Symmetric Small For Gestational Age Research Articles

Echocardiographic assessment of brain sparing in small-for-gestational age infants and association with neonatal outcomes

Brain sparing is an adaptive phenomenon (redistribution of blood flow to the brain) observed in fetuses exposed to chronic hypoxia, who are at risk of intrauterine growth restriction. Here, we assessed the blood flow distribution during the early neonatal period (< 7 days of life) using echocardiography, and evaluated the impact of brain-sparing on postnatal course and neurodevelopmental outcomes. This retrospective study included 42 small-for-gestational age (SGA) infants [further classified into asymmetric SGA (a-SGA, n = 21) and symmetric SGA (s-SGA, n = 21) groups according to their birth head circumference percentiles], and 1: 2 matched appropriate-for-gestational age (AGA) infants (n = 84) admitted to the neonatal intensive care unit. Left ventricular (LV) stroke volume, LV cardiac output (LVCO), upper body blood flow (UBBF), and UBBF/LVCO ratio (%) were significantly higher in both a-SGA and s-SGA infants than in AGA infants. Both a-SGA and s-SGA groups consisted predominantly of infants with higher UBBF/LVCO (%). A UBBF/LVCO ≥ 58.2% (3rd interquartile range) was associated with a later need for rehabilitative therapy after discharge. In summary, brain-sparing effect may continue during the early postnatal life in SGA infants, and may be a promising marker to detect future adverse neurodevelopmental outcomes.

Differences When Classifying Small for Gestational Age Preterm Infants According to the Growth Chart Applied.

Consensus around the ideal chart to classify preterm babies is scant. It is particularly relevant in small for gestational age (SGA) infants due to its clinical and therapeutic implications. The aim of the study was to compare Olsen, Intergrowth-21st, and Fenton growth charts, regarding the classification at birth and incidence of SGA preterm infants. Retrospective study of 529 preterm infants ≤ 32 weeks of gestational age. Birth weight Z-score was calculated applying the three growth charts and ponderal index (PI) was also estimated. Incidence of SGA (birth weight < 10th percentile) and clinical outcome were compared according to the chart used. Incidence of SGA was significantly higher (p < 0.001) with Olsen (101 cases, 19.1%) compared with Intergrowth-21st (75 cases, 14.2%) and Fenton (53 cases, 10%). Differences were also found with PI of SGA preterm infants, as those infants classified by Olsen were mostly symmetric (PI > 10th percentile), while Fenton and Intergrowth-21st identified less symmetric SGA infants. Kappa concordance between Intergrowth-21st and Fenton was 0.805, Intergrowth-21st versus Olsen 0.824, and Fenton versus Olsen 0.641. No differences were observed on neonatal morbidities or mortality. Significant differences were detected when classifying very preterm infants at birth according to the growth chart, mainly among symmetric SGA. Concordance between Fenton and Olsen was poor, but Intergrowth-21st showed high concordance with Fenton and Olsen. However, further research is needed to select the ideal chart. Variability in the population selected to create the curves and the accuracy dating the pregnancy are factors that may have explained differences. · Very preterm infants are differently classified at birth with various growth charts.. · Higher incidence of small for gestational age infants with Olsen compared with Fenton or Intergrowth.. · Variability in population selection and accuracy in dating pregnancy may have explained differences..

Neonatal hypoglycaemia and body proportionality in small for gestational age newborns: a retrospective cohort study

Small for gestational age (SGA) newborns are at risk of developing neonatal hypoglycaemia. SGA newborns comprise a heterogeneous group including both constitutionally small and pathologically growth restricted newborns. The process of fetal growth restriction may result in brain sparing at the expense of the rest of the body, resulting in disproportionally small newborns. The aim of this study was to discover whether body proportionality influences the risk of developing neonatal hypoglycaemia in SGA newborns. A retrospective cohort study was performed in 402 newborns who were SGA without additional risk factors for hypoglycaemia. Body proportionality was classified in two ways: (1) using symmetric (sSGA) or asymmetric (aSGA), defined as head circumference (HC) below or above the 10th percentile, respectively; (2) using cephalization index (HC/birth weight), standardized for gestational age. Hypoglycaemia was observed in 50% of aSGA and 40.9% of sSGA newborns (P-value 0.12). Standardized CI in newborns with hypoglycaemia was higher compared to newborns without hypoglycaemia (median 1.27 (1.21–1.35) versus 1.24 (1.20–1.29); (P 0.002)). Multivariate logistic regression analyses showed both CI and standardized CI to be associated with the occurrence of hypoglycaemia (OR 1.48 (1.24–1.77) and OR 1.44 (1.13–1.83), respectively). The majority of hypoglycaemic events (96.1%) occurred in the first 6 h after birth. Conclusion: Body proportionality might be of influence, depending on the classification used. Larger prospective studies with a clear consensus definition of body proportionality are needed.What is Known:• Neonatal hypoglycaemia is an important complication in newborns.• Small for gestational age (SGA) newborns are more vulnerable to hypoglycaemia.What is New:• Higher incidence of hypoglycaemia was not observed in asymmetric SGA compared to symmetric SGA, but standardized cephalization index was associated with increased likelihood of hypoglycaemia.• Consensus-based definitions of body proportionality in newborns are needed.

Longitudinal study of the newborn small for gestational age. Growth recovery and conditioning factors

Background: small-for-gestational-age (SGA) newborns present a higher morbidity and mortality rate when compared to infants born appropriate for gestational age (AGA), as well as insufficient growth, with height far from their target and in some cases a low final height (< -2 SDs). Objective: the aim of this study was to determine when catch-up growth (CUG) in height occurs in these children, and which factors are associated with lack of CUG. Material and methods: this is a retrospective study of SGAs born between 2011 and 2015 in a secondary hospital. Anthropometric measurements were taken consecutively until CUG was reached, and fetal, placental, parental, newborn, and postnatal variables were studied. Results: a total of 358 SGAs were included from a total of 5,585 live newborns. At 6 and 48 months of life, 93.6 % and 96.4 % of SGAs achieved CUG, respectively. By subgroups, symmetric SGAs performed worse than asymmetric SGAs with CUG in 84 % and 92 % at 6 and 48 months of life, respectively. The same occurred in the subgroup of preterm SGAs with respect to term SGAs, with worse CUGs of 88.2 % and 91.2 % at 6 and 48 months of life, respectively. Prematurity, symmetrical SGA, intrauterine growth retardation (IUGR), preeclampsia, previous child SGA, perinatal morbidity, and comorbidity during follow-up were associated with absence of CUG. Conclusions: the majority of SGAs had CUG in the first months of life. The worst outcomes were for preterm and symmetric SGAs.

Growth pattern of skinfold thicknesses in term symmetric & asymmetric small for gestational age infants.

Background & objectives:A etiologically symmetric and asymmetric small for gestational age (SGA) infants are two distinct entities. In view of absence of longitudinal information on growth pattern of skinfold thicknesses (SFTs) among Indian infants, this study was conducted to assess the auxological dynamics of SFTs (sub-cutaneous fat) of symmetric and asymmetric SGA infants.Methods:Triceps, sub-scapular, biceps, mid-axillary and anterior thigh SFTs among full-term, 100 symmetric SGA, 100 asymmetric SGA and 100 appropriate for gestational age (AGA) infants were measured at one, three, six, nine and 12 months. Ponderal Index (PI) was used to categorize infants into symmetric SGA (PI ≥2.2 g/cm3) and asymmetric SGA (PI <2.2 g/cm3). Intra-group (symmetric vs. asymmetric), inter-group (SGA vs. AGA) and gender differences were quantified.Results:SFTs among symmetric, asymmetric SGA infants increased to attain peak by six months. Maximum fat deposition in SGA infants was noticed for triceps, minimum for mid-axillary SFT. Mean triceps and sub-scapular skinfolds were measured higher in symmetric SGA than in asymmetric infants. SGA infants had significantly (P≤0.05) thinner SFTs than AGA. Growth velocity for SFTs, among symmetric and asymmetric SGA, was measured maximum between one and three months, threreafter it declined and relatively, steepness of fall was maximum for mid-axillary SFT followed by sub-scapular SFT.Interpretation & conclusions:Thinner SFTs obtained for symmetric and asymmetric SGA as compared to AGA infants reveal their compromised adiposity and nutritional status. Comparatively, higher SFTs in symmetric than in asymmetric SGA infants appear to suggest that the former have a tendency to accumulate more fat, than the latter during infancy.

126. Sex and growth specific characteristics of small for gestational age neonates: A prospective cohort study

Introduction Male bearing pregnancies and asymmetric fetal growth are associated with preeclampsia (PE). However, this has not been studied in small for gestational age (SGA) neonates, a group that is also associated with PE. Objective To provide insight regarding risk factors and differences in neonatal outcome for SGA neonates based on sex and growth symmetry. Methods Data from the Screening for Pregnancy Endpoints (SCOPE) study were used with 5628 nulliparous participants, of which 633 pregnancies were complicated with SGA and 3376 women had uncomplicated pregnancies. SGA pregnancies were grouped based on fetal sex (male/female) and growth symmetry [ponderal index below (asymmetric) and above (symmetric) the 10th percentile for gestation]. Association between risk factors for SGA, SGA subgroups and uncomplicated pregnancies were assessed with multinominal analyses. Results Of all asymmetric neonates, 24.2% were SGA, while 7.4% of all symmetric neonates were SGA. Of all SGA neonates, 45.8% showed asymmetric growth, while 5.5% of neonates with a customised birthweight >90th percentile (p 90th percentile) umbilical Doppler resistance index (RI) at 20 weeks’ gestation was more common in SGA females (9.6% vs 17.8% p = 0.003) but did not differ between symmetric and asymmetric SGA neonates. The presence of abnormal uterine artery Doppler RI at 20 weeks’ gestation did not differ between SGA subgroups. In each SGA subgroup PE incidence was increased (28.2% in symmetric SGA, 26.1% in asymmetric SGA, 27.2% in SGA male and 25.3% in SGA female bearing pregnancies) compared to non-SGA pregnancies (4.2%). The incidence of PE did not differ between SGA subgroups. Discussion A quarter of asymmetric neonates are SGA. Asymmetric SGA associates with male neonates. In contrast with literature, PE was associated with both symmetric and asymmetric growth in SGA neonates.

Progression of waist–hip circumference ratio in full-term symmetric and asymmetric small for gestational age infants

Background: Children born as small for gestational age (SGA) tend to develop central adiposity and may have chances of developing metabolic syndrome. Waist–hip circumference ratio (WHR) is considered as a good indicator of central/truncal obesity. The complete absence of information on growth dynamics of WHR among Indian symmetric and asymmetric SGA infants has prompted us to undertake this study. Aim: The aim was to study the pattern of growth of waist circumference, hip circumference, and WHR of symmetric and asymmetric SGA infants. Materials and Methods: Waist and hip circumference of full-term 100 symmetric SGA, 100 asymmetric SGA, and 100 appropriate for gestational age (AGA) infants was measured at 1, 3, 6, 9, and 12 months in Growth Laboratory/Clinic of the Department. Student's unpaired t-test was used to assess intragroup (symmetric vs. asymmetric), intergroup (SGA vs. AGA), and gender differences. Results: A consistent increase in the mean waist and hip circumference was noticed among symmetric and asymmetric SGA and AGA infants of two sexes. Male infants of both SGA groups possessed similar waist and hip circumference at 1 month. Whereafter, asymmetric SGA males had a larger waist and lesser hip circumference than symmetric infants. Asymmetric SGA females possessed larger waist circumference throughout infancy, while hip circumference measured larger only till 3 months as compared to symmetric females. Conclusion: SGA infants of two types and gender exhibited compromised auxological attainments for waist and hip circumference compared to normal babies. Higher WHR recorded in asymmetric SGA than symmetric SGA and AGA babies appear to suggest that asymmetric infants may have greater tendency to develop central obesity, subsequently.

Longitudinal growth dynamics of term symmetric and asymmetric small for gestational age infants

Background: Available information on auxological attainments of symmetric and asymmetric SGA (small for gestational age) infants presents conflicting views. The complete absence of longitudinal data on growth patterns of both types of Indian SGA infants prompted us to undertake this study. Aim: To study distance and velocity growth pattern of weight and crown-heel length (CHL) of symmetric and asymmetric SGA infants. Subjects & Methods: Weight and CHL amongst full-term 100 symmetric SGA, 100 asymmetric SGA and 100 AGA infants from upper socio-economic strata were mixed-longitudinally measured at birth, 1, 3, 6, 9 and 12 months in the Department of Pediatrics, PGIMER, Chandigarh, India. Results: The symmetric SGA infants measured significantly lighter and shorter than asymmetric infants. SGA infants of both types and sexes possessed significantly (p ≤ 0.001) lower weight and length values than AGA, normal Indian and western infants. Weight and CHL growth velocities demonstrated inconsistent trends. Peak growth velocity for weight and CHL of symmetric, asymmetric SGA and AGA infants was attained between 1-3 months. Average z-scores for weight and CHL were found to be lesser amongst symmetric SGA as compared to asymmetric infants, revealing compromised catch-up growth. Conclusion: The poorer postnatal auxological attainments of SGA infants as compared to normal infants reveals continuation of effect of intra-uterine nutritional insult during infancy, which measured significantly more in symmetric than asymmetric SGA infants.

Ischemia-Modified Albumin May Be a Novel Marker for Predicting Neonatal Neurologic Injury in Small-For-Gestational-Age Infants in Addition to Neuron-Specific Enolase.

Aim This study aims to evaluate hypoxia/ischemia and oxidant stress, and negative neurodevelopmental outcomes in small-for-gestational-age (SGA) infants. Material and Methods Two study groups were established as SGA and appropriate-for-gestational-age (AGA) infants. SGA infants were allocated asymmetric and symmetric SGA infants. Serum levels of neuron-specific enolase (NSE), ischemia-modified albumin (IMA), malondialdehyde (MDA), total antioxidant capacity (TAC), and total oxidant status (TOS) were determined and oxidative stress indexes (OSI) were calculated in all groups. Results Overall, 83 infants were diagnosed SGA, and 85 infants were determined AGA. TOS and OSI levels were significantly higher and TAC levels were significantly lower in SGA group (p < 0.05). MDA and IMA levels were significantly higher in SGA group (p < 0.05). NSE levels in SGA infants were significantly higher (p < 0.05). NSE and IMA were significantly higher in symmetric SGA infants (p < 0.05). TOS, OSI, MDA, TAC levels were not significantly different in SGA infants with abnormal neurological findings (p > 0.05); NSE and IMA levels were significantly higher in SGA group with abnormal neurological findings (p < 0.05). Conclusion SGA infants expose to hypoxia and oxidative stress led to neuronal damage. We suggest that in addition to NSE, IMA blood levels might be a sensitive novel marker for predicting the severity of neuronal damage.

Sonographic weight estimation in small for gestational age fetuses

Purpose: To determine the accuracy of sonographic weight estimation (WE) for small for gestational age (SGA) fetuses, and to further differentiate the evaluation between fetuses being symmetric and asymmetric SGA.

Sonographic Weight Estimation in Small-for-Gestational-Age Fetuses.

To determine the accuracy of sonographic weight estimation (WE) for small-for-gestational-age (SGA) fetuses, and to further differentiate the evaluation between symmetric and asymmetric SGA fetuses. The accuracy of WE in SGA fetuses (n = 898) was evaluated using 14 sonographic models and was further differentiated between symmetric (n = 750) and asymmetric (n = 148) SGA fetuses. SGA fetuses were considered to be asymmetric with a head circumference to abdominal circumference ratio above the 95th percentile. The accuracy of the different formulas was compared using means of percentage errors (MPE), medians of absolute percentage errors (MAPE), and proportions of estimates within 10 % of actual birth weight. RESULTS for the subgroup of asymmetric SGA fetuses differed significantly from the subgroup of symmetric SGA fetuses. MPE values were closer to zero with most of the formulas in the asymmetric SGA group. Apart from the Siemer, Shepard, Merz and Warsof equations, all formulas showed an underestimation of fetal weight in asymmetric SGA fetuses. In contrast, in the symmetric SGA group, all of the formulas commonly used for fetuses in a normal weight range showed a systematic overestimation of fetal weight. Overall the best accuracy was achieved by using the Sabbagha equation (MPE 1.7 %; SD 9.0 %; MAPE: 6.0). An accurate WE in SGA fetuses is feasible using the Sabbagha formula. However, one has to be aware of the significant differences in WE between symmetric and asymmetric SGA fetuses.

Cardiac Blood Flow Measurements in Stable Full Term Small for Gestational Age Neonates

Cardiac blood flow measurements are useful in the haemodynamic management of neonates. Cardiac blood flows can be estimated with functional echocardiography as follows; flow in Superior Vena Cava (SVC), Right Ventricular Outflow (RVO) and Left Ventricular Outflow (LVO). Studies in preterm infants have shown that abnormal superior vena cava flow is associated with poor neurodevelopmental outcomes. To date, normative data on LVO, RVO and SVC flows has been established for term appropriate for gestational age neonates and preterm neonates, but no data is available on RVO, LVO and SVC flows for term small for gestational age neonates. To determine Right Ventricular Output (RVO), Left Ventricular Output (LVO) and Superior Vena Cava (SVC) flow after the transitional period in stable full term Small for Gestational Age (SGA) neonates. Observational study. A tertiary care, perinatal centre in western Maharashtra, India. Full term (37 to 41 weeks) small for gestational age (weight below 10th percentile for gestational age) infants who were born during the study period. RVO, LVO and SVC flows were measured by functional echocardiography on day 7 of life in stable full term SGA neonates from January 2011 to August 2011. Infants who required respiratory or cardiovascular support and intensive care unit admissions for any indication and those with a clinical suspicion of an infection within 48 hours after data collection were excluded from the study. Unpaired t-test was used to compare SVC flow between symmetric and asymmetric SGA neonates. Measurements of RVO, LVO and SVC in term SGA neonates on day 7 of life. We performed measurements in 52 term SGA neonates with a median (range) birth weight of 2.190 (1.600-2.410) kg. Fifty two measurements were analyzed on day 7. The mean (SD) RVO, LVO and SVC flows were 255.59 (57.42) , 214.61 (52.04) and 126.28 (31.23) mL/kg/min. This study provides RVO, LVO and SVC flow values in a cohort of stable term SGA neonates after the transitional period.

Longitudinal growth of head circumference in term symmetric and asymmetric small for gestational age infants

AimsTo study longitudinal growth pattern of head circumference of full-term symmetric and asymmetric small for gestational age (SGA) infants of the two sexes during first year of life. Study DesignMixed-longitudinal growth research design. SubjectsHead circumference amongst full-term 100 symmetric, 100 asymmetric as well as 100 appropriate for gestational age (AGA) infants was measured at birth, 1, 3, 6, 9 and 12months of age using standardized technique and instrument. ResultsThe mean head circumference of male symmetric SGA infants measured significantly (p≤0.001) smaller than asymmetric SGA infants while, in female symmetric SGA infants it measured shorter beyond 6months. As compared to AGA infants, head circumference in symmetric and asymmetric SGA infants measured significantly smaller in size. Growth velocity for head circumference amongst symmetric and asymmetric SGA male infants did not show statistically significant differences. Rate of head circumference growth remained significantly higher amongst female asymmetric SGA infants than the symmetric ones between 3 and 6months while, a reversal of trend was observed between 9 and 12months. ConclusionThe better growth attainments for head circumference of male and female asymmetric SGA infants than their symmetric SGA counterparts during first postnatal year of life may be attributed to the continuation of influence of “head sparing” experienced by asymmetric SGA babies during prenatal life.

The Fetus That Is Small for Gestational Age

The symmetric small for gestational age (SGA) fetus presents a complex management problem for the obstetrician, but the growth restriction affects morbidity and mortality at all stages of life. The differential diagnosis in symmetric growth aberration includes the constitutionally small fetus, the fetus with pathology, and the cases with incorrect dating of pregnancy. The ultrasonographic examination focuses in the detection of anomalies, signs of intrauterine infection, and serial assessment of fetal growth. Accuracy of fetal biometry may be improved by using individualized fetal growth curves. From the available surveillance tools, the uterine artery Doppler has a value in predicting poor perinatal outcome. Magnetic resonance imaging is also useful in the evaluation of anomalies. Cesarean section is not justified for all symmetric SGA fetuses that may carry a guarded prognosis.

The auditory evoked potential in premature small for gestational age infants

Purpose:This study aimed to evaluate the usefulness of auditory evoked potential (AEP) in clarifying neuronal development in premature small for gestational age (SGA), and appropriate for gestational age (AGA) infants. Methods:A total of 183 premature infants who were born from August 2002 to July 2005, were examined with AEP. They were divided into three groups; AGA, symmetric-SGA and asymmetric- SGA group. Results:Statistically significant differences in the head circumference were observed in three groups. Among the risk factors, prevalence of hypoglycemia and hypoalbuminemia between AGA and asymmetric SGA infants were significantly different. V absolute peak latency (APL) in the right side of AGA infants was delayed were than that of asymmetric SGA infants. III-V interpeak latency (IPL) of asymmetric SGA infants was delayed more than that of symmetric SGA infants. Moreover, I-V IPL on both sides of symmetric SGA infants was shortened more than that of AGA infants. However, all the results of AEP were within the reference range, according to gestational age. Birth weight of, only asymmetric SGA, was related to the III APL on both sides and the III-V IPL on right side. Conclusion:This study shows that the values of APL and IPL of premature SGA infants are different than that of premature AGA infants. These data could be an indicator in evaluating the neurologic functions of small for gestational age infants

Effects of Symmetric and Asymmetric Fetal Growth on Pregnancy Outcomes

Objective: To assess the prevalence of head circumference to abdomen circumference (HC/AC) asymmetry among small for gestational age (SGA) fetuses, and to determine the likelihood of adverse outcomes among asymmetric and symmetric SGA infants compared with their appropriate for gestational age (AGA) counterparts. Methods: In a retrospective cohort study, we analyzed consecutive live-born singletons of women who had antepartum sonography within 4 weeks of delivery and delivered between January 1, 1989 and September 30, 1996. A gestational age–specific HC/AC nomogram was derived from our sonographic database of 33,740 nonanomalous live-born singletons. Asymmetric HC/AC was defined as greater than or equal to the 95th percentile for gestational age. Results: Among 1364 SGA infants, 20% had asymmetric HC/AC and 80% were symmetric. Asymmetric SGA infants were more likely to have major anomalies than symmetric SGA infants or AGA infants (14% versus 4% versus 3%, respectively; P < .001). After exclusion of anomalous infants, pregnancy-induced hypertension at or before 32 weeks’ gestation and cesarean delivery for nonreassuring fetal heart rate were more common in the asymmetric SGA than the AGA group (7% versus 1% and 15% versus 3%, respectively; both P < .001). A neonatal outcome composite, including one or more of respiratory distress, intraventricular hemorrhage, sepsis, or neonatal death, was more frequent among asymmetric SGA than AGA infants (14% versus 5%, P = .001). Symmetric SGA infants were not at increased risk of morbidity compared with AGA infants. Conclusion: The minority of SGA fetuses with HC/AC asymmetry are at increased risk for intrapartum and neonatal complications.

Effects of symmetric and asymmetric fetal growth on pregnancy outcomes

Objective: To assess the prevalence of head circumference to abdomen circumference (HC/AC) asymmetry among small for gestational age (SGA) fetuses, and to determine the likelihood of adverse outcomes among asymmetric and symmetric SGA infants compared with their appropriate for gestational age (AGA) counterparts. Methods: In a retrospective cohort study, we analyzed consecutive live-born singletons of women who had antepartum sonography within 4 weeks of delivery and delivered between January 1, 1989 and September 30, 1996. A gestational age–specific HC/AC nomogram was derived from our sonographic database of 33,740 nonanomalous live-born singletons. Asymmetric HC/AC was defined as greater than or equal to the 95th percentile for gestational age. Results: Among 1364 SGA infants, 20% had asymmetric HC/AC and 80% were symmetric. Asymmetric SGA infants were more likely to have major anomalies than symmetric SGA infants or AGA infants (14% versus 4% versus 3%, respectively; P < .001). After exclusion of anomalous infants, pregnancy-induced hypertension at or before 32 weeks’ gestation and cesarean delivery for nonreassuring fetal heart rate were more common in the asymmetric SGA than the AGA group (7% versus 1% and 15% versus 3%, respectively; both P < .001). A neonatal outcome composite, including one or more of respiratory distress, intraventricular hemorrhage, sepsis, or neonatal death, was more frequent among asymmetric SGA than AGA infants (14% versus 5%, P = .001). Symmetric SGA infants were not at increased risk of morbidity compared with AGA infants. Conclusion: The minority of SGA fetuses with HC/AC asymmetry are at increased risk for intrapartum and neonatal complications.

Cognitive development of term small for gestational age children at five years of age

AIMTo assess the relative significance for cognitive development of small for gestational age, parental demographic factors, and factors related to the child rearing environment.METHODSIQ of a population based cohort of...

母親危險因子對低出生體重嬰兒、早產兒、及生長遲滯嬰兒之影響--前瞻性懷孕世代研究

Objectives: This prospective cohort study investigated low birthweight (LBW), preterm delivery (PTD), and small for gestational age (SGA) in Taipei, Taiwan. Effects of maternal risk factors on birth outcomes were examined, including biological background, maternal obstetric history, as well as medical events and smoking during pregnancy. Methods: Between 1984 and 1987, each pregnant woman who came to the Taipei Municipal Maternal and Child Hospital for prenatal care was interviewed using a structured questionnaire. Maternal and newborn medical records were abstracted after delivery. A total of 12,273 singleton livebirths were analyzed. Potential risk factors associated with birth outcomes were examined using logistic models. Results: Antepartum hemorrhage and hypertension were the strongest risk factors for LBW or PTD history, and infection with syphilis had moderately increased risks. Female gender and primiparae were were also significantly associated with the risk of LBW infants. Antepartum hemorrhage was the strongest risk factor for PTD infants, whereas obese mothers, short fathers, two or more prior spontaneous abortions, and previous LBW or PTD history gave moderately increased risks. Maternal hypertension, low pre-pregnancy weight, and primiparae were the risk factors for both symmetric and asymmetric SGA infants Those effects except primiparae were considerably greater on asymmetric than symmetric SGA infants. Low parental height and previous LBW or PTD history were also significantly associated with the risk of symmetric SGA infants. Conclusions: The relationship between several known risk factors and birth outcomes consistently remains, and interventions should be promoted in Taiwan.

Prenatal growth in symmetric and asymmetric small-for-gestational-age infants.

We tested the hypothesis that growth retardation in symmetric small-for-gestational-age (SGA) infants may start in the first trimester of pregnancy, whereas in asymmetric SGA infants, it may start in the third trimester. We also examined if there may be a brain sparing effect in asymmetric SGA infants. Infants were classified as symmetric or asymmetric SGA infants, and 474 non-SGA infants. Intrauterine growth was assessed by prenatal ultrasonic measurements of fetal abdominal diameter, femur length and biparietal diameter at week 17, 25, 33 and 37 of gestation. Cross-sectional data as well as longitudinal growth curves suggested that growth retardation in both SGA groups started in the second trimester, and followed similar patterns until birth. Thus, our results did not support the hypothesis that symmetric and asymmetric growth retardation is associated with clear temporal differences in growth, and we found no sign of brain sparing in asymmetric compared to symmetric SGA infants.