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. 2013 Apr 11:39:23.
doi: 10.1186/1824-7288-39-23.

Intrauterine growth restriction and congenital malformations: a retrospective epidemiological study

Giuseppe Puccio  1 , Mario Giuffré, Maria Piccione, Ettore Piro, Grazia Rinaudo, Giovanni Corsello
Affiliations

Intrauterine growth restriction and congenital malformations: a retrospective epidemiological study

Giuseppe Puccio et al. Ital J Pediatr. .

Abstract

Background: Intrauterine growth restriction (IUGR) and small for gestational age (SGA) birth have been considered possible indicators of the presence of malformations. The aim of this study is to evaluate such relationships in a population of newborns, along with other epidemiological and auxological parameters, in particular the ponderal index (PI).

Methods: We analyzed the birth data of 1093 infants, classified according to weight for gestational age as SGA, appropriate for gestational age (AGA) or large for gestational age (LGA). The prevalence of malformations was analyzed in relation to weight percentile at birth and SGA birth, maternal smoking, pregnancy diseases and PI.

Results: Our analysis showed no significant relationship between the prevalence of malformations and SGA birth. Maternal smoking and pregnancy diseases were strongly related to SGA birth, but not to a higher prevalence of malformations. PI, however, had a significant relationship with a higher prevalence of malformations, if analyzed as either a continuous variable or a categorical variable (cutoff: < 2.4).

Conclusions: The association between congenital malformations and birth weight for gestational age seems to be weak. As part of diagnostic screening for malformations in the neonatal period, PI could be considered a better predictor of risk than weight percentile.

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Figures

Figure 1
Figure 1
Weight percentile distribution according to the presence of malformations. Wilcoxon test, p = 0.078.
Figure 2
Figure 2
Ponderal Index distribution according to the presence of malformations. Wilcoxon test, p = 0.006.
Figure 3
Figure 3
ROC curve of PI as a predictor for malformations. A ROC curve of the trade-off between true positive rate and false positive rate measures across the range of all cutoffs. The curve is parametrized with the cutoff.
Figure 4
Figure 4
Chi square values across the range of cutoffs for PI as a predictor for malformations. The vertical line corresponds to the chosen cutoff of 2.4.
Figure 5
Figure 5
Weight percentile at birth and Ponderal Index at birth in babies with congenital malformations. Horizontal dashed line: PI cutoff (2.4); Vertical dashed line: Weight percentile cutoff (10); Yellow and green rectangles: cases with weight percentile lower than 10; Blue and green rectangles: cases with PI lower than 2.4; Green rectangle: cases with weight percentile lower than 10 and PI lower than 2.4 (only babies with congenital malformations).
Figure 6
Figure 6
Sensitivity, Specificity, PPV, NPV of different parameters considered as predictors of malformations. PPV = Positive Predictive Value; NPV = Negative Predictive Value; CI = Confidence Interval; Perc = weight percentile at birth; PI = Ponderal Index at birth; SGA = Small for Gestational Age newborn.
Figure 7
Figure 7
Ponderal Index distribution according to the type of malformation. Horizontal blue line: PI cutoff (2.4); Kruskal Wallis test, p = 0.93.
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