Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Neonatal morbidity and small and large size for gestation: a comparison of birthweight centiles

Journal of Perinatology volume 40, pages 732–742 (2020)Cite this article

Subjects

Abstract

Objective

To compare rates of small- and large-for-gestational age (SGA and LGA) neonates using four different weight centiles, and to relate these classifications to neonatal morbidity.

Study design

Neonates born at 33–40 weeks’ gestation in a multiethnic population were classified as SGA or LGA by population reference (Fenton), population standard (INTERGROWTH), fetal growth curves (WHO), and customized (GROW) centiles. Likelihood of composite morbidity was determined compared with a common appropriate-for-gestational age referent group.

Result

Among 45,505 neonates, SGA and LGA rates varied up to threefold by different centiles. Those most likely to develop neonatal morbidity were SGA or LGA on both the population reference and an alternative centile. Customized centiles identified over twice as many at-risk SGA neonates.

Conclusions

Customized centiles were most useful in identifying neonates at increased risk of morbidity, and those that were small on both customized and population reference centiles were at the highest risk.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Horbar JD, Carpenter JH, Badger GJ, Kenny MJ, Soll RF, Morrow KA, et al. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics. 2012;129:1019–26.

    PubMed  Google Scholar 

  2. Manuck TA, Rice MM, Bailit JL, Grobman WA, Reddy UM, Wapner RJ, et al. Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort. Am J Obstet Gynecol. 2016;215:103.e101–103.e114.

    Google Scholar 

  3. Pasupathy D, McCowan LM, Poston L, Kenny LC, Dekker GA, North RA, et al. Perinatal outcomes in large infants using customised birthweight centiles and conventional measures of high birthweight. Paediatr Perinat Epidemiol. 2012;26:543–52.

    PubMed  Google Scholar 

  4. Roland D, Madar J, Connolly G. The Newborn Early Warning (NEW) system: development of an at-risk infant intervention system. Infant. 2010;6:116–20.

    Google Scholar 

  5. Yu J, Flatley C, Greer RM, Kumar S. Birth-weight centiles and the risk of serious adverse neonatal outcomes at term. J Perinat Med. 2018;46:1048–56.

    CAS  PubMed  Google Scholar 

  6. Chiavaroli V, Marcovecchio ML, de Giorgis T, Diesse L, Chiarelli F, Mohn A. Progression of cardio-metabolic risk factors in subjects born small and large for gestational age. PLoS ONE. 2014;9:e104278.

    PubMed  PubMed Central  Google Scholar 

  7. Crispi F, Miranda J, Gratacós E. Long-term cardiovascular consequences of fetal growth restriction: biology, clinical implications, and opportunities for prevention of adult disease. Am J Obstet Gynecol. 2018;218:S869–79.

    PubMed  Google Scholar 

  8. Theodore RF, Broadbent J, Nagin D, Ambler A, Hogan S, Ramrakha S, et al. Childhood to early-midlife systolic blood pressure trajectories: early-life predictors, effect modifiers, and adult cardiovascular outcomes. Hypertension. 2015;66:1108–15.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. McCowan LM, Figueras F, Anderson NH. Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. Am J Obstet Gynecol. 2018;218:S855–68.

    PubMed  Google Scholar 

  10. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59.

    PubMed  PubMed Central  Google Scholar 

  11. Papageorghiou AT, Ohuma EO, Altman DG, Todros T, Ismail LC, Lambert A, et al. International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. Lancet. 2014;384:869–79.

    PubMed  Google Scholar 

  12. Kiserud T, Piaggio G, Carroli G, Widmer M, Carvalho J, Jensen LN, et al. The World Health Organization Fetal Growth Charts: a multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight. PLoS Med. 2017;14:e1002220.

    PubMed  PubMed Central  Google Scholar 

  13. Gardosi J. New definition of small for gestational age based on fetal growth potential. Horm Res Paediatr. 2006;65:S15–8.

    Google Scholar 

  14. Gardosi J. Customized fetal growth standards: rationale and clinical application. Semin Perinatol. 2004;28:33–40.

    PubMed  Google Scholar 

  15. Villar J, Altman D, Purwar M, Noble J, Knight H, Ruyan P, et al. The objectives, design and implementation of the INTERGROWTH‐21st Project. BJOG. 2013;120:S9–S26.

    Google Scholar 

  16. Anderson NH, Sadler LC, McKinlay CJD, McCowan LM. INTERGROWTH-21st vs customized birthweight standards for identification of perinatal mortality and morbidity. Am J Obstet Gynecol. 2016;214:509.e501–507.

    Google Scholar 

  17. Hutcheon JA, Zhang X, Platt RW, Cnattingius S, Kramer MS. The case against customised birthweight standards. Paediatr Perinat Epidemiol. 2011;25:11–16.

    PubMed  Google Scholar 

  18. McIntire DD, Bloom SL, Casey BM, Leveno KJ. Birth weight in relation to morbidity and mortality among newborn infants. N Engl J Med. 1999;340:1234–8.

    CAS  PubMed  Google Scholar 

  19. Brown H, Speechley K, Macnab J, Natale R, Campbell M. Biological determinants of spontaneous late preterm and early term birth: a retrospective cohort study. BJOG. 2015;122:491–9.

    CAS  PubMed  Google Scholar 

  20. Gunay F, Alpay H, Gokce I, Bilgen H. Is late-preterm birth a risk factor for hypertension in childhood? Eur J Pediatr. 2014;173:751–6.

    CAS  PubMed  Google Scholar 

  21. Heinonen K, Eriksson JG, Lahti J, Kajantie E, Pesonen A-K, Tuovinen S, et al. Late preterm birth and neurocognitive performance in late adulthood: a birth cohort study. Pediatrics. 2015;135:e818–e825.

    PubMed  Google Scholar 

  22. Villar J, Cheikh Ismail L, Victora CG, Ohuma EO, Bertino E, Altman DG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014;384:857–68.

    PubMed  Google Scholar 

  23. Australasian Society for Ultrasound in Medicine. Guidelines for the mid trimester obstetric scan (D2); 2007. http://www.asum.com.au/site/policies.php.

  24. Australasian Society for Ultrasound in Medicine. Statement on normal ultrasonic fetal measurements (D7); 2007. http://www.asum.com.au/site/policies.php.

  25. Farquhar C. Seventh annual report of the Perinatal and Maternal Mortality Review Committee: Reporting mortality, 2011. Wellington: Health Quality and Safety Commission; 2013.

  26. Ministry of Health. Ethnicity data protocols for the health and disability sector; 2004. http://www.nzhis.govt.nz/documentation/ethnicity/index.html.

  27. Villar J, Ismail LC, Victora CG, Ohuma EO, Bertino E, Altman DG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014;384:857–68.

    PubMed  Google Scholar 

  28. Gardosi J, Mongelli M, Wilcox M, Chang A. An adjustable fetal weight standard. Ultrasound Obstet Gynecol. 1995;6:168–74.

    CAS  PubMed  Google Scholar 

  29. Anderson N, Sadler L, Stewart A, McCowan L. Maternal and pathological pregnancy characteristics in customised birthweight centiles and identification of at‐risk small‐for‐gestational‐age infants: a retrospective cohort study. BJOG. 2012;119:848–56.

    CAS  PubMed  Google Scholar 

  30. Engle WA. Age terminology during the perinatal period. Pediatrics. 2004;114:1362–4.

    PubMed  Google Scholar 

  31. Gluckman PD, Pinal CS. Maternal-placental-fetal interactions in the endocrine regulation of fetal growth. Endocrine. 2002;19:81–89.

    CAS  PubMed  Google Scholar 

  32. Bassett N, Oliver M, Breier B, Gluckman P. The effect of maternal starvation on plasma insulin-like growth factor I concentrations in the late gestation ovine fetus. Pediatr Res. 1990;27:401–4.

    CAS  PubMed  Google Scholar 

  33. Brosens I, Dixon H, Robertson W. Fetal growth retardation and the arteries of the placental bed. BJOG. 1977;84:656–63.

    CAS  Google Scholar 

  34. Salafia CM, Minior VK, Pezzullo JC, Popek EJ, Rosenkrantz TS, Vintzileos AM. Intrauterine growth restriction in infants of less than thirty-two weeks’ gestation: associated placental pathologic features. Am J Obstet Gynecol. 1995;173:1049–57.

    CAS  PubMed  Google Scholar 

  35. Salafia C, Pezzullo J, Ghidini A, Lopez-Zeno J, Whittington S. Clinical correlations of patterns of placental pathology in preterm pre-eclampsia. Placenta. 1998;19:67–72.

    CAS  PubMed  Google Scholar 

  36. Dekker G, De Vries J, Doelitzsch P, Huijgens P, Von Blomberg B, Jakobs C, et al. Underlying disorders associated with severe early-onset preeclampsia. Am J Obstet Gynecol. 1995;173:1042–8.

    CAS  PubMed  Google Scholar 

  37. Lorentzen B, Henriksen T. Plasma lipids and vascular dysfunction in preeclampsia. Semin Reprod Med. 1998;16:33–39.

    CAS  Google Scholar 

  38. Kaaja R. Insulin resistance syndrome in preeclampsia. Semin Reprod Endocrinol. 1998;16:41–46.

    CAS  PubMed  Google Scholar 

  39. Lackman F, Capewell V, Richardson B, Gagnon R. The risks of spontaneous preterm delivery and perinatal mortality in relation to size at birth according to fetal versus neonatal growth standards. Am J Obstet Gynecol. 2001;184:946–53.

    CAS  PubMed  Google Scholar 

  40. Walton A, Hammond J. The maternal effects on growth and conformation in shire horse-shetland pony crosses. Proc R Soc Lond B Biol Sci. 1938;125:311–35.

    Google Scholar 

  41. Fowden AL, Ward JW, Wooding F, Forhead AJ, Constancia M. Programming placental nutrient transport capacity. J Physiol. 2006;572:5–15.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Allen W, Wilsher S, Turnbull C, Stewart F, Ousey J, Rossdale P, et al. Influence of maternal size on placental, fetal and postnatal growth in the horse. I. Development in utero. Reproduction. 2002;123:445–53.

    CAS  PubMed  Google Scholar 

  43. Gluckman PD, Hanson MA. Maternal constraint of fetal growth and its consequences. Semin Fetal Neonatal Med. 2004;9:419–25.

    PubMed  Google Scholar 

  44. Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ. 1987;65:663–737.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Gardosi J, Clausson B, Francis A. The value of customised centiles in assessing perinatal mortality risk associated with parity and maternal size. BJOG. 2009;116:1356–63.

    CAS  PubMed  Google Scholar 

  46. Lawlor D, Fraser A, Lindsay R, Ness A, Dabelea D, Catalano P, et al. Association of existing diabetes, gestational diabetes and glycosuria in pregnancy with macrosomia and offspring body mass index, waist and fat mass in later childhood: findings from a prospective pregnancy cohort. Diabetologia. 2010;53:89–97.

    CAS  PubMed  Google Scholar 

  47. Logan KM, Gale C, Hyde MJ, Santhakumaran S, Modi N. Diabetes in pregnancy and infant adiposity: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2017;102:F65–F72.

    PubMed  Google Scholar 

  48. Donnelley E, Raynes-Greenow C, Turner R, Carberry A, Jeffery H. Antenatal predictors and body composition of large-for-gestational-age newborns: perinatal health outcomes. J Perinatol. 2014;34:698.

    CAS  PubMed  Google Scholar 

  49. Ananth CV, Vintzileos AM. Maternal-fetal conditions necessitating a medical intervention resulting in preterm birth. Am J Obstet Gynecol. 2006;195:1557–63.

    PubMed  Google Scholar 

  50. Villar J, Ohuma E, Stirnemann J, Papageorghiou A, Kennedy S. Clarification of INTERGROWTH-21st newborn birthweight standards—Authors’ reply. Lancet. 2018;391:1996.

    PubMed  Google Scholar 

  51. Robinson A, Winckworth LC, Eleftheriou G, Hewitson R, Holme H. Prospective evaluation of the Whitt Neonatal Trigger Score in an ‘at-risk’ neonatal population. J Paediatr Child Health. 2017;53:950–6.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Liggins Institute, University of Auckland, Auckland, New Zealand

    Robert D. Cartwright, Jane E. Harding & Christopher J. D. McKinlay

  2. Waitemata District Health Board, Auckland, New Zealand

    Ngaire H. Anderson

  3. Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand

    Ngaire H. Anderson, Lynn C. Sadler & Lesley M. E. McCowan

  4. National Women’s Health, Auckland City Hospital, Auckland, New Zealand

    Lynn C. Sadler & Lesley M. E. McCowan

  5. Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand

    Lynn C. Sadler

  6. Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand

    Christopher J. D. McKinlay

  7. Kidz First Neonatal Care, Counties Manukau Health, Auckland, New Zealand

    Christopher J. D. McKinlay

Authors
  1. Robert D. Cartwright
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ngaire H. Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lynn C. Sadler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jane E. Harding
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lesley M. E. McCowan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christopher J. D. McKinlay
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RDC and CJDM had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: RDC and CJDM. Acquisition, analysis, or interpretation of data: all authors. Drafting of the paper: RDC and CJDM. Critical revision of the paper for important intellectual content: all authors. Statistical analysis: RDC and CJDM. Administrative, technical, or material support: JEH and CJDM. Supervision: JEH and CJDM.

Corresponding author

Correspondence to Christopher J. D. McKinlay.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cartwright, R.D., Anderson, N.H., Sadler, L.C. et al. Neonatal morbidity and small and large size for gestation: a comparison of birthweight centiles. J Perinatol 40, 732–742 (2020). https://doi.org/10.1038/s41372-020-0631-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-020-0631-3

This article is cited by

Search

Advanced search

Quick links