Effect of antenatal detection of small-for-gestational-age newborns in a risk stratified retrospective cohort


Autoři: Anna Kajdy aff001;  Jan Modzelewski aff001;  Monika Jakubiak aff001;  Artur Pokropek aff002;  Michał Rabijewski aff001
Působiště autorů: Centre of Postgraduate Medical Education, Department of Reproductive Health, Warsaw, Poland aff001;  Institute of Philosophy and Sociology Polish Academy of Sciences, Warsaw, Poland aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224553

Souhrn

Objective

Small-for-gestational-age (SGA) are neonates born with birth weight below the 10th centile for a given week of pregnancy. It is a risk factor of perinatal and neonatal morbidity and mortality. There is an ongoing debate whether prenatal detection of SGA neonates is good predictor of perinatal outcome especially in low risk populations. Our primary aim was to compare the odds ratios for unfavorable outcome in a risk stratified cohort of SGA neonates in regard to prenatal detection status.

Methods

This is a retrospective cohort study analysing the effect of prenatal detection on perinatal outcome. This cohort has been divided into a predefined low-risk and high-risk population. Electronic records of 39,032 singleton deliveries from 2010 through 2016 were analysed. SGA was defined as newborn weight below the 10th percentile on the Fenton growth chart. Detected SGA (dSGA) neonates were those that were admitted for delivery with a prenatal ultrasound diagnosis of abnormal growth. Undetected SGA (uSGA) were neonates that were found to be below the 10th percentile after birth. Perinatal and neonatal outcome was compared.

Results

The detection rate in high-risk pregnancies was almost 45.7% versus low risk where it amounted to 18.9%. In both the high-risk and low-risk populations there was a significantly higher risk of composite mortality for undetected SGA compared to approporiate-for-gestational-age (AGA) (OR 7.95 CI 4.76–13.29; OR 14.4 CI 4.99–41.45 respectively). The odds for the composite neonatal outcome were significantly higher for dSGA and uSGA than for AGA in all the studied populations except for the uSGA in high risk population (OR 1.57 CI 0.97–3.53). Importantly, there was not a single case of intrauterine fetal death among detected SGA, in the low risk group.

Conclusions

Prenatal detection of SGA status is related to perinatal outcomes, especially mortality. Therefore, assessment of SGA status even in low-risk pregnancies could help predict potential perinatal and neonatal complications.

Klíčová slova:

Diabetes mellitus – Fetal death – Gestational diabetes – Hypertensive disorders in pregnancy – Management of high-risk pregnancies – Neonatal sepsis – Neonates – Obesity


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