGROWTH EFW (estimated fetal weight) charts when used to monitor babies’ growth during pregnancy, have too often failed to identify babies who are not growing as expected.

When growth restriction is not detected:

-babies may not receive additional scans when needed

-concerns may not be escalated

-opportunities to intervene are missed

Babies whose growth problems are not identified during pregnancy are at significantly higher risk of stillbirth.

The safety alert reflects serious concern that current practice in some Trusts has not been sufficiently sensitive to detect risk.

 

What Does the Alert Mean for NHS Trusts?

NHS Trusts that are currently using INTERGROWTH EFW charts have been instructed to stop using them by 31 March 2026.

Trusts must ensure that fetal growth surveillance is carried out using methods that more accurately reflect individual pregnancies and improve detection of growth restriction.

 

Which Growth Charts Are Recommended?

NHS England’s recent safety alert does not recommend a specific alternative chart.
Instead, it instructs NHS Trusts to stop using INTERGROWTH EFW charts and ensure that fetal growth surveillance is carried out using an appropriate alternative standard.

However, NHS England has not undertaken a new national review of the evidence comparing available growth charts.

 

Evidence-based recommendations from the Perinatal Institute

Based on extensive UK and international research, the Perinatal Institute recommends the use of GROW (Gestation Related Optimal Weight) charts as a safer alternative to INTERGROWTH EFW charts.

GROW charts are designed to be individualised to each pregnancy, taking into account factors known to influence normal fetal growth, including:

-maternal height

-maternal weight

-ethnic background

-parity

This approach supports clinicians to distinguish between babies who are constitutionally small and those who are genuinely growth restricted, rather than relying on a universal “one-size-fits-all” standard.

Research cited by the Perinatal Institute shows that use of GROW charts:

-improves antenatal detection of fetal growth restriction

-supports earlier clinical intervention where needed

-is associated with reductions in stillbirth rates when used as part of structured growth surveillance programmes

GROW charts are provided by the Perinatal Institute as part of the Growth Assessment Protocol (GAP), which also includes clinical training, audit, and implementation support for maternity teams.

MAMA Academy supports this evidence-based position and has worked closely with the Perinatal Institute and bereaved families to advocate for safer growth surveillance.

The Perinatal Institute has published an open letter summarising the evidence comparing different growth standards, which you can read here.

 

Why Other Charts Raise Safety Concerns

Some NHS Trusts currently use other fetal growth standards, including:

-Hadlock

-WHO

-FMF

According to evidence summarised by the Perinatal Institute, these charts share key limitations:

-They are population-average charts and are not customised to maternal characteristics

-They can overestimate growth restriction in smaller mothers

-They can miss growth restriction in babies of larger or higher-BMI mothers

-Some charts stop at 40 weeks, which does not align with NHS guidance recommending continued surveillance until delivery

-Some do not align fetal and neonatal standards, making interpretation inconsistent

These limitations increase the risk that genuine growth concerns may be missed during pregnancy.

 

What This Means for Parents

If you are currently pregnant, you have the right to ask:

“What growth chart is being used to monitor my baby’s growth?”

If INTERGROWTH EFW charts are still being used in your care setting, your maternity team should now be cross-checking measurements against an alternative method to ensure there are no concerns.

The Perinatal Institute has shared a GROW-Lite centile calculator, which allows scan measurements to be checked against a personalised growth standard. This tool supports safer decision-making while Trusts transition away from INTERGROWTH EFW charts.

Fetal growth restriction remains one of the leading risk factors for stillbirth.

Accurate growth surveillance is not optional, it is a fundamental patient safety issue.

MAMA Academy has consistently called for:

-evidence-based fetal growth monitoring

-national consistency and oversight

-transparency in maternity safety decisions

-systems that support clinicians to identify risk early

We welcome this NHS safety alert as an important step forward but implementation, training, and accountability will be critical.

We will continue to work with partners, clinicians, and families to ensure that every baby has the best possible chance of being identified, monitored, and protected.

 

For professional enquiries about growth surveillance and GROW charts:
GAP@perinatal.org.uk (Perinatal Institute)

For any other enquiries:
contact@mamaacademy.org.uk