Small for gestational age newborns--does pre-recognition make a difference in pregnancy outcome?

Abstract

Objective: We aimed to evaluate whether pre-recognition of small for gestational age (SGA) at late preterm or term pregnancies, has an impact on pregnancy outcome.

Methods: Retrospective analysis of SGA newborns, stratified to those with suspected or unsuspected IUGR according the sonographic estimated fetal weight (EFW), below the 10th percentile for gestational age (n = 619), with fetuses not suspected as SGA (EFW ≥10th percentile) preformed up to 7 days prior to delivery (n = 1770).

Results: SGA was correctly diagnosed prior to delivery in 26% of the fetuses. Women with suspected SGA were delivered earlier (37.9 ± 1.7 versus 38.8 ± 1.4 weeks, p < 0.001) and at a lower birth weight (2280 ± 321 versus 2454 ± 263 grams, p < 0.001). They also had higher rates of induction of labor (19.1% versus 6.2%, p < 0.001) and cesarean delivery (29.1% versus 19.8%, p < 0.001). Fetuses suspected for SGA had higher rate of neonatal adverse outcome, but on multivariate analysis suspected SGA (aOR 0.41, 95% CI 0.20-0.86), birthweight (aOR 0.67, 95% CI 0.5 to -0.77 for each additional 50 g), gestational age at delivery (aOR 0.63, 95% CI 0.56-0.71 for each additional week) and spontaneous vaginal delivery (aOR 0.88, 95% CI 0.19-3.89) were independently associated with an improved neonatal composite outcome.

Conclusion: Identification of SGA may improve neonatal outcome. However, by itself, it is not an indication for intervention, which may lead to adverse outcome.

Keywords: Adverse pregnancy outcome; small for gestational age; sonographic estimated fetal weight; ultrasound.