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  • Population Study Article
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Etiological subgroups of term small-for-gestational-age and childhood health outcomes

Pediatric Research volume 94, pages 378–384 (2023)Cite this article

Abstract

Background

Small-for-gestational-age (SGA) has a heterogeneous etiology. Our study aimed to examine the childhood health outcomes of etiology-distinct term SGA subgroups.

Methods

Data from the Collaborative Perinatal Project were used. The etiological factors of SGA were categorized into five groups: maternal, fetal, placental, environmental and physiological factors. Primary child outcomes included low IQ and growth restriction. A total of 8417 term infants were eligible.

Results

Compared with AGA, SGA children due to fetal factors had the highest risk of low IQ (aOR = 1.94, 95% CI: 1.45–2.59). SGA infants due to physiological factors had the highest risk of growth restriction (aOR = 6.04, 95% CI: 3.93–9.27). SGA children had a higher risk of growth restriction with the aOR ranging from 3.05 (95% CI: 2.36–3.96) to 5.77 (95% CI: 4.29–7.75) for the number of risk factors that the SGA infants had from 1 to 5. SGA children with any risk factor were associated with a higher risk of lower IQ with the aOR ranging from 1.59 (95% CI: 1.31–1.94) to 1.96 (95% CI: 1.50–2.55). SGA without the five types of etiologies was not associated with adverse child outcomes except for growth restriction (aOR = 3.82, 95% CI: 2.62–5.55).

Conclusion

Term SGA of different etiologies may lead to different child health outcomes.

Impact

  • Our study found that SGA of different etiologies may lead to different child health outcomes.

  • Compared with AGA, SGA children due to fetal factors had the highest risk of low IQ. SGA infants due to physiological factors had the highest risk of growth restriction.

  • SGA babies should not be treated the same. In the era of precision medicine, our findings may help pediatricians and parents better manage SGA babies according to different etiologies and the number of risk factors.

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Fig. 1: Sample selection.
Fig. 2: Adjusted odds ratios of adverse childhood outcomes in term SGA infant subgroups by etiologic risk factor, compared with AGA children without risk factors in the Collaborative Perinatal Project, 1959–1976.
Fig. 3: Adjusted odds ratios of adverse childhood outcomes in term SGA infants by the number of etiologic risk factors relative to AGA infants without risk factors.

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Data availability

The data of the National Collaborative Perinatal Project are available at the U.S. National Archives. Website: https://www.archives.gov/research/electronic-records/nih.html?_ga=2.166691642.504404601.1662257591–537933195.1662257591.

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Funding

All phases of this study were supported by research grants from the National Natural Science Foundation of China (Grant number 81903323) and Shanghai Municipal Health Commission (Grant number 20194Y0157). All authors have indicated they have no financial relationships relevant to this article to disclose.

Author information

Authors and Affiliations

  1. Developmental and Behavioral Pediatric Department & Child Primary Care Department, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China

    Fang Fang & Fei Li

  2. Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China

    Fang Fang, Qian Chen, Jiong Li, Zhong-Cheng Luo & Jun Zhang

  3. Department of Neonatology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China

    Yan Chen & Yongjun Zhang

  4. Department of Obstetrics and Gynecology, Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, M5G 1X5, ON, Canada

    Zhong-Cheng Luo

  5. Department of Developmental Behavior Pediatrics, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China

    Fan Jiang

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  1. Fang Fang
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Contributions

J.Z. conceptualized and designed the study. F.F. and Y.C. carried out the initial analyses and drafted the initial manuscript. Q.C., J.L., Z.-C.L., F.L., Y.Z. and F.J. critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Jun Zhang.

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The authors declare no competing interests.

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Anonymized data were used for this study, and the patient consent was not required.

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Fang, F., Chen, Y., Chen, Q. et al. Etiological subgroups of term small-for-gestational-age and childhood health outcomes. Pediatr Res 94, 378–384 (2023). https://doi.org/10.1038/s41390-022-02412-1

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