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Morbidity and Mortality in Small-for-Gestational-Age Infants: A Secondary Analysis of Nine MFMU Network Studies
Hector Mendez-Figueroa1, Van Thi Thanh Truong2, Claudia Pedroza2
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas.
Insights
Small-for-gestational-age (SGA) newborns face significantly higher risks of stillbirth and neonatal mortality compared to appropriate-for-gestational-age (AGA) infants. These findings suggest a need for revised clinical practices and management strategies for SGA neonates.
Area of Science:
- Perinatal Medicine
- Neonatalogy
- Obstetrics
Background:
- Small-for-gestational-age (SGA) is defined as birth weight below the 10th percentile for estimated gestational age (EGA).
- Neonatal morbidity and mortality are significant concerns in perinatal care.
Purpose of the Study:
- To compare neonatal morbidity and mortality rates between small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) newborns.
- To identify risks associated with SGA status in singleton pregnancies.
Main Methods:
- Analysis of data from nine Maternal-Fetal Medicine Units Network studies.
- Inclusion criteria: nonanomalous singletons, EGA ≥ 24 weeks, birth weight < 90% for EGA.
- Multivariable and random-effect logistic regression analyses adjusted for 10 variables.
Main Results:
- 13% of 71,744 singletons were SGA; 87% were AGA.
- SGA newborns had a threefold higher likelihood of stillbirth (aOR 3.98) and neonatal mortality (aOR 3.18) compared to AGA.
- For EGA ≥ 32 weeks, SGA showed higher risks of stillbirth (aOR 3.32) and neonatal mortality (aOR 2.50).
Conclusions:
- Neonatal mortality and stillbirth risks are significantly elevated in SGA infants compared to AGA.
- The findings indicate a potential need for modifications in clinical practice or new management protocols for SGA neonates.
Abstract:
Objective To compare the neonatal morbidity and mortality among small-for-gestational-age (SGA; birth weight < 10% for estimated gestational age [EGA]) versus appropriate-for-gestational-age (AGA; birth weight at 10-89%) newborns. Methods Data from nine Maternal-Fetal Medicine Units Network studies were used and included nonanomalous singletons at 24 weeks or more and birth weight < 90% for EGA. Using multivariable analysis, we compared the morbidity and mortality between SGA and AGA. Random-effect logistic regressions were utilized with adjustment for 10 variables. Results Among the nine studies 71,744 singletons met the inclusion criteria, with 13% (n = 9,415) SGA and 87% (n = 62,329) AGA. Among SGA, the likelihood of stillbirth (8.8 vs. 2.5 per 1,000 births; adjusted odds ratio [aOR] 3.98, 95% confidence interval [CI]: 2.92-5.42) and neonatal mortality (14.0 vs. 5.5 per 1,000 births; aOR 3.18, 95% CI: 2.55-3.95) was threefold higher compared with AGA. For the subgroup of newborns of EGA of 32 weeks or more, SGA, compared with AGA, had significantly higher risk of stillbirth (aOR 3.32, 95% CI: 2.16-5.12) and neonatal mortality (aOR 2.50; 95% CI: 1.38-4.54). From 35 weeks onward, the risk of stillbirth among SGA is almost four times higher than for AGA. Conclusion The risk of stillbirth and neonatal mortality is significantly higher with SGA than with AGA. Modification in practice or new management schema may be warranted.
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