Showing papers on "Small for gestational age published in 2000"

Birthweight by gestational age in Norway.

Abstract: Objective. To describe birthweight by gestational age in Norway for the period 1967-1998, evaluate secular trends and provide new standards for small for gestational age for 16 to 44 weeks of gestation. Subjects and methods. The analyses were based on more than 1.8 million singleton births, covering all births in Norway for a 32 year period. Percentiles for birthweight by gestational age were estimated using smoothed means and standard deviations. In the preterm weeks, means and standard deviations were carefully screened for birthweight-gestational age consistency, adapting a method of Wilcox and Russell. Differences in birthweight by gestational age for stillbirths and livebirths in extremely preterm weeks (16-28) are presented, and the effects of cesarean section are evaluated. We observed a clear increase in birthweight by gestational age for all term weeks, but a decrease for most of the preterm weeks over the same period. This decrease was related to the increase in deliveries by cesarean section. C...

Adult functional outcome of those born small for gestational age: twenty-six-year follow-up of the 1970 British Birth Cohort.

Abstract: ContextAlthough studies have documented cognitive impairment in children who were born small for gestational age (SGA), other studies have not demonstrated differences in IQ or other cognitive scores. The need exists for long-term studies of such children to assess functional outcomes not measurable with standardized testing.ObjectiveTo determine the long-term functional outcome of SGA infants.DesignProspective cohort study.Setting and ParticipantsA total of 14,189 full-term infants born in the United Kingdom on April 5 through 11, 1970, were studied as part of the 1970 British Birth Cohort; 1064 were SGA (birth weight less than the fifth percentile for age at term). Follow-up at 5, 10, 16, and 26 years was 93%, 80%, 72%, and 53%, respectively.Main Outcome MeasuresSchool performance and achievement, assessed at 5, 10, and 16 years; and years of education, occupational status, income, marital status, life satisfaction, disability, and height, assessed at 26 years, comparing persons born SGA with those who were not.ResultsAt 5, 10, and 16 years of age, those born SGA demonstrated small but significant deficits in academic achievement. In addition, teachers were less likely to rate those born SGA in the top 15th percentile of the class at 16 years (13% vs 20%; P<.01) and more likely to recommend special education (4.9% vs 2.3%; P<.01) compared with those born at normal birth weight (NBW). At age 26 years, adults who were SGA did not demonstrate any differences in years of education, employment, hours of work per week, marital status, or satisfaction with life. However, adults who were SGA were less likely to have professional or managerial jobs (8.7% vs 16.4%; P<.01) and reported significantly lower levels of weekly income (mean [SD], 185 [91] vs 206 [102] £; P<.01) than adults who were NBW. Adults who were SGA also reported significant height deficits compared with those who were NBW (mean [SD] z score, −0.55 [0.98] vs 0.08 [1.02]; P<.001). Similar results were also obtained after adjusting for social class, sex, region of birth, and the presence of fetal or neonatal distress.ConclusionsIn this cohort, adults who were born SGA had significant differences in academic achievement and professional attainment compared with adults who were NBW. However, there were no long-term social or emotional consequences of being SGA: these adults were as likely to be employed, married, and satisfied with life.

Prenatal active or passive tobacco smoke exposure and the risk of preterm delivery or low birth weight.

Abstract: We examined the association of exposure to environmental tobacco smoke with birth weight and gestational age in a large, prospective study We also compared these endpoints between infants of active maternal smokers and those of non-smoking, non-ETS exposed women Pregnant women were interviewed by telephone during the first trimester, and pregnancy outcome was determined for 99% Among the 4,454 singleton live births that could be linked to their birth certificate, we confirmed increased risks of low birth weight and small for gestational age with heavier maternal smoking (> 10 cigarettes/day), as well as noting an increased risk for "very preterm" birth ( or = 30 years) than those of younger mothers, as well as among non-whites High environmental tobacco smoke exposure (> or = 7 hours/day in non-smokers) was moderately associated with low birth weight (adjusted odds ratio (AOR) 18, 95% confidence limits (95% CL) = 082, 41), preterm birth (AOR 16, 95% CL = 087, 29), and most strongly with very preterm birth (AOR 24, 95% CL = 10, 53) These associations were generally greater among non-whites than whites The data support earlier studies suggesting that prenatal environmental tobacco smoke exposure, in addition to maternal smoking, affects infant health

Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women.

Abstract: The relationship between depressive symptom scores on the Center for Epidemiological Studies Depression Scale (CES-D; L. S. Radloff, 1977) at each trimester of pregnancy and a decrement in either fetal growth or gestational duration was evaluated among 666 pregnant women. There was no association overall, but among 222 women from lower occupational status households, each unit increase on the CES-D at 28 weeks gestation was associated with a reduction of 9.1 g (95% confidence interval [CI] = -16.0, -2.3) in gestational-age-adjusted birth weight. When missing data were multiply imputed, the estimate was -4.6 g (95% CI = - 10.7, 1.5). CES-D score was unrelated to fetal growth or gestational duration in analyses among other potentially high-risk subgroups: smokers, women with a history of adverse outcome, and women with social vulnerabilities. These results raise the possibility that among lower status women, depressive mood may be associated with restricted fetal growth.

Effects of gestation and birth weight on the growth and development of very low birthweight small for gestational age infants: a matched group comparison.

Abstract: AIMS—To investigate the effects of small for gestational age (SGA) in very low birthweight (VLBW) infants on growth and development until the fifth year of life. METHODS—VLBW (< 1500 g) infants, selected from a prospective study, were classified as SGA (n = 115) on the basis of birth weight below the 10th percentile for gestational age and were compared with two groups of appropriate for gestational age (AGA) infants matched according to birth weight (AGA-BW; n = 115) or gestation at birth (AGA-GA; n = 115). Prenatal, perinatal, and postnatal risk factors were recorded, and duration and intensity of treatment were computed from daily assessments. Body weight, length, and head circumference were measured at birth, five and 20 months (corrected for prematurity), and at 56 months. General development was assessed at five and 20 months with the Griffiths scale of babies abilities, and cognitive development at 56 months with the Columbia mental maturity scales, a vocabulary (AWST) and language comprehension test (LSVTA). RESULTS—Significant group differences were found in complications (pregnancy, birth, and neonatal), parity, and multiple birth rate. The AGA-GA group showed most satisfactory growth up to 56 months, with both the AGA-BW and SGA groups lagging behind. The AGA-GA group also scored significantly more highly on all developmental and cognitive tests than the other groups. Developmental test results were similar for the SGA and AGA-BW groups at five and 20 months, but AGA-BW infants (lowest gestation) had lower scores on performance intelligence quotient and language comprehension at 56 months than the SGA group. When prenatal and neonatal complications, parity, and multiple birth were accounted for, group differences in growth remained, but differences in cognitive outcome disappeared after five months. CONCLUSIONS—Being underweight and with a short gestation (SGA and VLBW) leads to poor weight gain and head growth in infancy but does not result in poorer growth than in infants of the same birth weight but shorter gestation (AGA-BW) in the long term. SGA is related to early developmental delay and later language problems; however, neonatal complications may have a larger detrimental effect on long term cognitive development of VLBW infants than whether they are born SGA or AGA.

Adult Functional Outcome of Those Born Small for Gestational Age: Twenty-six-year Follow-up of the 1970 British Birth Cohort

Abstract: The long-term effects of fetal growth retardation, if any, on intellectual and educational outcomes remain incompletely understood. Some but not all studies indicate cognitive impairment in children born small for gestational age (SGA). The present prospective cohort study reviewed school performance and achievement at ages 5, 10, and 16 years in 14,189 full-term infants born in the United Kingdom during 1 week in 1970. The group included 1064 SGA infants with a birth weightless than the fifth percentile for age at term. About half of the participants were followed up for 26 years for occupational status, income, marital status, life satisfaction, and disability. SGA children were significantly deficient in their performance on a wide range of standard tests from ages 5 to 16 years, but typically the deficits were not large. Reading scores at age 10 and spelling and word recognition at age 16 were not significantly abnormal. Teachers rated the 10-year-old SGA children significantly lower than children in the comparison group. SGA adolescents earned lower math grades. In addition, SGA children were more likely to be enrolled in special education classes. The two groups were similar in their emotional and social development. Adjusted years of education and weekly hours of work did not differ significantly. SGA adults were significantly less tall than their peers with an appropriate-for-gestational-age (AGA) birthweight (25 and 10 percent, respectively, had a height Significant functional impairment in childhood, adolescence, and early adult life is not uncommon in those who were SGA infants, suggesting that every effort should be made to enrich the environment for these children. JAMA 2000;283:625–632

Reduced uterine and ovarian size in adolescent girls born small for gestational age.

Abstract: Reduced fetal growth is known to be associated with a reduced ovarian fraction of primordial follicles, with ovarian hyperandrogenism and anovulation in late adolescence. In this study, we examined whether adolescent girls born small for gestational age also present an abnormality in uterine or ovarian size. Standardized ultrasound measurements of the internal genitalia were performed in 36 healthy post-menarcheal girls (mean age 14 y) born with a size that was either appropriate for gestational age (AGA) or small (SGA), birth weight averaging 0.1 and -3.0 SD, respectively; clinical and endocrine characteristics were documented concomitantly. Compared with AGA girls, the SGA girls had a smaller uterus (mean difference of 20%; p < 0.006) and a reduced ovarian volume (mean difference of 38%; p < 0.0002). In conclusion, the gynecological correlates of prenatal growth restriction are herewith extended to include a reduced size of the uterus and the ovaries.

Epidemiology of fetal death in Latin America.

Abstract: To identify risk factors associated with fetal death and to measure the rate and the risk of fetal death in a large cohort of Latin American women. We analyzed 837232 singleton births recorded in the Perinatal Information System Database of the Latin American Center for Perinatology and Human Development (CLAP) between 1985 and 1997. The risk factors analyzed included fetal factors and maternal sociodemographic obstetric and clinical characteristics. Adjusted relative risks were obtained after adjustment for potential confounding factors through multiple logistic regression models based on the method of generalized estimating equations. There were 14713 fetal deaths (rate=17.6 per 1000 births). The fetal death risk increased exponentially as pregnancy advanced. Thirty-seven percent of all fetal deaths occurred at term and 64% were antepartum. The main risk factors associated with fetal death were lack of antenatal care (adjusted relative risk [aRR]= 4.26; 95% confidence interval 3.84– 4.71) and small for gestational age (aRR=3.26; 95% CI 3.13–3.40). In addition the risk of death during the intrapartum period was almost tenfold higher for fetuses in noncephalic presentations. Other risk factors associated with stillbirth were: third trimester bleeding eclampsia chronic hypertension preeclampsia syphilis gestational diabetes mellitus Rh isoimmunization interpregnancy interval 6 months parity =4 maternal age =35 years illiteracy premature rupture of membranes body mass index =29.0 maternal anemia previous abortion and previous adverse perinatal outcomes. There are several preventable factors that should be dealt with in order to reduce the gap in fetal mortality between Latin America and developed countries. (authors)

Body composition, blood pressure, and lipid metabolism before and during long-term growth hormone (GH) treatment in children with short stature born small for gestational age either with or without GH deficiency.

Abstract: To assess the effects of long-term continuous GH treatment on body composition, blood pressure (BP), and lipid metabolism in children with short stature born small for gestational age (SGA), body mass index (BMI), skinfold thickness measurements, systemic BP measurements, and levels of blood lipids were evaluated in 79 children with a baseline age of 3‐11 yr with short stature (height SD-score, ,21.88) born SGA (birth length SD-score, ,21.88). Twenty-two of the 79 children were GH deficient (GHD). All children participated in a randomized, double-blind, dose-response multicenter GH trial. Fourand 6-yr data were compared between two GH dosage groups (3 vs. 6 IU/m 2 body surface/day). Untreated children with short stature born SGA are lean (mean BMI SD-score, 21.3; mean SD-score skinfolds, 20.8), have a higher systolic BP (SD-score, 0.7) but normal diastolic BP (SD-score, 20.1), and normal lipids (total cholesterol, 4.7 mmol/L; low-density lipoprotein, 2.9 mmol/L; high-density lipoprotein, 1.3 mmol/L) compared with healthy peers. During long-term continuous GH treatment, the BMI normalized without overall changes in sc fat compared with age-matched references, whereas the BP SD-score and the atherogenic index decreased significantly. Although the mean 6-yr increase in height SD-score was significantly higher in the children receiving GH treatment with 6 IU/m 2 zday (2.7) than in those receiving treatment with 3 IU/m 2 zday (2.2), no differences in the changes in BMI, skinfold measurements, BP, and lipids were found between the GH dosage groups. The pretreatment SD-scores for BMI, skinfold, and BP, as well as the lipid levels, were not significantly different between GHD and non-GHD children, but after 6 yr of GH treatment the skinfold SD-score and BP SD-score had decreased significantly more in the GHD than in the non-GHD children. Our data indicate that GH treatment has at least up to 6 yr positive instead of negative effects on body composition, BP, and lipid metabolism. In view of the reported higher risk of cardiovascular diseases in later life in children born SGA, further research into adulthood remains warranted. (J Clin Endocrinol Metab 85: 3786 ‐3792, 2000)

Maternal pregnancy estriol levels in relation to anamnestic and fetal anthropometric data.

Abstract: In epidemiologic studies of perinatal exposures, birth weight has been proposed as a proxy variable for intrauterine estrogen exposure. To assess the validity of this assumption, we performed analyses of the association between estriol levels in 188 women in the 17th, 25th, 33rd, and 37th weeks of pregnancy and the birth weights of their infants. We found a general increase in mean cumulative estriol dose with increasing birth weight category throughout pregnancy. In late pregnancy, mean pregnancy estriol level of mothers of infants in the highest birth weight category (>4,500 gm) was twice as high as that of mothers of infants in the lowest category (<2,500 gm), 775 nmol/liter and 392 nmol/liter, respectively. Smoking lowered the maternal estriol levels by 20% or more throughout pregnancy. With smoking and birth weight included in a regression analysis, maternal age, placental weight, and infant ponderal index did not add any explanatory power to the model. Our data suggest that, on an aggregate level, birth weight can be used as a proxy variable of intrauterine estriol exposure.

Growth hormone treatment of short children born small for gestational age: growth responses with continuous and discontinuous regimens over 6 years.

Abstract: We report an epi-analysis of 6-yr growth responses obtained with GH treatment in short children born small for gestational age (SGA). Four randomized, multicenter studies explored the effects of continuous and discontinuous regimens of GH treatment in short, non-GH-deficient SGA children. A total of 49 untreated and 139 treated children were followed over 2 and 6 yr, respectively. At the start of the study, the age of these 188 children averaged 5.2 yr (range, 2–8 yr), height was− 3.4 sd score, and height adjusted for parental height was −2.4 sd score. Onset of puberty was observed in 46% of the GH-treated cohort, on the average, at 10.7 yr in girls and 11.7 yr in boys. Two studies essentially investigated the effects of continuous GH treatment at a dose of 33 or 67 μg/kg·day, and two studies focused on the growth characteristics during an initial GH treatment for 2–3 yr (dose range, 33–100 μg/kg·day), followed by a withdrawal phase of 1–2 yr, and then by either no or 1 or more episodes of further GH trea...

Neonatal outcome in growth-restricted versus appropriately grown preterm infants.

Abstract: The objective of this paper is to examine whether growth-restricted preterm infants have a different neonatal outcome than appropriately grown preterm infants. All consecutive, singleton preterm deliveries between 27-35 weeks' gestation were included over a 4-year period. Infants with congenital anomalies and infants of diabetic mothers were excluded. Infants were categorized as small-for-gestational-age (SGA) when birth weight was at or below the 10th percentile, and appropriate-for-gestational-age (AGA) when between the 11th and 90th percentiles. Outcome variables included: neonatal death, respiratory distress syndrome (RDS), sepsis, intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Neonatal morbidity and mortality were examined by univariate and stepwise multivariate logistic regression analyses. Factors controlled for during the analysis included: maternal age; gestational age; mode of delivery; presence of preeclampsia, HELLP syndrome, prolonged premature rupture of membranes (PROM), placental abruption, placenta previa, prenatal steroid exposure, infant gender, and low Apgar score. Seventy-six infants were included in the SGA group and 209 in the AGA group. SGA infants had a higher mortality rate (p = 0.003). They also had more culture-proven sepsis episodes (p = 0.001). No differences were found with respect to the other outcomes. The results were similar when analyzed separately for the group of infants born at or below 32 weeks' gestation. Growth-restricted preterm infants were found to have both higher mortality and infection rates compared with AGA preterm infants. Growth restriction in the preterm neonate was not found to protect against other neonatal outcomes associated with prematurity. When considering elective preterm delivery for this high-risk group of pregnancies, the increased risks in the neonatal period should be taken into account.

Increased blood pressure but normal renal function in adult women born preterm.

Abstract: It has been suggested that children born small for gestational age may develop hypertension and renal dysfunction in adulthood due to impaired fetal kidney development Very little information on this issue is available on children born preterm The objective of this study was to investigate the relationship between birth weight, blood pressure, and kidney function in adult subjects who were born preterm or born small for gestational age (SGA) Study design: Subjects (n=50), all women born between 1966 and 1974, were evaluated at a mean age of 26±19 years They were allocated to three groups: (1) born before gestational week 32 (n=15), (2) born full term with birth weight 130 mmHg/subject during ABPM was calculated, the preterms had significantly more recordings above this value (P 130 mmHg and >140 mmHg systolic (P<005) compared to the controls SGA subjects were not significantly different from controls There were no significant differences in GFR, ERPF or urinary albumin excretion between the three groups Conclusion: Women born preterm seem to have a disturbance in blood pressure regulation in adulthood, a finding that is not observed for those born small for gestational age Kidney function in early adulthood seems to be normal in subjects born preterm or small for gestational age

A Comparison of Neonatal Mortality Risk Prediction Models in Very Low Birth Weight Infants

Abstract: Background. Risk-adjusted severity of illness is frequently used in clinical research and quality assessments. Although there are multiple methods designed for neonates, they have been infrequently compared and some have not been assessed in large samples of very low birth weight (VLBW; <1500 g) infants. Objectives. To test and compare published neonatal mortality prediction models, including Clinical Risk Index for Babies (CRIB), Score for Neonatal Acute Physiology (SNAP), SNAP-Perinatal Extension (SNAP-PE), Neonatal Therapeutic Interventions Scoring System, the National Institute of Child Health and Human Development (NICHD) network model, and other individual admission factors such as birth weight, low Apgar score (<7 at 5 minutes), and small for gestational age status in a cohort of VLBW infants from the Washington, DC area. Methods. Data were collected on 476 VLBW infants admitted to 8 neonatal intensive care units between October 1994 and February 1997. The calibration (closeness of total observed deaths to the predicted total) of models with published coefficients (SNAP-PE, CRIB, and NICHD) was assessed using the standardized mortality ratio. Discrimination was quantified as the area under the curve (AUC) for the receiver operating characteristic curves. Calibrated models were derived for the current database using logistic regression techniques. Goodness-of-fit of predicted to observed probabilities of death was assessed with the Hosmer-Lemeshow goodness-of-fit test. Results. The calibration of published algorithms applied to our data was poor. The standardized mortality ratios for the NICHD, CRIB, and SNAP-PE models were .65,.56, and.82, respectively. Discrimination of all the models was excellent (range:.863-.930). Surprisingly, birth weight performed much better than in previous analyses, with an AUC of.869. The best models using both 12- and 24-hour postadmission data, significantly outperformed the best model based on birth data only but were not significantly different from each other. The variables in the best model were birth weight, birth weight squared, low 5-minute Apgar score, and SNAP (AUC =.930). Conclusion. Published models for severity of illness overpredicted hospital mortality in this set of VLBW infants, indicating a need for frequent recalibration. Discrimination for these severity of illness scores remains excellent. Birth variables should be reevaluated as a method to control for severity of illness in predicting mortality.

Maternal smoking affects fetal growth more in the male fetus.

Abstract: This study investigated the association between maternal cigarette smoking and fetal growth, evaluated by longitudinal ultrasound examinations and by neonatal anthropometric measurements. The investigation was carried out in a healthy population of affluent Scandinavian women, parity 1 and 2, who were selected consecutively and prospectively, and with term, normal pregnancies. Three hundred and six non-smoking, 242 light-smoking and 308 heavy-smoking mothers and their newborns were examined. Ultrasound measurements were performed in pregnancy weeks 17, 25, 33 and 37. Biparietal diameter (BPD), mean abdominal diameter (MAD) and femur length were recorded. The negative effect on fetal growth from maternal smoking was found to affect the male fetus proportionally more than the female. Boys born to heavy-smoking mothers had a weight reduction of 8.2% and a lower fat accretion (as measured by subscapular skinfold) of 12%, whereas girls had a weight and fat reduction of 4.8% and 2% respectively. In boys (but not girls) born to smokers, head circumference was significantly smaller, also reflected by significantly smaller mean BPD measurements recorded from pregnancy week 18 onwards. The MAD measurements became successively more negatively affected in the second half of pregnancy in both males and females. A greater intrauterine growth velocity and a different hormonal milieu are suggested as possible explanations of the greater male susceptibility.

Cognitive development of term small for gestational age children at five years of age

Abstract: AIM To assess the relative significance for cognitive development of small for gestational age, parental demographic factors, and factors related to the child rearing environment. METHODS IQ of a population based cohort of 338 term infants who were small for gestational age (SGA) and without major handicap, and a random control sample of 335 appropriate for gestational age (AGA) infants were compared at 5 years of age. RESULTS The mean non-verbal IQ was four points lower, while the mean verbal IQ was three points lower for the children in the SGA group. The results were not confounded by parental demographic or child rearing factors. However, parental factors, including maternal non-verbal problem solving abilities, and child rearing style, accounted for 20% of the variance in non-verbal IQ, while SGA versus AGA status accounted for only 2%. The comparable numbers for verbal IQ were 30 and 1%. Furthermore, we found no evidence that the cognitive development of SGA children was more sensitive to a non-optimal child rearing environment than that of AGA children. Maternal smoking at conception was associated with a reduction in mean IQ comparable to that found for SGA status, and this effect was the same for SGA and AGA children. The cognitive function of asymmetric SGA was comparable to that of symmetric SGA children. CONCLUSIONS Our findings indicate that child cognitive development is strongly associated with parental factors, but only marginally associated with intrauterine growth retardation.