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  1. Crawford K, Hong J, Kumar S
    Am J Obstet Gynecol MFM, 2023 Dec;5(12):101187.
    PMID: 37832646 DOI: 10.1016/j.ajogmf.2023.101187
    BACKGROUND: Many risk factors for stillbirth are linked to placental dysfunction, which leads to suboptimal intrauterine growth and small for gestational age infants. Such infants also have an increased risk for stillbirth.

    OBJECTIVE: This study aimed to investigate the effect of known causal risk factors for stillbirth, and to identify those that have a large proportion of their risk mediated through small for gestational age birth.

    STUDY DESIGN: This retrospective cohort study used data from all births in the state of Queensland, Australia between 2000 and 2018. The total effects of exposures on the odds of stillbirth were determined using multivariable, clustered logistic regression models. Mediation analysis was performed using a counterfactual approach to determine the indirect effect and percentage of effect mediated through small for gestational age. For risk factors significantly mediated through small for gestational age, the relative risks of stillbirth were compared between small for gestational age and appropriate for gestational age infants. We also investigated the proportion of risk mediated via small for gestational age for late stillbirths (≥28 weeks).

    RESULTS: The initial data set consisted of 1,105,612 births. After exclusions, the final study cohort constituted 925,053 births. Small for gestational age births occurred in 9.9% (91,859/925,053) of the study cohort. Stillbirths occurred in 0.5% of all births (4234/925,053) and 1.5% of small for gestational age births (1414/91,859). Births at ≥28 weeks occurred in 99.4% (919,650/925,053) of the study cohort and in 98.9% (90,804/91,859) of all small for gestational age births. Of the ≥28-week births, stillbirths occurred in 0.2% (2156/919,650) of all births and 0.8% (677/90,804) of the small for gestational age births. Overall, increased odds of stillbirth were significantly mediated through small for gestational age for age <20 years, low socioeconomic status, Indigenous ethnicity, birth in sub-Saharan and North Africa or the Middle East, smoking, nulliparity, multiple pregnancy, assisted conception, previous stillbirth, preeclampsia, and renal disease. Preeclampsia had the largest proportion mediated through small for gestational age (66.7%), followed by nulliparity (61.6%), smoking (29.4%), North-African or Middle Eastern ethnicity (27.6%), multiple pregnancy (26.3%), low socioeconomic status (25.8%), and Indigenous status (18.7%). Sensitivity analysis showed that for late stillbirths, the portions mediated through small for gestational age remained very similar for many of the risk factors.

    CONCLUSION: Although small for gestational age is an important mediator between many pregnancy risk factors and stillbirth, mitigating the risk of small for gestational age is likely to be of value only when it is a major contributor in the pathway to fetal demise.

    Matched MeSH terms: Fetal Growth Retardation/epidemiology
  2. Lim NL, Cheah IGS, Soosai AP
    Med J Malaysia, 2001 Mar;56(1):65-70.
    PMID: 11503299
    A prospective observational study of feeding in low birth weight (LBW) infants with birth weight (BW) of at least 1.8 kg admitted to the Neonatal Intensive Care Unit (NICU) showed that nearly 80% of mothers provided expressed breastmilk (EBM) and a further 14% breastfed their infants before discharge. Weight gain was overall poor at a mean of 9.48 +/- 7.82 grams per kg per day with those on predominant EBM feeding (EBM > 70%) doing worse than those on predominant preterm formula (PTF) feeding (EBM < 31%), weight gain being 5.40 +/- 6.88 and 11.10 +/- 8.15 grams per kg per day respectively (p < 0.01). Weight gain was also poorer (7.72 +/- 5.55 grams per kg per day) in patients with respiratory distress syndrome (RDS) compared to those who did not have RDS (12.02 +/- 9.58 grams per kg per day). p < 0.05. Incidence of infants < 10th centile body weight at birth was 16.8% and at discharge was 69.1%.
    Matched MeSH terms: Fetal Growth Retardation/epidemiology
  3. Hastuti L, Litasari A, Kardiatun K, Mardiyani R, Rahmawati A, Jais S
    Med J Malaysia, 2024 Nov;79(6):757-763.
    PMID: 39614795
    INTRODUCTION: The weight of an infant at the time of birth is an indicator of its health. Infants with low birth weight (LBW) are at a higher risk of neonatal mortality and morbidity as well as stunted growth. Low birth weight (LBW) remains a public health concern in developing countries, such as Indonesia. In fact, the neonatal mortalities and morbidities that occur as a consequence of LBW can be prevented by addressing the relevant risk factors. It is believed that by identifying these risk factors, prevention and management efforts can be efficiently and effectively implemented to reduce incidences of LBW (LBWIs). As such, the present study determined the factors affecting LBWIs in a rural setting in Pontianak City, Indonesia.

    MATERIALS AND METHODS: This is a retrospective unmatched case-control study. The required data was obtained from the medical records maintained by the University Tanjungpura Hospital, Pontianak City, Indonesia. Simple random sampling was used to select and equally divide the 60 chosen respondents into LBW case and normal birth weight control groups.

    RESULTS: Mothers with low educational levels had a 1.5 times greater chance of giving birth to LBW babies. The results of the multivariate analysis also revealed a correlation between gestational age (GA), incidence of premature rupture of membranes (PROM), and intrauterine growth restriction (IUGR) and that their combined effects that contributed to 56% of LBWIs.

    CONCLUSION: Low maternal education level, low gestational age, IUGR, and premature rupture of membranes contribute to LBW babies. This study recommends that it is necessary to educate women of childbearing age about routine antenatal care checks to identify risk factors that can lead to LBW.

    Matched MeSH terms: Fetal Growth Retardation/epidemiology
  4. TambyRaja RL
    Matern Child Health J, 1999 Jun;3(2):111-3.
    PMID: 10892419
    Singapore provides a rich environment for investigations into ethnic differences in pregnancy outcome, as it is populated by Malays, Indians, and Chinese. Years of clinical practice and obstetric research in this environment have affirmed the observation that many factors interact in determining length of gestation and birth weight, and that these factors have differential affects among these three different ethnic groups. Although technological advances have furthered our understanding of obstetrical outcomes and provided essential tools to promote the survival of premature infants, the persistent use of uniform growth standards hampers our ability to assure positive outcomes for women of different ethnicity. Recognition of ethnic differences has resulted in declines in certain negative pregnancy outcomes for women in Singapore. The development of race-specific uterine growth curves will enhance the provision of perinatal care for all women.
    Matched MeSH terms: Fetal Growth Retardation/epidemiology
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