Abstract
ObjectiveSmall-for-gestational-age (SGA) are neonates born with birth weight below the 10th centile for a given week of pregnancy. It is a risk factor of perinatal and neonatal morbidity and mortality. There is an ongoing debate whether prenatal detection of SGA neonates is good predictor of perinatal outcome especially in low risk populations. Our primary aim was to compare the odds ratios for unfavorable outcome in a risk stratified cohort of SGA neonates in regard to prenatal detection status.MethodsThis is a retrospective cohort study analysing the effect of prenatal detection on perinatal outcome. This cohort has been divided into a predefined low-risk and high-risk population. Electronic records of 39,032 singleton deliveries from 2010 through 2016 were analysed. SGA was defined as newborn weight below the 10th percentile on the Fenton growth chart. Detected SGA (dSGA) neonates were those that were admitted for delivery with a prenatal ultrasound diagnosis of abnormal growth. Undetected SGA (uSGA) were neonates that were found to be below the 10th percentile after birth. Perinatal and neonatal outcome was compared.ResultsThe detection rate in high-risk pregnancies was almost 45.7% versus low risk where it amounted to 18.9%. In both the high-risk and low-risk populations there was a significantly higher risk of composite mortality for undetected SGA compared to approporiate-for-gestational-age (AGA) (OR 7.95 CI 4.76–13.29; OR 14.4 CI 4.99–41.45 respectively). The odds for the composite neonatal outcome were significantly higher for dSGA and uSGA than for AGA in all the studied populations except for the uSGA in high risk population (OR 1.57 CI 0.97–3.53). Importantly, there was not a single case of intrauterine fetal death among detected SGA, in the low risk group.ConclusionsPrenatal detection of SGA status is related to perinatal outcomes, especially mortality. Therefore, assessment of SGA status even in low-risk pregnancies could help predict potential perinatal and neonatal complications.
Highlights
Small-for-gestational-age (SGA) is a neonate with birth weight below the 10th percentile
The odds for the composite neonatal outcome were significantly higher for Detected SGA (dSGA) and Undetected SGA (uSGA) than for appropriate-for gestational-age (AGA) in all the studied populations except for the uSGA in high risk population
Prenatal detection of SGA status is related to perinatal outcomes, especially mortality
Summary
Small-for-gestational-age (SGA) is a neonate with birth weight below the 10th percentile. If the estimated weight falls below the 3rd percentile or the fetus presents with abnormal Doppler results it is classified as growth restricted (FGR) [1]. There are studies showing that detection in low risk pregnancies may improve perinatal outcome [7,8,9]. Detection rates in the latter remain low and often fall below 15% [10,11,12]. The primary aim of our study was to compare outcome of SGA neonates according to detection status in a risk stratified cohort. The study hypothesis was that detection improves outcome in both low and high-risk pregnancies. The secondary aim was to inspect detections rate in low and high-risk pregnancies
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