Anogenital distance and penile width measurements in the Infant Development and the Environment Study (TIDES)

Methods and predictors

Sheela Sathyanarayana, Richard Grady, J. B. Redmon, Kristy Ivicek, Emily Barrett, Sarah Janssen, Ruby Nguyen, Shanna H. Swan

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background Anogenital distance (AGD) is an androgen responsive anatomic measurement that may have significant utility in clinical and epidemiological research studies. We describe development of standardized measurement methods and predictors of AGD outcomes. Methods We examined infants born to 758 participants in The Infant Development and the Environment Study (TIDES cohort) in four clinical centers in 2011-2013. We developed and implemented a detailed training protocol that incorporated multiple quality control (QC) measures. In males, we measured anoscrotal distance (AGDAS), anopenile distance (AGDAP), and penile width (PW) and in females, anofourchette distance (AGDAF,) and anoclitoral distance (AGDAC). A single examiner obtained three repetitions of all measurements, and a second examiner obtained independent measurements for 14% of infants. We used the intra-rater ICC to assess within-examiner variability and the inter-rater ICC to assess between-examiner variability. We used multivariable linear regression to examine predictors of AGD outcomes including: gestational age at birth, birth weight, gestational age, several measures of body size, race, maternal age, and study center. Results In the full TIDES cohort, including 758 mothers and children, significant predictors of AGD and PW included: age at exam, gestational age at birth, weight-for-length Z-score, maternal age and study center. In 371 males, the mean (SD) AGDAS, AGDAP, and PW were 24.7 (4.5), 49.6 (5.9), and 10.8 (1.3) mm, respectively. In 387 females, the mean (SD) AGDAF and AGDAC were 16.0 (3.2) mm and 36.7 (3.8) mm, respectively. The intra-examiner ICC and inter-examiner ICC averaged over all subjects and examiners were between 0.89-0.92 and 0.69-0.84 respectively. Conclusions Our study confirms that with appropriate training and quality control measures, AGD and PW measurements can be performed reliably and accurately in male and female infants. In order for reliable interpretation, these measurements should be adjusted for appropriate covariates in epidemiologic analysis.

Original languageEnglish (US)
Pages (from-to)76.e1-76.e6
JournalJournal of Pediatric Urology
Volume11
Issue number2
DOIs
StatePublished - Apr 1 2015

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Child Development
Gestational Age
Maternal Age
Birth Weight
Quality Control
Cohort Studies
Body Size
Androgens
Epidemiologic Studies
Linear Models
Mothers
Parturition
Research

Keywords

  • Anogenital distance
  • Pediatric
  • Penile width
  • Urology

Cite this

Anogenital distance and penile width measurements in the Infant Development and the Environment Study (TIDES) : Methods and predictors. / Sathyanarayana, Sheela; Grady, Richard; Redmon, J. B.; Ivicek, Kristy; Barrett, Emily; Janssen, Sarah; Nguyen, Ruby; Swan, Shanna H.

In: Journal of Pediatric Urology, Vol. 11, No. 2, 01.04.2015, p. 76.e1-76.e6.

Research output: Contribution to journalArticle

Sathyanarayana, Sheela ; Grady, Richard ; Redmon, J. B. ; Ivicek, Kristy ; Barrett, Emily ; Janssen, Sarah ; Nguyen, Ruby ; Swan, Shanna H. / Anogenital distance and penile width measurements in the Infant Development and the Environment Study (TIDES) : Methods and predictors. In: Journal of Pediatric Urology. 2015 ; Vol. 11, No. 2. pp. 76.e1-76.e6.
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AU - Redmon, J. B.

AU - Ivicek, Kristy

AU - Barrett, Emily

AU - Janssen, Sarah

AU - Nguyen, Ruby

AU - Swan, Shanna H.

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N2 - Background Anogenital distance (AGD) is an androgen responsive anatomic measurement that may have significant utility in clinical and epidemiological research studies. We describe development of standardized measurement methods and predictors of AGD outcomes. Methods We examined infants born to 758 participants in The Infant Development and the Environment Study (TIDES cohort) in four clinical centers in 2011-2013. We developed and implemented a detailed training protocol that incorporated multiple quality control (QC) measures. In males, we measured anoscrotal distance (AGDAS), anopenile distance (AGDAP), and penile width (PW) and in females, anofourchette distance (AGDAF,) and anoclitoral distance (AGDAC). A single examiner obtained three repetitions of all measurements, and a second examiner obtained independent measurements for 14% of infants. We used the intra-rater ICC to assess within-examiner variability and the inter-rater ICC to assess between-examiner variability. We used multivariable linear regression to examine predictors of AGD outcomes including: gestational age at birth, birth weight, gestational age, several measures of body size, race, maternal age, and study center. Results In the full TIDES cohort, including 758 mothers and children, significant predictors of AGD and PW included: age at exam, gestational age at birth, weight-for-length Z-score, maternal age and study center. In 371 males, the mean (SD) AGDAS, AGDAP, and PW were 24.7 (4.5), 49.6 (5.9), and 10.8 (1.3) mm, respectively. In 387 females, the mean (SD) AGDAF and AGDAC were 16.0 (3.2) mm and 36.7 (3.8) mm, respectively. The intra-examiner ICC and inter-examiner ICC averaged over all subjects and examiners were between 0.89-0.92 and 0.69-0.84 respectively. Conclusions Our study confirms that with appropriate training and quality control measures, AGD and PW measurements can be performed reliably and accurately in male and female infants. In order for reliable interpretation, these measurements should be adjusted for appropriate covariates in epidemiologic analysis.

AB - Background Anogenital distance (AGD) is an androgen responsive anatomic measurement that may have significant utility in clinical and epidemiological research studies. We describe development of standardized measurement methods and predictors of AGD outcomes. Methods We examined infants born to 758 participants in The Infant Development and the Environment Study (TIDES cohort) in four clinical centers in 2011-2013. We developed and implemented a detailed training protocol that incorporated multiple quality control (QC) measures. In males, we measured anoscrotal distance (AGDAS), anopenile distance (AGDAP), and penile width (PW) and in females, anofourchette distance (AGDAF,) and anoclitoral distance (AGDAC). A single examiner obtained three repetitions of all measurements, and a second examiner obtained independent measurements for 14% of infants. We used the intra-rater ICC to assess within-examiner variability and the inter-rater ICC to assess between-examiner variability. We used multivariable linear regression to examine predictors of AGD outcomes including: gestational age at birth, birth weight, gestational age, several measures of body size, race, maternal age, and study center. Results In the full TIDES cohort, including 758 mothers and children, significant predictors of AGD and PW included: age at exam, gestational age at birth, weight-for-length Z-score, maternal age and study center. In 371 males, the mean (SD) AGDAS, AGDAP, and PW were 24.7 (4.5), 49.6 (5.9), and 10.8 (1.3) mm, respectively. In 387 females, the mean (SD) AGDAF and AGDAC were 16.0 (3.2) mm and 36.7 (3.8) mm, respectively. The intra-examiner ICC and inter-examiner ICC averaged over all subjects and examiners were between 0.89-0.92 and 0.69-0.84 respectively. Conclusions Our study confirms that with appropriate training and quality control measures, AGD and PW measurements can be performed reliably and accurately in male and female infants. In order for reliable interpretation, these measurements should be adjusted for appropriate covariates in epidemiologic analysis.

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