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Risk factors for small for gestational age infants: a New Zealand study. New Zealand Cot Death Study Group
J M Thompson1, S P Wright, E A Mitchell
1Department of Paediatrics, University of Auckland, School of Medicine.
Insights
Maternal smoking is the leading preventable cause of small for gestational age (SGA) infants. Other risk factors include primiparity, inadequate antenatal care, and lower maternal education.
Area of Science:
- Obstetrics and Gynecology
- Perinatology
- Public Health
Background:
- Small for gestational age (SGA) infants face increased risks of adverse neonatal outcomes and long-term health issues.
- Identifying modifiable risk factors is crucial for developing effective prevention strategies.
Purpose of the Study:
- To investigate and identify key risk factors associated with the development of small for gestational age (SGA) infants.
Main Methods:
- A case-control study was conducted with 1800 infants, excluding preterm births.
- Cases were SGA infants (n=157), and controls were non-SGA, full-term infants (n=1519).
- Data were collected from obstetric records and parental interviews to assess risk factors.
Main Results:
- Maternal smoking during pregnancy was a significant risk factor (OR 2.61, 95% CI 1.65-4.15).
- Other identified risk factors included primiparity (OR 2.96), lack of first-trimester antenatal care (OR 1.83), and younger maternal age at school leaving (OR 1.56).
- Maternal smoking accounted for 31.1% of SGA cases.
Conclusions:
- Maternal smoking is the most significant modifiable risk factor for SGA in this population.
- Public health initiatives should focus on smoking cessation during pregnancy.
- Addressing factors like primiparity and access to early antenatal care may also reduce SGA incidence.
Aim:
The aim was to identify risk factors for small for gestational age infants.
Method:
Case-control study. The study population was 1800 infants selected randomly from all babies born over a three year period over 78% of the country. Of these 1800 infants, 85 (4.8%) were classified as preterm (< 37 weeks completed gestation) and were excluded. 157 (8.9%) were classified as small for gestational age (cases) and 1519 (86.3%) were fullterm, nonsmall for gestational age infants (controls). Risk factors were investigated using data collected from obstetric records and parental interviews.
Results:
Risk factors associated with small for gestational age after controlling for potential confounders included maternal smoking during pregnancy (Odds ratio (OR) 2.61, 95% confidence interval (CI) 1.65, 4.15), primiparity (OR 2.96, 95% CI 1.59, 5.48), lack of antenatal care in the first trimester (OR 1.83, 95% CI 1.13, 2.98) and young age when mother left school (OR 1.56, 95% CI 1.01, 2.41). Use of marijuana in pregnancy significantly increased risk of small for gestational age at the 6% level (OR = 1.86, 95% CI 0.98, 3.52). The population attributable risk for maternal smoking was 31.1% (95% CI 18.2, 41.9).
Conclusion:
Maternal smoking was the most important modifiable risk factor in this dataset for small for gestational age.