Assessment of Fetal Malnutrition Based on the CANSCORE Index and Anthropometric Indices

Document Type : Review Article


1 Department of Pediatrics, Shahrekord University of Medical Sciences, Shahrekord, Iran.

2 Student of Pediatrics, Shahrekord University of Medical Sciences, Shahrekord, Iran.

3 Neonatal Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.


Introduction: To prevent the adverse effects of fetal malnutrition (FM), its management and early diagnosis by reliable tools are essential. The present study aimed to identify the rate of malnutrition in a referral maternity center in Iran using different systems for evaluating the nutritional status and determining a better index for FM. Methods: This cross-sectional study was performed on the neonates born in the maternity ward of Hajar Hospital in Shahrekord, Iran in 2020. FM was evaluated based on different parameters, including the CANSCORE index, body mass index (BMI), Ponderal index, and mid-arm circumference/head circumference (MAC/HC) index. After recording the measurements, birth weight and height were plotted on the intrauterine growth chart, and the infants were classified into groups of appropriate for gestational age (AGA), small for gestational age (SGA), and large for gestational age (LGA). Results: Based on the fetal growth status index, 14.7% of the neonates were in the AGA group, and 95.3% were in the LGA group. Malnourishment was detected in 40.5% of the neonates based on the CANSCORE index, 8.3% based on the MAC/HC index, 6.9% based on the BMI, and 5.2% based on the Ponderal index. In addition, the CANSCORE index had a significant positive correlation with all the growth indices (except the MAC/HC index), and the Ponderal index was also significantly correlated with all the growth indices except height. Conclusion: According to the results, the CANSCORE index could show growth status and FM more accurately compared to other anthropometric parameters that may underestimate FM. Furthermore, BMI is a highly sensitive indicator, and infants malnourished in terms of BMI should be examined based on the CANSCORE index to accurately identify FM. 


  1. 1.Fall CH. Fetal malnutrition and long-term outcomes.  Maternal and Child Nutrition: The First 1,000 Days. 74: Karger Publishers. 2013;11-25.

    2.Kim S, Fleisher B, Sun JY. The Long‐term health effects of fetal malnutrition: Evidence from the 1959–1961 China great leap forward famine. J Health Econ. 2017; 26 (10):1264-77.

    3.Han T, Jiang W, Wu H, Wei W, Lu J, Lu H, et al. Fetal malnutrition is associated with impairment of endogenous melatonin synthesis in pineal via hypermethylation of promoters of protein kinase C alpha and cAMP response element‐binding. J Pineal Res. 2021;71(4):e12764.

    4.Yelam B, Merchant S, Yelam J, Tumram NK, Madhura A. Study of adverse perinatal events in full term small for gestational age (SGA) babies with or without fetal malnutrition. J Med Sci Clin Res. 2020;8(1):202-8.

    5.Shaikh S, Islam MT, Campbell RK. Low birth weight and birth weight status in Bangladesh: A systematic review and meta-analysis. Anthropol Rev. 2021;84(3):257-74.

    6.Bhutta ZA, Berkley JA, Bandsma RH, Kerac M, Trehan I, Briend A. Severe childhood malnutrition. Nat Rev Dis Primers. 2017;3(1):1-18.

    7.Furuse T, Wakana S. Does Malnutrition during Fetal Life Have a Potential to Be a Precipitating Factor for Developmental Disorders? Nihon eiseigaku zasshi Japanese journal of hygiene. 2018;73(2):97-100.

    8.Fall CHD. Evidence for the intra-uterine programming of adiposity in later life. Ann Hum Biol. 2011;38(4):410-28.

    9.Chew LC, Verma RP. Fetal Growth Restriction. StatPearls [Internet]. 2020.

    1. Sethi A, Gandhi DD, Patel SH, Presswala DK, Patel SB. CANSCORE-Important index for detection of fetal malnutrition at birth. Res J Med Sci. 2016:226.

    11.Poudel A, Bhatta NK, Regmi MC, Shah L, Paudel R. Assessment of Common Maternal Risk Factors in Fetal Malnutrition. Birat J Health Sci. 2021;6(1):1377-82.

    12.Haschke F, Binder C, Huber-Dangl M, Haiden N. Early-life nutrition, growth trajectories, and long-term outcome.  Human Milk: Composition, Clinical Benefits and Future Opportunities. 90: Karger Publishers; 2019; 107-20.

    13.Ezenwa B, Ezeaka V. Is canscore a good indicator of fetal malnutrition in preterm newborn. Alexandria J Med. 2018;54(1):57-61.

    14.Singh S, Sood A. Assessment of Fetal Malnutrition and its proportion among AGA and SGA using CAN Score. J Medical Science AND clinical Res. 2018;6(6):902-7.

    15.Soundarya M, Basavaprabhu A, Raghuveera K, Baliga BS, Shivanagaraja B. Comparative Assessment of Fetal Malnutrition by Anthropometry and CAN Score. Iran J Pediatr. 2012;22:70 - 6.

    16.Singh S, Sharif M, Yadav V, Jafri N, Saxena A. Can Score Versus Other Anthropometric Indices To Assess Nutritional Status In New-Borns. 2019.

    17.Metcoff J. Clinical Assessment of Nutritional Status at Birth: Fetal Malnutrition and SGA Are Not Synonymous. Pediatr Clin North Am. 1994;41(5):875-91.

    18.Lakkappa L, Somasundara S. Assessment of fetal nutrition status at birth using the clinical assessment of nutritional status score. Indian J Child Health. 2018;5(12):713-6.

    19.Adebami OJ, Owa J. Comparison between CANSCORE and other anthropometric indicators in fetal malnutrition. Indian J Pediatr. 2008;75(5):439-42.