• Fetal growth restriction;
  • small-for-gestational-age


Examine whether small-for-gestational-age (SGA) risk factors differed by prior SGA birth.


Hospital-based cohort study.


Utah, USA.


Electronic medical record data from 25 241 women who were nulliparous at study entry with ≥2 subsequent consecutive singleton deliveries (2002–2010).


Estimated adjusted relative risks (RR) and 95% confidence intervals (95% CI) for the association between second pregnancy characteristics and SGA risk. Tested for risk factor differences between recurrence and incidence (Pdifference).

Main outcome measures

Second pregnancy incident (= 1067) and recurrent SGA (= 484) determined using a population-based reference.


SGA complicated 20.3 and 4.5% of deliveries to women with and without a prior SGA birth, respectively. Young maternal age (Pdifference = 0.01) and pregnancy hypertensive diseases (Pdifference = 0.03) were associated with incident but not recurrent SGA. Significant risk factors for incidence and recurrence were smoking (incident RR = 1.64 [95% CI 1.22–2.19]; recurrent RR = 1.59 [95% CI 1.17–2.17]), short stature (incident RR = 1.34 [95% CI 1.16–1.54]; recurrent RR = 1.54 [95% CI 1.31–1.82]), prepregnancy underweight (incident RR = 1.32 [95% CI 1.07–1.64]; recurrent RR = 1.30 [95% CI 1.03–1.64]), and inadequate weight gain (incident RR = 1.41 [95% CI 1.22–1.64]; recurrent RR = 1.33 [95% CI 1.10–1.60]). Race-ethnicity, marital or insurance status, alcohol, diabetes, asthma, thyroid disease, depression, or interpregnancy interval were not associated with incidence or recurrence.


There was considerable overlap in the risk factors for SGA recurrence and incidence. Recurrence and incidence risk factors included smoking, short stature, underweight, and inadequate weight gain. Maternal age and hypertensive diseases increased the risk for incidence only. Regardless of the SGA definition, some potentially modifiable risk factors for recurrence were identified.