Analysis of birth weight percentile as a predictor of perinatal outcome

Birth weight-gestational age tables are convenient methods for the neonatal evaluation of intrauterine growth, however, the limits of acceptable birth weight for gestational age are controversial. The purpose of this study was to identify the birth weight percentiles that accurately predicted poor perinatal outcome from 28 through 41 weeks' gestational age. In a homogeneous population of 44,811 patients, the birth weight percentile that predicted poor perinatal outcome varied with gestational age. The birth weight percentile that predicted normal outcome in 80% of normal patients declined from the 55th percentile at 28 to 29 weeks to the 24th percentile at 34 to 35 weeks. From 28 through 35 weeks' gestational age, possibly owing to the confounding effects of prematurity, patients classified as normal by birth weight criteria still had a significant risk of poor outcome. After 36 weeks' gestational age, poor perinatal outcome occurred in 3.9% of patients and tended to occur at the extremes of birth weight. Classification by birth weights approximating the tenth and 90th percentiles identified a population in which the majority of the poor perinatal outcome occurred. However, poor outcome occurred in only 10% of patients with birth weights below the tenth or above the 90th percentiles. Among those with birth weights between the tenth and 90th percentiles, outcome was normal in 98%. Therefore, from 36 through 41 weeks' gestational age, the prevalence of poor perinatal outcome was low, and birth weight percentile was a weak predictor of outcome in the individual patient.