Risk factors for developmental delays in small for gestational age children at age of 24-36 months

Long-term neurodevelopmental/socioemotional risks in small for gestational age (SGA) children lack robust evidence, especially maternal/neonatal predictors. The study aims to identify independent maternal and neonatal risk factors associated with atypical neurodevelopmental and socioemotional outcomes in SGA children. This longitudinal cohort study included 412 singleton SGA infants born at Peking University People's Hospital in Beijing from January 2020 to December 2022. Participants underwent 24-36 months follow-up median 30 months, with neurodevelopmental and socioemotional outcomes evaluated using the Ages and Stages Questionnaires, Third Edition (ASQ-3) and Ages and Stages Questionnaires: Social-Emotional (ASQ: SE). These assessments categorized SGA children into normal/atypical development groups for both domains. Through assessment, there were 292 cases (70.9%) of development on track SGA children. The atypical neurodevelopment group included 92 cases (22.3%), among which 38 cases (9.2%) exhibited atypical development in one domain and 54 cases (13.1%) in ≥ 2 domains. The atypical socioemotional development group included 48 cases (11.7%). Additionally, 20 cases (4.9%) of SGA children exhibited both atypical neurodevelopment and atypical socioemotional development. Multivariable regression analysis showed that maternal pre-pregnancy underweight (OR = 6.93, 95% CI = 2.76-17.41), maternal inadequate gestational weight gain (GWG) (OR = 4.63, 95% CI = 2.15-9.99), maternal excessive GWG (OR = 2.51, 95% CI = 1.14-5.55), preterm infant (OR = 1.26, 95% CI = 1.03-1.55), severe SGA (OR = 2.95, 95% CI = 1.47-5.90) and neonatal respiratory distress syndrome Peking University People's Hospital (OR = 1.29, 95% CI = 1.06-1.57) were independently related to the occurrence of atypical neurodevelopment outcomes in SGA children; maternal pre-pregnancy underweight (OR = 3.54, 95% CI = 1.11-7.27), maternal inadequate GWG (OR = 3.60, 95% CI = 1.32-8.84), preterm infant (OR = 3.08, 95% CI = 1.09-7.17) and male (OR = 2.23, 95% CI = 1.05-4.75) were independently related to the occurrence of atypical socioemotional development in SGA children. Monitoring and promoting of maternal appropriate weight gain or the maternal health would improve outcome of SGA infants.