Prevalence and associations of small for gestational age in a cohort of women birthing in Honiara, the Solomon Islands.

Abstract

Background: Small for gestational age (SGA) is a significant indicator of subsequent neonatal and child morbidity. In low- and middle-income countries (LMICs), around a fifth of infants are born small for gestational age as defined by the Intergrowth-21 st (IG21) standard. We sought to examine the prevalence and associations of small for gestational age using IG21 among women attending antenatal care in Honiara, Solomon Islands, to compare these rates with regional data and explore the demographic factors associated with this outcome. Methods: From January 2014 – April 2015 we undertook a prospective cohort study that used a structured questionnaire to collect data on women presenting to the National Referral Hospital and community clinics in Honiara for antenatal care. Follow up data was collected by midwives regarding the outcomes of these pregnancies. We used the IG21 data to derive birthweight centiles. Results: Of the 1441 women enrolled, 1311 records on singleton live births were obtained. Gestational age was calculated on a recorded last menstrual period in 1058 (80.7%) and relied on clinical assessment at birth in 253 (19.3%). Using IG21 the prevalence of SGA in this population was 16.8% with the majority being term SGA. SGA was significantly associated with maternal primiparity and preeclampsia, and SGA babies had higher rates of delivery by caesarean section and neonatal nursery admission. Conclusions: The rate of SGA in this study was a little lower than pooled estimates across all LMICs. Improving antenatal care attendance, access to ultrasound assessment of gestational age and employing birth growth standards will assist to monitor the prevalence of SGA and manage the consequences.