Incidence Of Small For Gestational Age Infants Research Articles

OP21.03: Incidence of pregnancy induced hypertension (PIH) and small‐for‐gestational‐age (SGA) infants in egg donation pregnancies: a prospective study

The aim of this study was to explore if fetal and maternal outcomes, in particular the incidence of PIH and the incidence of SGA infants, are different in pregnancies achieved with ED or pregnancies achieved by in vitro fertilisation with autologous oocytes (IVF). This is a prospective study during a three-year period. We included 320 pregnancies; 68 (21,3%) achieved with ED, 82 (25,6%) with IVF and 170 (53,1%) spontaneous (S). Women with uterine malformations, chronic hypertension, autoimmune diseases, pregnancy with fetal structural abnormalities, aneuploidy or multiple gestations were excluded. Since ED are obtained by intra-cytoplasmatic sperm injection (ICSI), we included only ICSI procedures. For each ED pregnancy, except for the patients aged >45 years, the first two subsequent pregnancies obtained with the couples' gametes were retained as controls, with matching for mother's age and parity. No statistically significant difference was found in demographic characteristics (age, body mass index and parity), although only in ED group patients conceived after 45 years. Patients with ED compared with those with IVF pregnancies had significantly higher mean uterine artery pulsatility index (UtA PI) in the 1st (1.87 vs 1.67, p=0.029) and 2nd (1.51 vs 0.91, p<0.001) trimester of pregnancy, and higher incidence of SGA (25% vs 13.4%, p<0.001) and PIH (25% vs 12.2%, p=0.042). Logistic regression analysis demonstrated that maternal age (OR=0.89 CI 95% 0.841-0.956; p<0.001) and ED (OR=7,233 CI 95% 2.862-20.666; p<0.001) were the two only independent risk factors for PIH; while ED was the only independent risk factor for SGA (OR=3.61 CI 95% 1,457-8.957; p=0.006) when adjusted with other confounder variables. Pregnancies achieved with ED are at increased risk of PIH, even at young age and the risk of delivering a SGA infant is three time higher compared to IVF and spontaneous pregnancies.

Incidence and influencing factors of term small for gestational age infants in China

To investigate the incidence and influencing factors of term small for gestational age infants (SGA ) in China. This study is a multicenter study. Data were collected from Chinese Neonatal Network with term infants, born from May 1st 2010 to February 28th 2014, from 83 nationwide hospitals. A total of 170 565 neonates were recorded from 83 nationwide hospitals; 144 659 cases were term newborn, and 3 543 neonates were found to be term SGA. The incidence of term SGA was 2.45%. In term SGA, the girl's incidence (2.88%, 1 985/69 003) was higher than boy (2.05%, 1 531/74 707), P<0.001. Furthermore, the incidence of in vitro fertilization (IVF) and artificial fertilization of term SGA was 9.12% (66/724), which was higher than the natural conception (2.42%, 3 465/143 283), P<0.001. The incidence of term SGA in multiple births (30.37%, 741/2 440) was higher than that of single birth (1.97%, 2 787/141 366), P<0.001. The incidence of SGA with maternal age <18 years old was 4.86% (27/556) and was 3.20% (307/9 592) with maternal age > 35 years old, meanwhile both were higher than that with maternal age as 18-35 years old (2.39%, 3 197/133 662). The incidence of SGA with maternal occupation as farmers was 4.67% (854/18 284), which was significantly higher than other professions. The incidence of SGA with maternal education as illiterate and elementary education was 8.65% (187/2 162), 5.17% (397/7 678), respectively, both were significantly higher than those with mother graduated from university (1.72%, 853/49 692). Moreover, the geographical distribution of the main residence of the term SGA mothers showed Northeast Area (1.54%, 30/1 946)and East Area (2.21%, 1 267/57 334) had lower incidence of term SGA than those of Central South Area (2.71%, 493/18 223) and Southwest Area (3.67%, 876/23 852). The incidence of term SGA was 2.45% in this study, which was influenced significantly by gender, IVF, multiple births, maternal factors (age, maternal occupation, level of education) and geographical distribution. This multicenter study with large data, to a certain extent, reflected status of the incidence and influencing factors of term SGA in China, which will help prevent and treat term SGA.

Relation between low 50-g glucose challenge test results and small-for-gestational-age infants.

There is no consensus opinion regarding a possible relation between low 50-g glucose challenge test (GCT) results and small-for-gestational-age infants (SGA). This study aimed to clarify the relation between low 50-g GCT results and SGA, after adjusting for potential confounding factors, using a large clinical dataset. Our retrospective cohort study evaluated the obstetric records of women who delivered at Kofu Municipal Hospital (Japan) between January 2011 and December 2013. The exclusion criteria were gestational diabetes mellitus, diabetes in pregnancy, and GCT results of ≥140 mg/dL. Based on these criteria, we included 1603 women who had undergone a GCT between 24 and 28 weeks of gestation, and divided the subjects into a low-GCT group (≤90 mg/dL) and a non-low-GCT group (91-139 mg/dL). The χ(2) -test and multivariate logistic regression analysis were used to investigate the association between low GCT results and SGA. The mean subject age was 30.4 ± 5.4 years, with 45.1% nulliparity (n = 723) and 1538 (96.0%) term deliveries. The incidence of SGA was 10.7% (172/1603), and 17.9% (287/1603) of the women had low GCT results. Low GCT results were significantly associated with an increased risk of SGA (odds ratio, 1.66; 95% confidence interval, 1.14-2.42), after controlling for maternal age, pre-pregnancy maternal weight, maternal weight gain during pregnancy, and pregnancy-induced hypertension. It appears that there is a significant association between low GCT results and SGA. However, further studies are needed to explore the detailed mechanisms of this association.

Risk factors for term small for gestational age infants in women with low prepregnancy body mass index

The purpose of our study was to investigate the association between low maternal prepregnancy body mass index (BMI) less than 18.5 kg/m(2) and the incidence of small for gestational age (SGA) infants. This was a cross-sectional study. The women with BMI of less than 25.0 kg/m(2) who gave birth to single term infants (37-42 weeks) at clinics and hospitals in the Tokyo metropolitan area between 2003 and 2004 were analyzed for risk factors for SGA. Five hundred and seventy-two women were underweight (BMI < 18.5 kg/m(2)) and 2708 (75.1%) were normal (18.5 <or= BMI < 25.0 kg/m(2)). Birthweight, analyzed by multiple regression analysis, was highly related (P < 0.05) to gestational age, maternal age, parity, prepregnancy BMI, maternal weight gain and maternal smoking status. Women with a less than 9 kg weight during pregnancy were 1.8 times (confidence interval [CI], 1.6-2.2) more likely to give birth to an SGA infant compared with women who gained 9-12 kg. Maternal smoking more than 10 cigarettes per day was associated with an increased risk of having an SGA infant (odds ratio [OR], 2.5; CI, 1.8-3.5). Women with prepregnancy BMI less than 21.0 kg/m(2) were associated with an increased risk of having an SGA infant (OR, 1.6; CI, 1.3-2.2 for BMI < 18.5 kg/m(2), and OR, 1.4; CI, 1.2-1.7 for 18.5 <or= BMI <or= 21.0 kg/m(2)). We conclude that the detrimental effect of low prepregnancy BMI in Japanese women on birthweight and incidence of SGA infants. Our findings suggest that appropriate maternal BMI at conception followed by adequate weight gain during pregnancy may have a substantial influence on reducing the SGA infants and increasing the birthweight.

Risk factors for small for gestational age

The purpose of the paper was to determine the risk factors for small-for-gestational-age (SGA) infants at full term, in Japan. The study was conducted at four hospitals and clinics in the Tokyo metropolitan area. A retrospective review of 2972 mothers and their infants born from singleton pregnancies at any time during the years 2002 and 2003 was conducted. Of these women, 8.4% gave birth to SGA infants. The proportion of SGA infants was significantly higher among heavy smokers (>10 cigarettes/day; 13.7%, P < 0.01). The odds ratio (OR) for SGA decreased significantly in proportion to the pregnancy body mass index (OR, 0.89; 95% confidence interval [CI]: 0.84-0.94, P < 0.001). The OR of SGA for stratified maternal weight gain was 1.79 (95%CI: 1.24-2.58, P </= 0.01) for weight gain < 8.0 kg; 1.16 (95%CI: 0.79-1.71, P = 0.45) for weight gain 8.0-10.0 kg; and 0.49 (95%CI: 0.3-0.78, P < 0.01) for weight gain >12 kg. The present study clearly confirms the detrimental effect of a low prepregnancy body mass index, low maternal weight gain and maternal smoking during pregnancy on the incidence of SGA infants.

The association between customised small for gestational age infants and pre‐eclampsia or gestational hypertension varies with gestation at delivery

(1) To describe the association between small for gestational age (SGA) infants and pre-eclampsia (PE) and gestational hypertension (GH) and (2) to determine how this association changes with gestational age at delivery using customised centiles to classify infants as SGA. A retrospective observational study. National Women's Hospital, a Tertiary Referral Centre in Auckland, New Zealand. A total of 17 855 nulliparous women delivering between 1992 and 1999. A comparison of the number of women with a customised SGA infant, PE and GH according to gestational age at delivery. The incidence of SGA infants (defined as birthweight <10th customised centile), PE and GH at <34, 34-36(+6) and > or =37 weeks. A total of 1847 (10.3%) infants were SGA, 520 (2.9%) women had PE and 1361 (7.6%) had GH. SGA, PE and GH all occurred more commonly with increasing gestation at delivery with 85%, 62% and 90% of cases delivered at term. In women delivering SGA infants, coexisting PE was more likely to occur among those delivered preterm than at term (38.6% at <34 weeks [relative risk, RR 10.2 95%CI 7.3-14.4], 22.4% at 34-36(+6) weeks [RR 6.0 95%CI 4.1-8.6] and 3.8% at > or =37 weeks [OR 1.0]). Women with preterm PE were more likely to have a SGA infant than women with term PE (57.1% at <34 weeks [RR 3.1 95%CI 2.3-4.2], 31.7% at 34-36(+6) weeks [RR 1.7 95%CI 1.2-2.5]) and 18.3% at > or =37 weeks [OR 1.0]). There was a similar association between GH and SGA infants as gestation advanced (57.6% at <34 weeks [RR 4.8 95%CI 3.4-6.6], 30.5% at 34-36(+6) weeks [RR 2.5 95%CI 1.8-3.5] and 12.1% > or =37 weeks [OR 1.0]). SGA infants and PE are more likely to coexist in preterm births compared with term births. This is likely to reflect the degree of placental involvement in each disease process.

Routine ultrasound screening in the third trimester: a population‐based study

No population-based study has evaluated the effects of third trimester ultrasound screening on prognosis. To study the effects of routine ultrasound screening in the third trimester on perinatal/infant mortality, prevalence of small for gestational age infants (SGA) and low Apgar score. Two university clinics using routine ultrasound screening in the third trimester were compared with seven county or district hospitals with no routine screening. Deliveries between 1985 and 1996 were included. In all, 16 municipalities including 56 371 pregnancies with routine screening were compared with 59 municipalities and 153 355 pregnancies without third trimester screening. An observational design was applied, using data stored during pregnancy, delivery, and during the first year (infant mortality) at the Swedish Medical Birth Registry, The National Board of Health and Welfare. Odds ratio with 95% confidence interval was used in the evaluation. End-points included incidence of SGA, perinatal/infant mortality, Apgar score at 5 min, cesarean section and instrumental delivery in areas with versus without routine third trimester screening. No significant difference was seen in the prevalence of the most extreme SGA (< -3 SD from the mean), perinatal complications including cesarean section or instrumental delivery, or perinatal/infant mortality between units with versus without routine ultrasound screening in the third trimester. Added to the findings of previous small randomized studies, it seems as if routine third trimester ultrasound screening in an unselected population does not reduce perinatal mortality or early neonatal morbidity, expressed as Apgar scores or SGA.

Routine ultrasound screening in the third trimester: a population-based study

Background. No population-based study has evaluated the effects of third trimester ultrasound screening on prognosis. Objective. To study the effects of routine ultrasound screening in the third trimester on perinatal/infant mortality, prevalence of small for gestational age infants (SGA) and low Apgar score. Study design. Two university clinics using routine ultrasound screening in the third trimester were compared with seven county or district hospitals with no routine screening. Deliveries between 1985 and 1996 were included. In all, 16 municipalities including 56 371 pregnancies with routine screening were compared with 59 municipalities and 153 355 pregnancies without third trimester screening. An observational design was applied, using data stored during pregnancy, delivery, and during the first year (infant mortality) at the Swedish Medical Birth Registry, The National Board of Health and Welfare. Odds ratio with 95% confidence interval was used in the evaluation. End-points included incidence of SGA, perinatal/infant mortality, Apgar score at 5 min, cesarean section and instrumental delivery in areas with versus without routine third trimester screening Results. No significant difference was seen in the prevalence of the most extreme SGA (< −3 SD from the mean), perinatal complications including cesarean section or instrumental delivery, or perinatal/infant mortality between units with versus without routine ultrasound screening in the third trimester. Conclusion. Added to the findings of previous small randomized studies, it seems as if routine third trimester ultrasound screening in an unselected population does not reduce perinatal mortality or early neonatal morbidity, expressed as Apgar scores or SGA.

The Effect of Hypertension on Fetal Growth

To assess the effect of hypertension on fetal growth we studied all hypertensive patients who delivered at the University Hospital “Wilhelmina Gasthuis”, Amsterdam, over a five-year period. They were studied on a retrospective basis. Patients were excluded from this study if they had a multiple pregnancy or a hydatidiform mole. Out of 7454 women who delivered after 28 weeks gestation between 1975 and 1981, 716 nulliparae (N.P.) and 489 multiparae (M.P.) had a diastolic bloodpressure of ≥ 90 mm on at least two occasions. They were matched for age and parity with a normotensive control group, who delivered at our University Hospital in the same period. The Small-for-Gestational-Age (SGA) infant was designated as one whose birthweight fell below 5th percentile. Only the maximum diastolic bloodpressure level proved to have an association with the incidence of SGA infants. The influence of proteinuria appeared to be of minor importance with respect to fetal growth retardation when maximum diastolic bloodpressu...

The Effect of Hypertension on Fetal Growth

To assess the effect of hypertension on fetal growth we studied all hypertensive patients who delivered at the University Hospital “Wilhelmina Gasthuis”, Amsterdam, over a five-year period. They were studied on a retrospective basis. Patients were excluded from this study if they had a multiple pregnancy or a hydatidiform mole. Out of 7454 women who delivered after 28 weeks gestation between 1975 and 1981, 716 nulliparae (N.P.) and 489 multiparae (M.P.) had a diastolic bloodpressure of ≥ 90 mm on at least two occasions. They were matched for age and parity with a normotensive control group, who delivered at our University Hospital in the same period. The Small-for-Gestational-Age (SGA) infant was designated as one whose birthweight fell below 5th percentile. Only the maximum diastolic bloodpressure level proved to have an association with the incidence of SGA infants. The influence of proteinuria appeared to be of minor importance with respect to fetal growth retardation when maximum diastolic bloodpressu...