All babies the world over should grow similarly in the womb and achieve a similar size for their gestational age at birth. This is a basic human right.
Instead, there are massive global disparities in fetal growth and size at birth with resulting adverse effects on health, resistance to infection and cognitive development. Too many babies die in the first year of life as a result of being born too small or too soon.
An Oxford-led project, INTERGROWTH-21st, funded by the Bill & Melinda Gates Foundation, has shown these differences are nothing to do with race, ethnicity or genes, as many have previously suggested. The critical factors are the health, nutritional state, living conditions and socio-economic status of mothers, and the care they receive during pregnancy. This simple but striking finding has huge implications for low and middle income countries in reducing avoidable deaths in early life, and improving general health in adulthood.
The INTERGROWTH-21st Project was carried out by a consortium of more than 300 doctors and scientists from in 18 countries worldwide, studying 60,000 mothers and infants across five continents. The Consortium has now produced a package of clinical tools to monitor growth, nutritional status and development from early pregnancy to the age of two. The team has been working with WHO regional offices to ensure the tools are adopted into clinical practice around the world.
At the end of 2016, Sri Lanka became the first country in the world to adopt the INTERGROWTH-21st postnatal growth standards for preterm infants based on the use of human milk. INTERGROWTH-21st size at birth standards have been adopted by both WHO and Centers for Disease Control and Prevention in the context of the Zika epidemic.
A team from Johns Hopkins University has calculated that worldwide implementation of the INTERGROWTH-21st standards could offer more than 20 million vulnerable infants every year the benefits of a correct diagnosis of malnourishment and appropriate health interventions.