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Perinatal mortality by birthweight centile.

Julia H Francis1, Michael Permezel, Mary Ann Davey

  • 1Mercy Hospital for Women, Heidleberg, Victoria, Australia.

The Australian & New Zealand Journal of Obstetrics & Gynaecology
|April 16, 2014
PubMed
Summary

Babies with birthweights below the 50th centile face higher risks of perinatal death, even if considered appropriate for gestational age. The optimal birthweight range for lowest mortality is the 50th to 90th centile.

Keywords:
birthweight centilelarge for gestational ageperinatal mortalitysmall for gestational agestillbirth

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Area of Science:

  • Perinatal health
  • Fetal growth assessment
  • Obstetrics

Background:

  • Accurate detection of abnormal fetal growth is crucial for antenatal care.
  • Traditional classification uses small for gestational age (<10th centile) and large for gestational age (>90th centile) categories.
  • Outcomes for birthweight centiles outside these extremes require further investigation.

Purpose of the Study:

  • To investigate the association between birthweight centile and perinatal mortality.
  • To identify the optimal birthweight centile range associated with the lowest perinatal death rate.

Main Methods:

  • Analysis of Victorian birth data (1999-2008) using refined birthweight centile subsets.
  • Stratified analysis for all gestations, term births, and employing the 'fetus at risk' approach.
  • Logistic regression adjusted for maternal age, parity, and comorbidities.

Main Results:

  • The optimal birthweight centile range for term births was 50th-90th, with 1.1 perinatal deaths/1000 births.
  • Birthweights below the 50th centile showed significantly increased perinatal mortality risk.
  • Risk of perinatal death was doubled for 10th-25th centile (AOR 2.10) and elevated for 25th-50th centile (AOR 1.58).
  • Higher mortality was observed after 37 weeks gestation, particularly for small for gestational age babies.

Conclusions:

  • Birthweights below the 50th centile are linked to a greater risk of perinatal mortality.
  • The optimal range for reduced perinatal mortality is between the 50th and 90th birthweight centiles.
  • Current classification of appropriate for gestational age may not fully capture all risks.