Work

Comparison of methods for identifying small‐for‐gestational‐age infants at risk of perinatal mortality among obese mothers: a hospital‐based cohort study

Year: 2016

Type: article

Abstract: Objective To assess differences in small‐for‐gestational age (SGA) classifications for the detection of neonates with increased perinatal mortality risk among obese women and subsequently assess the association between prepregnancy body mass index (BMI) status and SGA. Design Hospital‐based cohort. Setting Twelve US clinical centres (2002–08). Population A total of 114 626 singleton, nonanomalous pregnancies. Methods Data were collected using electronic medical record abstraction. Relative risks (RR) with 95% CI were estimated. Main outcome measures SGA trends (birthweight < 10th centile) classified using population‐based (SGAPOP), intrauterine (SGAIU) and customised (SGACUST) references were assessed. The SGA‐associated perinatal mortality risk was estimated among obese women. Using the SGA method most associated with perinatal mortality, the association between prepregnancy BMI and SGA was estimated. Results The overall perinatal mortality prevalence was 0.55% and this increased significantly with increasing BMI (P < 0.01). Among obese women, SGAIU detected the highest proportion of perinatal mortality cases (2.49%). Perinatal mortality was 5.32 times (95% CI 3.72–7.60) more likely among SGAIU neonates than non‐SGAIU neonates. This is in comparison with the 3.71‐fold (2.49–5.53) and 4.81‐fold (3.41–6.80) increased risk observed when SGAPOP and SGACUST were used, respectively. Compared with women of normal weight, overweight women (RR = 0.82, 95% CI 0.78–0.86) and obese women (RR = 0.80; 95% CI 0.75–0.83) had a lower risk for delivering an SGAIU neonate. Conclusion Among obese women, the intrauterine reference best identified neonates at risk of perinatal mortality. Based on SGAIU, SGA is less common among obese women but these SGA babies are at a high risk of death and remain an important group for surveillance. Tweetable abstract SGA is less common among obese women but these SGA babies are at a high risk of death.

Source: BJOG An International Journal of Obstetrics & Gynaecology

DOI: 10.1111/1471-0528.13896

Authors: SN Hinkle, LA Sjaarda, PS Albert, P Mendola, KL Grantz

Institutions: National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development

Language: English

Topic: Gestational Diabetes Research and Management

Subfield: Obstetrics and Gynecology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funders: National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development