Abstract
BackgroundSmall for gestational age (SGA) is not only a major indicator of perinatal mortality and morbidity, but also the morbidity risks in later in life. We aim to estimate the association between the birth of SGA infants and the risk factors and adverse perinatal outcomes among twenty-nine countries in Africa, Latin America, the Middle East and Asia in 359 health facilities in 2010–11.MethodsWe analysed facility-based, cross-sectional data from the WHO Multi-country Survey on Maternal and Newborn Health. We constructed multilevel logistic regression models with random effects for facilities and countries to estimate the risk factors for SGA infants using country-specific birthweight reference standards in preterm and term delivery, and SGA’s association with adverse perinatal outcomes. We compared the risks and adverse perinatal outcomes with appropriate for gestational age (AGA) infants categorized by preterm and term delivery.ResultsA total of 295,829 singleton infants delivered were analysed. The overall prevalence of SGA was highest in Cambodia (18.8%), Nepal (17.9%), the Occupied Palestinian Territory (16.1%), and Japan (16.0%), while the lowest was observed in Afghanistan (4.8%), Uganda (6.6%) and Thailand (9.7%). The risk of preterm SGA infants was significantly higher among nulliparous mothers and mothers with chronic hypertension and preeclampsia/eclampsia (aOR: 2.89; 95% CI: 2.55–3.28) compared with AGA infants. Higher risks of term SGA were observed among sociodemographic factors and women with preeclampsia/eclampsia, anaemia and other medical conditions. Multiparity (> = 3) (AOR: 0.88; 95% CI: 0.83–0.92) was a protective factor for term SGA. The risk of perinatal mortality was significantly higher in preterm SGA deliveries in low to high HDI countries.ConclusionPreterm SGA is associated with medical conditions related to preeclampsia, but not with sociodemographic status. Term SGA is associated with sociodemographic status and various medical conditions.
Highlights
Small for gestational age (SGA) refers to infants whose size and weight is less than the average range for infants of the same gestational age
After adjusting for country, facility- and individual-level effects, we found no association between increased risks of preterm SGA and sociodemographic status, such as age or education, compared with preterm AGA; we did observe that nulliparity and medical conditions, such as chronic hypertension and preeclampsia/eclampsia, were significantly associated with increased risks of preterm SGA compared with preterm AGA
Our results demonstrate that preterm SGA is associated with medical conditions related to chronic hypertension and preeclampsia/eclampsia, but is not associated with sociodemographic status
Summary
Small for gestational age (SGA) refers to infants whose size and weight is less than the average range for infants of the same gestational age. Based on the secondary analysis using 20 cohort studies for national and regional estimates of SGA babies, 62% of SGA deliveries occurred in India, and 56% occurred in Nepal [7] This overestimation arose due to the use of the Alexander reference in the analysis, which adapted very high-income country group (US) data from 1991 to low- and middle-income countries. Mikolajczyk developed an ultrasound-based generic global reference to measure fetal weight and birthweight in low-, middle- and high-income settings [8] This country-specific reference has already been used in a previous study to define macrosomia for international comparison [9], our study is the first to use this global reference to define SGA for international comparison. We aim to estimate the association between the birth of SGA infants and the risk factors and adverse perinatal outcomes among twenty-nine countries in Africa, Latin America, the Middle East and Asia in 359 health facilities in 2010–11
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