Outcome of small for gestational age preterm singletons: a population-based cohort study
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Natasa Tul
Abstract
Objective:
To examine the outcomes of births among small and appropriate for gestational age (SGA and AGA) infants by gestational age and maternal characteristics.
Materials and methods:
We used a national perinatal registry to compare the selected maternal and neonatal outcomes between AGA and SGA neonates born at gestational age groups 33–36, 30–32, 28–29, and <28 weeks. We evaluated maternal body mass index (BMI), pre-gestational/gestational diabetes, hypertensive disorders, and cesarean births as well as frequencies of 5-min Apgar score <7, intraventricular hemorrhage (IVH), respiratory distress syndrome (RDS), the need for assisted ventilation, and early neonatal deaths.
Results:
We evaluated 159,774 AGA (8871 preterm) and 13,735 SGA (1147 preterm) infants and found a gradual decrease in the incidence of SGA infants with increasing gestational age. Diabetes was unrelated to having an SGA or AGA infant among preterm births, but the odds ratio (OR) for preeclampsia among preterm-SGA pregnancies was up to 6.9 (95% CI 3.8, 12.5) at <28 weeks. SGA infants fare worse compared to AGA neonates in every parameter tested but only in preterm births >30 weeks.
Conclusions:
Being SGA further complicates preterm births after 30 weeks of gestation but not earlier. This might suggest that an extended period in the hostile intrauterine environment, or that being born at <30 weeks, is bad enough and is not further aggravated by being SGA.
References
[1] Bardin C, Zelkowitz P, Papageorgiou A. Outcome of small-forgestational age and appropriate-for-gestational age infants born before 27 weeks of gestation. Pediatrics. 1997;100:E4.10.1542/peds.100.2.e4Suche in Google Scholar
[2] Gortner L, Wauer RR, Stock GJ, Reiter HL, Reiss I, Jorch G, et al. Neonatal outcome in small for gestational age infants: do they really better? J Perinat Med. 1999;27:484–9.10.1515/JPM.1999.065Suche in Google Scholar
[3] Piper JM, Xenakis EM, McFarland M, Elliott BD, Berkus MD, Langer O. Do growth-retarded premature infants have different rates of perinatal morbidity and mortality than appropriately grown premature infants? Obstet Gynecol. 1996;87:169–74.10.1016/0029-7844(95)00400-9Suche in Google Scholar
[4] Tyson JE, Kennedy K, Broyles S, Rosenfeld CR. The small for gestational age infant: accelerated or delayed pulmonary maturation? Increased or decreased survival? Pediatrics. 1995;95:534–8.10.1542/peds.95.4.534Suche in Google Scholar
[5] Simchen MJ, Beiner ME, Strauss-Liviathan N, Dulitzky M, Kuint J, Mashiach S, et al. Neonatal outcome in growth-restricted versus appropriately grown preterm infants. Am J Perinatol. 2000;17:187–92.10.1055/s-2000-9423Suche in Google Scholar
[6] Sharma P, McKay K, Rosenkrantz TS, Hussain N. Comparisons of mortality and pre-discharge respiratory outcomes in small-for-gestational-age and appropriate-for-gestational-age premature infants. BMC Pediatr. 2004;4:9.10.1186/1471-2431-4-9Suche in Google Scholar
[7] Regev RH, Lusky A, Dolfin T, Litmanovitz I, Arnon S, Reichman B, et al. Excess mortality and morbidity among small-for-gestational-age premature infants: a population-based study. J Pediatr. 2003;143:186–91.10.1067/S0022-3476(03)00181-1Suche in Google Scholar
[8] Lee AC, Katz J, Blencowe H, Cousens S, Kozuki N, Vogel JP et al. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. Lancet Glob Health. 2013;1:e26–36.10.1016/S2214-109X(13)70006-8Suche in Google Scholar
[9] American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122:1122–31.Suche in Google Scholar
[10] Morrison JL, Botting KJ, Soo PS, McGillick EV, Hiscock J, Zhang S, et al. Antenatal steroids and the IUGR fetus: are exposure and physiological effects on the lung and cardiovascular system the same as in normally grown fetuses? J Pregnancy 2012;2012:839656.10.1155/2012/839656Suche in Google Scholar PubMed PubMed Central
[11] Miller SL, Chai M, Loose J, Castillo-Meléndez M, Walker DW, Jenkin G, et al. The effects of maternal betamethasone administration on the intrauterine growth-restricted fetus. Endocrinology. 2007;148:1288–95.10.1210/en.2006-1058Suche in Google Scholar PubMed
[12] Unterscheider J, Daly S, Geary MP, Kennelly MM, McAuliffe FM, O’Donoghue K, et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am J Obstet Gynecol. 2013;208:290.e1–6.10.1097/OGX.0b013e3182a0597fSuche in Google Scholar
The authors stated that there are no conflicts of interest regarding the publication of this article.
©2016 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Editorial
- Multiple gestation: more research challenges to come
- Highlight articles - Multiples
- Fertility treatment and dichorionic discordant twins – are they related?
- Intertwin estimated fetal weight or crown rump length discordance and adverse perinatal outcome
- Prospective risk of intrauterine death of monochorionic twins: update
- Perinatal outcome of dichorionic-triamniotic as compared to trichorionic triplets
- Outcome of monochorionic-biamniotic twins conceived by assisted reproduction: a population-based study
- Neonatal morbidities and need for intervention in twins and singletons born at 34–35 weeks of gestation
- Glucose tolerance in singleton, twin and triplet pregnancies
- Respiratory morbidity in twins by birth order, gestational age and mode of delivery
- Neonatal outcomes of twin pregnancies delivered at late-preterm versus term gestation based on chorionicity and indication for delivery
- Original papers - Newborn
- Congenital diaphragmatic hernia – a Belgrade single center experience
- Iron homeostasis after blood transfusion in stable preterm infants – an observational study
- Detection and quantification of left-to-right shunting using transpulmonary ultrasound dilution (TPUD): a validation study in neonatal lambs
- Clinical utility of transcutaneous bilirubinometer (TcB) in very low birth weight (VLBW) infants
- Outcome of small for gestational age preterm singletons: a population-based cohort study
- Congress Calendar
- Congress Calendar
Artikel in diesem Heft
- Frontmatter
- Editorial
- Multiple gestation: more research challenges to come
- Highlight articles - Multiples
- Fertility treatment and dichorionic discordant twins – are they related?
- Intertwin estimated fetal weight or crown rump length discordance and adverse perinatal outcome
- Prospective risk of intrauterine death of monochorionic twins: update
- Perinatal outcome of dichorionic-triamniotic as compared to trichorionic triplets
- Outcome of monochorionic-biamniotic twins conceived by assisted reproduction: a population-based study
- Neonatal morbidities and need for intervention in twins and singletons born at 34–35 weeks of gestation
- Glucose tolerance in singleton, twin and triplet pregnancies
- Respiratory morbidity in twins by birth order, gestational age and mode of delivery
- Neonatal outcomes of twin pregnancies delivered at late-preterm versus term gestation based on chorionicity and indication for delivery
- Original papers - Newborn
- Congenital diaphragmatic hernia – a Belgrade single center experience
- Iron homeostasis after blood transfusion in stable preterm infants – an observational study
- Detection and quantification of left-to-right shunting using transpulmonary ultrasound dilution (TPUD): a validation study in neonatal lambs
- Clinical utility of transcutaneous bilirubinometer (TcB) in very low birth weight (VLBW) infants
- Outcome of small for gestational age preterm singletons: a population-based cohort study
- Congress Calendar
- Congress Calendar
