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. 2014 Mar 18;9(3):e92074.
doi: 10.1371/journal.pone.0092074. eCollection 2014.

Prevalence of small-for-gestational-age and its mortality risk varies by choice of birth-weight-for-gestation reference population

Joanne Katz  1 , Lauren A Wu  1 , Luke C Mullany  1 , Christian L Coles  1 , Anne C C Lee  2 , Naoko Kozuki  1 , James M Tielsch  3
Affiliations

Prevalence of small-for-gestational-age and its mortality risk varies by choice of birth-weight-for-gestation reference population

Joanne Katz et al. PLoS One. .

Abstract

Background: We use data from rural Nepal and South India to compare the prevalence of small-for-gestational-age (SGA) and neonatal mortality risk associated with SGA using different birth-weight-for-gestation reference populations.

Methods: We identified 46 reference populations in low-, middle-, and high-income countries, of which 26 met the inclusion criteria of being commonly cited and having numeric 10th percentile cut points published. Those reference populations were then applied to populations from two community-based studies to determine SGA prevalence and its relative risk of neonatal mortality.

Results: The prevalence of SGA ranged from 10.5% to 72.5% in Nepal, and 12.0% to 78.4% in India, depending on the reference population. Females had higher rates of SGA than males using reference populations that were not sex specific. SGA prevalence was lowest when using reference populations from low-income countries. Infants who were both preterm and SGA had much higher mortality risk than those who were term and appropriate-for-gestational-age. Risk ratios for those who are both preterm and SGA ranged from 7.34-17.98 in Nepal and 5.29-11.98 in India, depending on the reference population.

Conclusions: These results demonstrate the value of a common birth-weight-for-gestation reference population that will facilitate comparisons of SGA prevalence and mortality risk across research studies.

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Conflict of interest statement

Competing Interests: Procter and Gamble Company provided commodity support for the Nepal Chlorhexidine study. There are no further patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Figure 1
Figure 1. Risk ratios for Term-Small-for-Gestational-Age, Neonatal Mortality: Southern Nepal (reference: Term-Appropriate-for-Gestational-Age).
Figure 2
Figure 2. Risk ratios for Preterm-Appropriate-for-Gestational-Age, Neonatal Mortality: Southern Nepal (reference: Term-Appropriate-for-Gestational-Age).
Figure 3
Figure 3. Risk ratios for Preterm-Small-for-Gestational-Age, Neonatal Mortality: Southern Nepal (reference: Term-Appropriate-for-Gestational-Age).
See this image and copyright information in PMC

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