Abstract
BackgroundSmall for gestational age (SGA) infants are at increased risk of morbidity and mortality. We sought to identify risk factors associated with SGA and examined the potential for reducing the proportion of infants with SGA at a population level.MethodsBirth and hospital records were linked for births occurring in 2007–2010 in New South Wales, Australia. The analysis was stratified into three groups: preterm births, term births to non-diabetic mothers and term births to diabetic mothers. Logistic regression was used to examine the association between SGA and a range of socio-demographic and behavioural factors and health conditions, with generalised estimating equations to account for correlation among births to the same mother. Model-based population attributable fractions (PAFs) were calculated for risk factors that were considered causative and potentially modifiable.ResultsOf 28,126 SGA infants, the largest group was term infants of non-diabetic mothers (88.5%), followed by term infants of diabetic mothers (6.3%) and preterm infants (5.3%). The highest PAFs were for smoking: 12.4% for preterm SGA and 10.3% for term SGA infants of non-diabetic mothers. Other risk factors for SGA that were considered modifiable included: illicit drug dependency or abuse in pregnancy in all three groups, and pregnancy hypertension and late commencement of antenatal care in term infants of non-diabetic mothers, but PAFs were less than 3%.ConclusionsThere are opportunities for modest reduction of the prevalence of SGA through reduction in smoking in pregnancy, and possibly earlier commencement of antenatal care and improved management of high-risk pregnancies.
Highlights
Small for gestational age (SGA) infants are at increased risk of morbidity and mortality
Data sources Data were obtained from two linked New South Wales (NSW) population databases: the Perinatal Data Collection (PDC) and Admitted Patient Data (APD)
Incomplete obstetric history was more likely to occur in mothers with high-risk pregnancy, i.e., older maternal age (≥35 years: 37.9% vs. 20.8%), multiparous, socio-economically disadvantaged (4th–5th quintiles: 45.0% vs. 37.9%), residence in a geographically remote area (10.5% vs. 8.6%), smoking in pregnancy (18.1% vs. 11.1%) and late commencement of antenatal care (24.9% vs. 18.6%)
Summary
Small for gestational age (SGA) infants are at increased risk of morbidity and mortality. Infants with LBW are at increased risk of morbidity and mortality, inhibited growth and cognitive development, and poor quality of life in infancy, childhood and adult life [1]. Small for gestational age (SGA) is preferable to LBW as a measurement of adequate fetal growth as SGA takes into account the variation in birthweights across gestational ages and infant sex. Obstetric history factors include: nulliparity [9], previous infant with SGA [3,10], previous preterm birth [11], previous stillbirth [3], previous abortion [12], maternal history of being SGA [11], and short and long inter-pregnancy interval [13]. Other factors include: low maternal weight gain [11], body mass index [3], inadequate antenatal care [11], assisted reproductive technology use [19], exposure to toxic substances [11], maternal work and psychosocial stress [11], parental factors [11], vigorous physical activity [10] and fetus with congenital anomaly [11]
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