Abstract
The actual burden and future burden of the small-for-gestational-age (SGA) babies turn their screening in pregnancy a question of major concern for clinicians and policymakers. Half of stillbirths are due to growth restriction in utero, and possibly, a quarter of livebirths of low- and middle-income countries are SGA. Growing body of evidence shows their higher risk of adverse outcomes at any period of life, including increased rates of neurologic delay, noncommunicable chronic diseases (central obesity and metabolic syndrome), and mortality. Although there is no consensus regarding its definition, birthweight centile threshold, or follow-up, we believe birthweight <10th centile is the most suitable cutoff for clinical and epidemiological purposes. Maternal clinical factors have modest predictive accuracy; being born SGA appears to be of transgenerational heredity. Addition of ultrasound parameters improves prediction models, especially using estimated fetal weight and abdominal circumference in the 3rd trimester of pregnancy. Placental growth factor levels are decreased in SGA pregnancies, and it is the most promising biomarker in differentiating angiogenesis-related SGA from other causes. Unfortunately, however, only few societies recommend universal screening. SGA evaluation is the first step of a multidimensional approach, which includes adequate management and long-term follow-up of these newborns. Apart from only meliorating perinatal outcomes, we hypothesize SGA screening is a key for socioeconomic progress.
Highlights
This finding is due to the diverse PlGF measurements and fetal growth restriction (FGR) definitions used by the studies included in the systematic review, which considered either the estimated fetal weight, birth weight, or the presence of additional findings of severity
Fetal growth restriction is related to adverse outcomes in the perinatal period, childhood, and adulthood; the estimated actual burden of SGA [13, 25] might be even higher in the few years
Starting antenatal care at early pregnancy leads to adequate risk management and additional evaluation assessment, with ultrasound scan (US) or biomarkers. e “inverted pyramid” of prenatal care claims attention to the early pregnancy risk evaluation [85], and we strongly believe screening is the first step towards a better disease diagnosis and management
Summary
E actual burden and future burden of the small-for-gestational-age (SGA) babies turn their screening in pregnancy a question of major concern for clinicians and policymakers. Maternal undernourishment is not synonymous of SGA infant and considering that the birthweight approach has changed over time, these findings mean that adequate fetal development is the standpoint for long-term health. In the United Kingdom, a logistic regression model included maternal height, weight, parity, ethnic background, smoking, and previous history of preeclampsia or SGA [71] In this model, maternal factors evaluation between 35 and 37 w have had similar AUC for delivery within two weeks (0.744; 95% CI 0.731–0.756) and term delivery (0.712; 95% CI 0.700–0.725) for SGA without preeclampsia. Except for NT, the lower the fetal biometry, the higher the odds for SGA; in general, there is a trend towards better US predictive
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