title: Morbidity and Mortality in Small-for-Gestational-Age Infants: A Secondary Analysis of Nine MFMU Network Studies.
abstract: ObjectiveTo compare the neonatal morbidity and mortality among small-for-gestational-age (SGA; birth weight < 10% for estimated gestational age [EGA]) versus appropriate-for-gestational-age (AGA; birth weight at 10-89%) newborns.MethodsData from nine Maternal-Fetal Medicine Units Network studies were used and included nonanomalous singletons at 24 weeks or more and birth weight < 90% for EGA. Using multivariable analysis, we compared the morbidity and mortality between SGA and AGA. Random-effect logistic regressions were utilized with adjustment for 10 variables.ResultsAmong the nine studies 71,744 singletons met the inclusion criteria, with 13% (n= 9,415) SGA and 87% (n= 62,329) AGA. Among SGA, the likelihood of stillbirth (8.8 vs. 2.5 per 1,000 births; adjusted odds ratio [aOR] 3.98, 95% confidence interval [CI]: 2.92-5.42) and neonatal mortality (14.0 vs. 5.5 per 1,000 births; aOR 3.18, 95% CI: 2.55-3.95) was threefold higher compared with AGA. For the subgroup of newborns of EGA of 32 weeks or more, SGA, compared with AGA, had significantly higher risk of stillbirth (aOR 3.32, 95% CI: 2.16-5.12) and neonatal mortality (aOR 2.50; 95% CI: 1.38-4.54). From 35 weeks onward, the risk of stillbirth among SGA is almost four times higher than for AGA.ConclusionThe risk of stillbirth and neonatal mortality is significantly higher with SGA than with AGA. Modification in practice or new management schema may be warranted.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Hector
authors.initials: H
authors.lastname: Mendez-Figueroa
authors.affiliation: Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Van Thi Thanh
authors.initials: VT
authors.lastname: Truong
authors.affiliation: Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Claudia
authors.initials: C
authors.lastname: Pedroza
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Suneet P
authors.initials: SP
authors.lastname: Chauhan
mesh_terms: D000328:Adult; D001724:Birth Weight; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D064887:Observational Studies as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D047928:Premature Birth / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D018805:Sepsis / Q000453:epidemiology; D012737:Sex Factors; D050497:Stillbirth / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult