Trends of change in the individual contribution of risk factors for small for gestational age over more than 2 decades
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MATERNAL-FETAL MEDICINE
Trends of change in the individual contribution of risk factors for small for gestational age over more than 2 decades Reut Rotem1 · Misgav Rottenstriech1 · Ella Prado2 · Yael Baumfeld2 · David Yohay2 · Gali Pariente2 · Adi Y. Weintraub2 Received: 5 March 2020 / Accepted: 28 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Over the past years, the prevalence of various risk factors for small for gestational age (SGA) neonates has changed. Little is known if there was also a change in the specific contribution of these risk factors to the prevalence of SGA. We aim to identify trends in the specific contribution of various risk factors for SGA by observing their odds ratios (ORs) throughout different time periods. Methods A nested case–control study was conducted. The ORs for selected known risk factors for SGA occurring in three consecutive 8-year intervals between 1988 and 2014 (T1 – 1988–1996; T2 – 1997–2005; T3 – 2006–2014) were compared. Data were retrieved from the medical centre’s computerized perinatal database. Multivariable logistic regression models were constructed and ORs were compared to identify the specific contribution of independent risk factors for SGA along the study period. Results During the study period, 285,992 pregnancies met the study’s inclusion criteria, of which 15,013 (5.25%) were SGA. Between 1988 and 2014, the incidence of SGA increased from 2.6% in 1988 to 2.9% in 2014. Using logistic regression models, nulliparity, maternal age, gestational age, hypertensive disorders of pregnancy, oligohydramnios and pre-gestational diabetes mellitus were found to be independently associated with SGA. While the adjusted ORs (aOR) of hypertensive disorders of pregnancy and pre-gestational diabetes mellitus had increased, aORs for nulliparity, maternal age and gestational age had remained stable over time. Oligohydramnios had demonstrated a mixed trend of change over the time. Conclusion In our study, the specific contribution of factors associated with SGA had changed over time. Having a better understating of the changes in the specific contribution of different risk factors for SGA may enable obstetricians to provide consultations. Keywords Birthweight · Epidemiology · Small for gestational age · Risk factors
Introduction
Reut Rotem and Misgav Rottenstriech have equally contributed to the manuscript. * Misgav Rottenstriech [email protected] 1
Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Jerusalem, Affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Soroka University Medical Centre, Ben-Gurion University of the Negev, Beer‑Sheva, Israel
2
The most commonly used clinical definition for small-forgestational age (SGA) is an infant born with a birthweight under the tenth percentile [1] according to different growth curves. There seems to be an unexplained trend of increasing occurrence of SGA
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