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. 2013 Jul;1(1):e26-36.
doi: 10.1016/S2214-109X(13)70006-8. Epub 2013 Jun 25.

National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010

Anne C C Lee  1 , Joanne Katz  2 , Hannah Blencowe  3 , Simon Cousens  3 , Naoko Kozuki  2 , Joshua P Vogel  4 , Linda Adair  5 , Abdullah H Baqui  2 , Zulfiqar A Bhutta  6 , Laura E Caulfield  2 , Parul Christian  2 , Siân E Clarke  7 , Majid Ezzati  8 , Wafaie Fawzi  9 , Rogelio Gonzalez  10 , Lieven Huybregts  11 , Simon Kariuki  12 , Patrick Kolsteren  11 , John Lusingu  13 , Tanya Marchant  14 , Mario Merialdi  15 , Aroonsri Mongkolchati  16 , Luke C Mullany  2 , James Ndirangu  17 , Marie-Louise Newell  18 , Jyh Kae Nien  19 , David Osrin  20 , Dominique Roberfroid  21 , Heather E Rosen  2 , Ayesha Sania  22 , Mariangela F Silveira  23 , James Tielsch  24 , Anjana Vaidya  20 , Barbara A Willey  25 , Joy E Lawn  26 , Robert E Black  2 ; CHERG SGA-Preterm Birth Working Group
Collaborators, Affiliations

National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010

Anne C C Lee et al. Lancet Glob Health. 2013 Jul.

Erratum in

  • Lancet Glob Health. 2013 Aug;1(2):e76

Abstract

Background: National estimates for the numbers of babies born small for gestational age and the comorbidity with preterm birth are unavailable. We aimed to estimate the prevalence of term and preterm babies born small for gestational age (term-SGA and preterm-SGA), and the relation to low birthweight (<2500 g), in 138 countries of low and middle income in 2010.

Methods: Small for gestational age was defined as lower than the 10th centile for fetal growth from the 1991 US national reference population. Data from 22 birth cohort studies (14 low-income and middle-income countries) and from the WHO Global Survey on Maternal and Perinatal Health (23 countries) were used to model the prevalence of term-SGA births. Prevalence of preterm-SGA infants was calculated from meta-analyses.

Findings: In 2010, an estimated 32·4 million infants were born small for gestational age in low-income and middle-income countries (27% of livebirths), of whom 10·6 million infants were born at term and low birthweight. The prevalence of term-SGA babies ranged from 5·3% of livebirths in east Asia to 41·5% in south Asia, and the prevalence of preterm-SGA infants ranged from 1·2% in north Africa to 3·0% in southeast Asia. Of 18 million low-birthweight babies, 59% were term-SGA and 41% were preterm-SGA. Two-thirds of small-for-gestational-age infants were born in Asia (17·4 million in south Asia). Preterm-SGA babies totalled 2·8 million births in low-income and middle-income countries. Most small-for-gestational-age infants were born in India, Pakistan, Nigeria, and Bangladesh.

Interpretation: The burden of small-for-gestational-age births is very high in countries of low and middle income and is concentrated in south Asia. Implementation of effective interventions for babies born too small or too soon is an urgent priority to increase survival and reduce disability, stunting, and non-communicable diseases.

Funding: Bill & Melinda Gates Foundation by a grant to the US Fund for UNICEF to support the activities of the Child Health Epidemiology Reference Group (CHERG).

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Figures

Figure 1
Figure 1
Scatterplots showing the relation of term-SGA to LBW and neonatal mortality rate (A) logit(term-SGA prevalence) versus ln(LBW prevalence). (B) logit(term-SGA prevalence) versus neonatal mortality rate. SGA=small for gestational age. LBW=low birthweight.
Figure 2
Figure 2
Estimated prevalence of SGA births in 138 low-income and middle-income countries SGA=small for gestational age.
Figure 3
Figure 3
Prevalence of SGA, preterm births, and LBW by UN-MDG region in 2010 AGA=appropriate for gestational age. SGA=small for gestational age. LBW=low birthweight.
Figure 4
Figure 4
Public health implications of the burden of preterm and SGA births for 120 million births in countries of low and middle income AGA=appropriate for gestational age. SGA=small for gestational age. LBW=low birthweight. Adapted from reference 37, with permission of WHO.
See this image and copyright information in PMC

Comment in

  • Born too small or too soon.
    Kramer MS. Kramer MS. Lancet Glob Health. 2013 Jul;1(1):e7-8. doi: 10.1016/S2214-109X(13)70014-7. Epub 2013 Jun 25. Lancet Glob Health. 2013. PMID: 25103586 No abstract available.

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