Objectives: To investigate the factors influencing the occurrence of small for gestational age (SGA) at different degrees and provide a basis for early identification of severe SGA cases.
Methods: Neonatal and maternal prenatal information were retrospectively collected from January 2018 to December 2022 at Peking University People's Hospital. The neonates were divided into three groups: severe SGA group (birth weight below the 3rd percentile for gestational age and sex), mild SGA group (birth weight ≥3rd percentile and <10th percentile), and non-SGA group (birth weight ≥10th percentile). An ordered multinomial logistic regression model was used to analyze the factors influencing the occurrence of SGA at different degrees.
Results: A total of 14 821 neonates were included, including 258 cases (1.74%) in the severe SGA group, 902 cases (6.09%) in the mild SGA group, and 13 661 cases (92.17%) in the non-SGA group. The proportions of preterm births and stillbirths were higher in the severe SGA group compared to the mild SGA and non-SGA groups (P<0.0125). The proportion of neonatal asphyxia was higher in both the severe SGA and mild SGA groups compared to the non-SGA group (P<0.0125). Ordered multinomial logistic regression analysis showed that maternal pre-pregnancy underweight (OR=1.838), maternal pre-pregnancy obesity (OR=3.024), in vitro fertilization-embryo transfer (OR=2.649), preeclampsia (OR=1.743), connective tissue disease during pregnancy (OR=1.795), nuchal cord (OR=1.213), oligohydramnios (OR=1.848), and intrauterine growth restriction (OR=27.691) were all associated with a higher risk of severe SGA (P<0.05). Maternal parity as a multipara (OR=0.457) was associated with a lower likelihood of severe SGA (P<0.05).
Conclusions: Maternal pre-pregnancy underweight, maternal pre-pregnancy obesity, in vitro fertilization-embryo transfer, preeclampsia, connective tissue disease during pregnancy, oligohydramnios, nuchal cord, and intrauterine growth restriction are closely related to the occurrence of more severe SGA. Maternal parity as a multipara acts as a protective factor against the occurrence of severe SGA.
目的: 探讨不同程度小于胎龄儿（small for gestational age, SGA）发生的影响因素，为早期识别重度SGA的发生提供依据。方法: 回顾性收集2018年1月—2022年12月北京大学人民医院产科出生的新生儿及其母亲围产期资料。新生儿分为重度SGA组（出生体重低于同胎龄同性别婴儿的第3百分位数）、轻度SGA组（出生体重≥第3百分位数且<第10百分位数）和非SGA组（出生体重≥第10百分位数）。采用有序多分类logistic回归模型分析不同程度SGA发生的影响因素。结果: 共纳入14 821例新生儿，其中重度SGA组258例（1.74%），轻度SGA组902例（6.09%），非SGA组13 661例（92.17%）。早产儿比例和死产比例均为重度SGA组>轻度SGA组>非SGA组（P<0.0125）；重度SGA组与轻度SGA组新生儿窒息比例均大于非SGA组（P<0.0125）。有序多分类logistic回归分析显示：母孕前消瘦（OR=1.838）、母孕前肥胖（OR=3.024）、体外受精-胚胎移植（OR=2.649）、妊娠合并子痫前期（OR=1.743）、妊娠合并结缔组织病（OR=1.795）、脐带绕颈（OR=1.213）、羊水少（OR=1.848）、宫内生长受限（OR=27.691）等均与发生更严重的SGA有关（P<0.05）；孕母为经产妇（OR=0.457）更倾向于不发生严重的SGA（P<0.05）。结论: 母孕前消瘦、母孕前肥胖、体外受精-胚胎移植、妊娠合并子痫前期、妊娠合并结缔组织病、羊水少、脐带绕颈、宫内生长受限与更严重的SGA发生密切相关；孕母为经产妇是发生严重SGA的保护因素。.
Keywords: Body mass index; Multipara; Neonate; Risk factor; Small for gestational age.