4 years ago

Neonatal Morbidity of Small- and Large-for-Gestational-Age Neonates Born at Term in Uncomplicated Pregnancies

Tita, Alan T. N., Wapner, Ronald J., Reddy, Uma M., Caritis, Steve N., MSCE, for the Eunice Kennedy Shriver National Institute of Child Health, Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network, Thorp, John M. Jr, Saade, George, Sorokin, Yoram, Varner, Michael W., Grobman, William A., Rice, Madeline Murguia, Rouse, Dwight J., Tolosa, Jorge E., Prasad, Mona, Leveno, Kenneth J., Chauhan, Suneet P., Bailit, Jennifer
imageOBJECTIVE: To compare morbidity among small-for-gestational-age (SGA; birth weight less than the 10th percentile for gestational age), appropriate-for-gestational-age (AGA; birth weight 10th to 90th percentile; reference group), and large-for-gestational-age (LGA; birth weight greater than the 90th percentile) neonates in apparently uncomplicated pregnancies at term (37 weeks of gestation or greater). METHODS: This secondary analysis, derived from an observational obstetric cohort of 115,502 deliveries, included women with apparently uncomplicated pregnancies of nonanomalous singletons who had confirmatory ultrasound dating no later than the second trimester and who delivered between 37 0/7 and 42 6/7 weeks of gestation. We used two different composite neonatal morbidity outcomes: hypoxic composite neonatal morbidity for SGA and traumatic composite neonatal morbidity for LGA neonates. Log Poisson relative risks (RRs) with 95% CIs adjusted for potential confounding factors (nulliparity, body mass index, insurance status, and neonatal sex) were calculated. RESULTS: Among the 63,436 women who met our inclusion criteria, SGA occurred in 7.9% (n=4,983) and LGA in 8.3% (n=5,253). Hypoxic composite neonatal morbidity was significantly higher in SGA (1.1%) compared with AGA (0.7%; adjusted RR 1.44, 95% CI 1.07–1.93) but similar between LGA (0.6%) and AGA (adjusted RR 0.84, 95% CI 0.58–1.22). Traumatic composite neonatal morbidity was significantly higher in LGA (1.9%) than AGA (1.0%; adjusted RR 1.88, 95% CI 1.51–2.34) but similar in SGA (1.3%) compared with AGA (adjusted RR 1.28, 95% CI 0.98–1.67). CONCLUSION: Among women with uncomplicated pregnancies, hypoxic composite neonatal morbidity is more common with SGA neonates and traumatic–composite neonatal morbidity is more common with LGA neonates.
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