The association between small size for gestational age and perinatal and neonatal death in a UK Regional Health Authority

Abstract

Confidential enquiry into stillbirth and death in infancy is a health service requirement in England, Wales and Northern Ireland. A confidential review of perinatal death has been conducted in South-East Thames Region since 1988. Data collected for this review are analysed here. Among the 1662 singleton deaths in the enquiry from 1988 to 1991, 530 (32%) babies were small for gestational age (SGA < 10th centile): 338 of these (64%) were < 3rd centile and the remainder were between 3rd-10th centile. Small size for gestational age was significantly associated with a previous SGA baby (P = 0.02), proteinuric hypertension (P = 0.001) and increased placental-birthweight ratio (P = 0.008). Only 135 (25%) SGA fetuses were identified antenatally and multiple logistic regression showed that antenatal detection was independently related to proteinuric hypertension [odds ratio (OR) = 2.47, 95% confidence interval (CI) 1.47-4.17, P = 0.001) and to being < 3rd centile rather than 3rd-10th centile (OR = 3.16, 95% CI 1.96-5.10, P = 0.001). Although confidential enquiries have been criticised for a lack of objectivity the study indicates how data from such an enquiry can increase knowledge of events influencing peri- and neonatal outcome allowing strategies to be devised to effect change.

The association of maternal ACE A11860G with small for gestational age babies is modulated by the environment and by fetal sex: a multicentre prospective case-control study

“…Being born SGA not only increases the risk of morbidity and mortality in the perinatal period (de Courcy-Wheeler et al , 1995; McCowan and Horgan, 2009), but is also associated with an increased risk of the metabolic syndrome in later life, in particular type II diabetes mellitus, cardiovascular disease and hypertension (Barker et al , 1989, 1990, 2007; McKeigue et al , 1998). To date, the exact cause of SGA pregnancies remains largely unknown; however, impairments in maternal plasma volume expansion (Duvekot et al , 1995; Salas et al , 2006) and spiral artery remodelling in the uterus (Khong et al , 1986) have been implicated.…”

The Functions of Postpartum Depression

“…Beischer et al 1996 Gestational diabetes was associated with a significantly higher rate of perinatal mortality, especially if untreated (Australia). de Courcy-Wheeler et al 1995 Small size for gestational age (itself a strong predictor of perinatal mortality) was significantly associated with proteinuric hypertension (Britain). Gupta et al 1996 Twenty percent of babies born through meconium-stained amniotic fluid (MSAF) suffered severe birth anoxia (lack of oxygen) compared to 5.6% in the non-MSAF group (India).…”

Substandard factors in perinatal care in The Netherlands: a regional audit of perinatal deaths

“…This may be an aspect of perinatal care that needs further attention. It has, however, also been shown that the actual antenatal detection rate of fetuses small-for-gestational-age is only about 14 to 26% in hospitals (23,24). Another study concluded that 76% of all cases of small-for-gestational-age could be detected antenatally (22).…”