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

Abstract

Objective To compare morbidity among small-for-gestational-age (SGA; birthweight [BW] < 10th percentile for gestational age), appropriate-for-gestational-age (AGA; BW 10-90th percentile; reference group), and large-for-gestational-age (LGA; BW > 90th percentile) neonates in apparently uncomplicated pregnancies at term (≥ 37 weeks). Material and Methods This secondary analysis, derived from an observational obstetric cohort of 115,502 deliveries, included women with apparently uncomplicated pregnancies of non-anomalous singletons who had confirmatory ultrasound dating no later than the second trimester, and who delivered between 370 and 426 weeks. 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 (aRR) with 95% confidence intervals (CI), 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%) vs. AGA (0.7%; aRR 1.44, 95% CI 1.07-1.93) but similar between LGA (0.6%) vs. AGA (aRR 0.84; 95% CI 0.58-1.22). Traumatic composite neonatal morbidity was significantly higher in LGA (1.9%) vs. AGA (1.0%; aRR 1.88, 95% CI 1.51-2.34)) but similar in SGA (1.3%) vs. AGA (aRR 1.28; 95% CI 0.98-1.67). Conclusions 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.

Safety of the balloon catheter for cervical ripening in outpatient care: complications during the period from insertion to expulsion of a balloon catheter in the process of labour induction: a systematic review

“…Therefore the real risk of developing an adverse event during cervical balloon ripening in low-risk pregnancies will likely be lower than our results imply. 30,31 These neonates had higher rates of composite neonatal morbidity and therefore inpatient induction of labour in women with SGA infants is indicated as more appropriate. [26][27][28] Even though outpatient cervical ripening would generally be unsuitable for these high-risk women, the occurrence rate of 'uterine rupture/scar dehiscence' was still zero.…”

“…Two recent studies have shown that in apparently uncomplicated pregnancies, small-for-gestational age occurred in 7.9 and 10.8%. 30,31 These neonates had higher rates of composite neonatal morbidity and therefore inpatient induction of labour in women with SGA infants is indicated as more appropriate. Clinicians should be aware of this possible risk.…”

Prediction of adverse perinatal outcome by fetal biometry: comparison of customized and population‐based standards

“…Low and high birth weight are associated with increased perinatal morbidity and mortality. Therefore, antenatal surveillance of fetal growth is essential to ensure close monitoring and to suggest potential measures to reduce the risk (e.g.…”

Antenatal risk factors associated with neonatal morbidity in large‐for‐gestational‐age infants: an international prospective cohort study

“…This is much higher than the expected 5.4-11.7% rate of admission to NICU for LGA infants (4,6). We recognize that the causes of neonatal morbidity relate to fetal growth (SGA or LGA) (28). We recognize that the causes of neonatal morbidity relate to fetal growth (SGA or LGA) (28).…”

“…Most lifestyle interventions involving physical activity during pregnancy have been shown to reduce gestational weight gain during pregnancy but have not reduced the risk of GDM, LGA or neonatal morbidity; the latter is often a secondary outcome in these trials (26,27). We recognize that the causes of neonatal morbidity relate to fetal growth (SGA or LGA) (28). Our findings suggest that lifestyle interventions based on physical activity are more likely to improve neonatal outcomes in LGA infants either born to obese women or to women with high glucose concentration in mid-pregnancy.…”