Small for gestational age newborns--does pre-recognition make a difference in pregnancy outcome?

We aimed to evaluate whether pre-recognition of small for gestational age (SGA) at late preterm or term pregnancies, has an impact on pregnancy outcome.

Retrospective analysis of SGA newborns, stratified to those with suspected or unsuspected IUGR according the sonographic estimated fetal weight (EFW), below the 10th percentile for gestational age (n = 619), with fetuses not suspected as SGA (EFW ≥10th percentile) preformed up to 7 days prior to delivery (n = 1770).

SGA was correctly diagnosed prior to delivery in 26% of the fetuses. Women with suspected SGA were delivered earlier (37.9 ± 1.7 versus 38.8 ± 1.4 weeks, p < 0.001) and at a lower birth weight (2280 ± 321 versus 2454 ± 263 grams, p < 0.001). They also had higher rates of induction of labor (19.1% versus 6.2%, p < 0.001) and cesarean delivery (29.1% versus 19.8%, p < 0.001). Fetuses suspected for SGA had higher rate of neonatal adverse outcome, but on multivariate analysis suspected SGA (aOR 0.41, 95% CI 0.20-0.86), birthweight (aOR 0.67, 95% CI 0.5 to -0.77 for each additional 50 g), gestational age at delivery (aOR 0.63, 95% CI 0.56-0.71 for each additional week) and spontaneous vaginal delivery (aOR 0.88, 95% CI 0.19-3.89) were independently associated with an improved neonatal composite outcome.

Identification of SGA may improve neonatal outcome. However, by itself, it is not an indication for intervention, which may lead to adverse outcome.