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The relationship between intrauterine growth restriction and preterm delivery: an empirical approach using data from
J Zeitlin1, P Y Ancel, M J Saurel-Cubizolles
1Port-Royal Maternity Hospital, Paris, France.
Insights
Being small for gestational age (SGA) is a significant risk factor for preterm delivery. This association is particularly strong for medically indicated preterm births and those occurring before 34 weeks gestation.
Area of Science:
- Perinatal Medicine
- Neonatology
- Obstetrics
Background:
- Preterm birth is a leading cause of neonatal morbidity and mortality.
- Identifying risk factors for preterm delivery is crucial for developing preventative strategies.
- Small for gestational age (SGA) is defined as birthweight below the 10th percentile for gestational age.
Purpose of the Study:
- To investigate if being small for gestational age (SGA) is a risk factor for preterm delivery in singleton live births.
- To quantify the association between SGA and different types of preterm birth.
Main Methods:
- A case-control study was conducted across 16 European maternity hospitals.
- Data included 4,700 preterm infants (22-36 weeks gestation) and 6,460 controls (37-40 weeks gestation).
- Infants were classified as SGA using customized intrauterine growth references; logistic regression analyzed the impact on preterm delivery.
Main Results:
- Being small for gestational age (SGA) is significantly associated with preterm birth.
- The association is strongest for induced preterm births (OR 6.41) not due to premature rupture of membranes, compared to controls (10.7% SGA).
- For spontaneous or premature rupture of membranes-related preterm births, the association is weaker (OR 1.51), and strongest for births before 34 weeks gestation.
Conclusions:
- Abnormal fetal growth, indicated by SGA, is prevalent in preterm infants, especially those delivered electively.
- The link between SGA and spontaneous preterm birth warrants further investigation into underlying causal mechanisms.
- Findings emphasize the importance of monitoring fetal growth in predicting preterm delivery risk.
Objective:
To test whether being small for gestational age, defined as having a birthweight less than the 10th centile of intrauterine growth references, is a risk factor for preterm delivery for singleton live births.
Design:
A case-control study.
Setting:
Maternity hospitals in 16 European countries.
Sample:
Four thousand and seven hundred preterm infants between 22 and 36 completed weeks of gestation and 6,460 control infants between 37 and 40 weeks of gestation.
Methods:
Newborn babies are identified as being small for gestational age using customized reference standards derived from models of fetal growth. The impact of being small for gestational age on preterm delivery is estimated using logistic regression.
Main Outcome Measure:
Spontaneous or induced preterm delivery.
Results:
Being small for gestational age is significantly associated with preterm birth, although the magnitude of this association differs greatly by type of delivery and gestational age. Over 40% of induced preterm births for reasons other than the premature rupture of membranes are small for gestational age compared with 10.7% of control infants (OR 6.41). For spontaneous or premature rupture of membranes related preterm births, the association is also significant, but weaker (OR 1.51). The relationship between growth restriction and preterm delivery is strongest for preterm births before 34 weeks of gestation.
Conclusions:
These findings highlight the phenomenon of abnormal fetal growth in all premature infants and, in particular, infants delivered by medical decision for reasons other than premature rupture of membranes. The observed association between being small for gestational age and preterm delivery among spontaneous preterm births merits further attention because the causal mechanisms are not well understood.