title: The association between temporal changes in the use of obstetrical intervention and small-for-gestational age live births.
abstract: BACKGROUND
  The literature attributes secular declines in small-for-gestational age (SGA) live births to changes in maternal smoking and other maternal characteristics. However, there are reasons to believe that the observed reductions in SGA may be a consequence of early delivery following obstetric intervention.
  
  
  METHODS
  We examined temporal trends in obstetrical intervention and SGA among singleton live births in the United States from 1990 to 2010. The modified Kitagawa decomposition, based on the fetuses-at-risk approach, was used to assess the relative contribution of changes in the gestational age distribution and gestational age-specific SGA to overall changes in SGA. Reductions in SGA rates due to a left shift in the gestational age distribution were assumed to primarily reflect increased obstetrical intervention, whereas decreases in overall SGA due to decreases in gestational-age-specific SGA rates were assumed to reflect declines in risk factors.
  
  
  RESULTS
  Temporal trends in SGA followed a non-linear pattern, with substantial declines from 10.1% in 1990-92 to 8.9% in 2002-04, followed by a small increase to 9.1% in 2008-10. Rates of maternal smoking steadily decreased throughout the same time period and changes in SGA rates were more consistent with changes in the gestational age distribution. The modified Kitagawa decomposition analysis also attributed the initial decline in SGA rates to changes in the gestational age distribution.
  
  
  CONCLUSIONS
  Complex temporal pattern in SGA rates cannot be explained by the linear pattern of changes in factors like maternal smoking. Changes in the gestational age distribution are more consistent with the observed secular trends in SGA rates.
authors.affiliation: Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada. amy.metcalfe@albertahealthservices.ca.
authors.forename: Amy
authors.initials: A
authors.lastname: Metcalfe
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada. slisonkova@cw.bc.ca.
authors.forename: Sarka
authors.initials: S
authors.lastname: Lisonkova
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada. ksjoseph@cfri.ca.|School of Population and Public Health, University of British Columbia, Vancouver, Canada. ksjoseph@cfri.ca.
authors.forename: K S
authors.initials: KS
authors.lastname: Joseph
mesh_terms: D000328:Adult; D017677:Age Distribution; D036861:Delivery, Obstetric / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011247:Pregnancy; D012307:Risk Factors; D013997:Time Factors; D014481:United States; D055815:Young Adult