Abstract
Introduction: Small-for-gestational-age (SGA) is defined by a birth weight below the 10th percentile for mean weight corrected for gestational age. It is associated with adverse health events throughout life, including substantial perinatal morbidity and mortality rates.
 Objectives: The aims of the study was to estimate the prevalence of the SGA newborns, attributable factors for SGA and perinatal outcomes of SGA.
 Methodology: A hospital based prospective cohort study was conducted among pregnant women after 28 weeks' gestational age in the Department of Obstetrics and Gynaecology, BPKIHS, Dharan from October, 2016 to June, 2017.A total of 150 study population was sampled using purposive sampling technique whose symphysio-fundal height lags the gestational age by four cms. The association for risk factors between the various socio-demographic parameters and SGA was analysed using chi-square test for categorical data and t-Test for continuous data with p value<0.05 considered as significant. The mothers and babies were followed up till discharge from the hospital for outcomes.
 Result: There was a total of 140 SGA with 10 appropriate for gestational age (AGA) fetuses among 6,500 hospital deliveries above 28 weeks' gestation, hence the prevalence was 2.15%. The risk factors for very small for gestational age were history of birth of SGA fetus (OR, 1.25; 95% CI, 1.15-1.35); history of recurrent pregnancy loss (OR, 1.25; 95% CI, 1.15-1.35); personal history of substances abuse in the index pregnancy (OR, 1.68; 95% CI, 1.47-1.92); adverse obstetrics or medical events in the index pregnancy (OR, 2.21; 95% CI, 1.10-4.45); high blood pressure at admission (OR, 1.58; 95% CI, 1.96- 2.59) and significant urinary proteinuria (OR, 2.26; 95% CI, 1.00-5.09).SGA newborns correlated with increased risk of operative delivery and adverse perinatal outcomes, including oligohydramnios, low Apgar scores, resuscitation at birth, admission to the neonatal intensive care unit or nursery, metabolic complications and fetal death.
 Conclusions: SGA have distinct modifiable risk factors and mortality patterns suggesting potential implications for public health and urgent need to intervene with effective interventions.
Highlights
Birth weight, a func on of both gesta onal age and fetal growth, is the most important determinant of a newborn infant's chances to survive and grow in health
small-for-gesta onal age (SGA) have dis nct modifiable risk factors and mortality pa erns sugges ng poten al implica ons for public health and urgent need to intervene with effec ve interven ons KEYWORDS Outcomes, prevalence, risk factors, small for gesta onal age
Our results demonstrate that SGA is a common perinatal health concern with causal associa on with condi ons like birth of SGA babies, recurrent pregnancy loss, adverse obstetric events, substances abuse during pregnancy and medical condi ons related to pre- eclampsia or eclampsia and urinary proteinuria
Summary
A func on of both gesta onal age and fetal growth, is the most important determinant of a newborn infant's chances to survive and grow in health. In the 1940s clinicians became aware that low birth weight did not necessarily signify an infant born preterm, but may be caused by fetal growth insult. In 1967, Lubchenko and Ba aglia introduced the terms small-for-gesta onal age (SGA), appropriate-for-gesta onal age (AGA) and large-forgesta onal age (LGA).[1] SGA is defined by birth weight below the 10th percen le for their gesta onal age. Growth poten al percen les are superior to conven onal reference ranges for the predic on of adverse perinatal outcome.[7,8]
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