Preterm and term births of small for gestational age infants: a population-based study of risk factors among nulliparous women

Authors

  • Britt Clausson,

    Senior Staff Fellow , Corresponding author
    1. Department of Medical Epidemiology, Karolinska Institute, Stockholm
    2. Department of Obstetrics and Gynaecology, Uppsala University, Sweden
      Correspondence: Dr B. Clausson, Department of Obstetrics and Gynaecology, University Hospital, S-751 85 Uppsala, Sweden.
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  • Sven Cnattingius,

    Associate Professor
    1. Department of Medical Epidemiology, Karolinska Institute, Stockholm
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  • Ove Axelsson

    Associate Professor
    1. Department of Obstetrics and Gynaecology, Uppsala University, Sweden
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Correspondence: Dr B. Clausson, Department of Obstetrics and Gynaecology, University Hospital, S-751 85 Uppsala, Sweden.

Abstract

Objective To study risk factors for small for gestational age (SGA) infants by gestational age among nulliparous women and to estimate mortality rates among SGA and appropriate-for-gestational-age (AGA) infants by gestational age.

Design A population-based study from the Swedish Medical Birth Register.

Setting Sweden 1992–1993.

Population Liveborn singleton infants to nulliparous women (n= 96,662).

Main outcome measures Crude and adjusted odds ratios of risk factors for SGA by gestational age. Rates of neonatal and postneonatal mortality.

Results Older maternal age (≥ 30 years) was foremost associated with increased risks of very and moderately preterm SGA (≥ 32 weeks and 33–36 weeks, respectively), but also with term SGA (≥ 37 weeks). Risks of SGA increased with decreasing maternal height at all gestational ages. Smoking increased the risks of moderately preterm and term SGA. Short maternal education increased the risk of preterm SGA and low pre-pregnancy body mass index slightly increased the risk of term SGA. Pre-eclampsia and essential hypertension foremost increased the risk of very preterm SGA (OR = 40.5 and 32.4, respectively) and moderately preterm SGA (OR = 17.4 and 10.6, respectively), but also increased the risk of term SGA. Neonatal and postneonatal mortality rates of SGA infants were substantially influenced by gestational age, and mortality rates were consistently higher among preterm SGA infants compared with AGA infants.

Conclusions Risk factors for SGA and mortality rates among SGA infants vary by gestational age. A subdivision of risk factors by gestational age adds knowledge, particularly about risks of preterm SGA, where the highest rates of mortality were observed.

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