Potential prevention of small for gestational age in Australia: a population-based linkage study.
BACKGROUND
Small for gestational age (SGA) infants are at increased risk of morbidity and mortality. We sought to identify risk factors associated with SGA and examined the potential for reducing the proportion of infants with SGA at a population level.


METHODS
Birth and hospital records were linked for births occurring in 2007-2010 in New South Wales, Australia. The analysis was stratified into three groups: preterm births, term births to non-diabetic mothers and term births to diabetic mothers. Logistic regression was used to examine the association between SGA and a range of socio-demographic and behavioural factors and health conditions, with generalised estimating equations to account for correlation among births to the same mother. Model-based population attributable fractions (PAFs) were calculated for risk factors that were considered causative and potentially modifiable.


RESULTS
Of 28,126 SGA infants, the largest group was term infants of non-diabetic mothers (88.5%), followed by term infants of diabetic mothers (6.3%) and preterm infants (5.3%). The highest PAFs were for smoking: 12.4% for preterm SGA and 10.3% for term SGA infants of non-diabetic mothers. Other risk factors for SGA that were considered modifiable included: illicit drug dependency or abuse in pregnancy in all three groups, and pregnancy hypertension and late commencement of antenatal care in term infants of non-diabetic mothers, but PAFs were less than 3%.


CONCLUSIONS
There are opportunities for modest reduction of the prevalence of SGA through reduction in smoking in pregnancy, and possibly earlier commencement of antenatal care and improved management of high-risk pregnancies.
Centre for Epidemiology and Evidence, New South Wales Ministry of Health, Sydney, Australia. ltayl@doh.health.nsw.gov.au.
Lee K
LK
Taylor
Yuen Yi Cathy
YY
Lee
Kim
K
Lim
Judy M
JM
Simpson
Christine L
CL
Roberts
Jonathan
J
Morris
D000328:Adult; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology* / Q000517:prevention & control; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D009517:New South Wales / Q000453:epidemiology; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology; D011295:Prenatal Care; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D000074606:Smoking Prevention; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control; D047929:Term Birth