Is small for gestational age a marker of future fetal survival in utero?
OBJECTIVE
We sought to assess whether small for gestational age is a risk factor for stillbirth of a subsequent sibling.


METHODS
The Missouri maternally linked cohort data set, containing data on births from 1978 through 1997, was used. We identified the study group (women who delivered a SGA infant in the first pregnancy) and a comparison group (women who delivered a non-SGA infant in their first pregnancy) and compared the outcome (stillbirth) in the second pregnancy between both groups.


RESULTS
We analyzed information on the first and second pregnancies of 402,015 women (43,549 [10.8%] in the study arm and 358,466 [89.2%] in the comparison arm). Of the 1,883 cases of stillbirth in the second pregnancy, 314 cases occurred in mothers with a history of SGA (stillbirth rate 7.2/1,000) and 1,569 in the comparison group (stillbirth rate 4.4/1,000), P < .001. The adjusted risk of stillbirth was 60% higher in women with a prior SGA (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.4-1.8). The risk for stillbirth in the second pregnancy increased with decreasing gestational age at birth of the SGA infant in the first pregnancy (term: OR 1.4, 95% CI 1.2-1.6; preterm: OR 2.8, 95% CI 2.0-3.8; and very preterm: OR 4.2, 95% CI 2.4-7.3), P for trend < .001.


CONCLUSIONS
Small for gestational age is a marker for subsequent stillbirth, and the risk rises with decreasing gestational age of the SGA birth. This information is potentially useful for counseling parents of SGA infants.


METHODS
II-2.
Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08901-1977, USA. hamisu.salihu@gmail.com
Hamisu M
HM
Salihu
Puza P
PP
Sharma
Muktar H
MH
Aliyu
Sibylle
S
Kristensen
Jaqui
J
Grimes-Dennis
Russell S
RS
Kirby
John
J
Smulian
D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000032:analysis; D015992:Body Mass Index; D016009:Chi-Square Distribution; D005260:Female; D005313:Fetal Death / Q000000981:diagnostic imaging / Q000453:epidemiology*; D047109:Fetal Development / Q000502:physiology; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008423:Maternal Age; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods; D011336:Probability; D012016:Reference Values; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology*; D016216:Ultrasonography, Prenatal
D015415:Biomarkers