Small for gestational age (SGA) fetuses have been shown to have a higher risk of stillbirth and neonatal mortality, but few studies have examined long-term mortality. In this prospective cohort study, 3,795,603 non-malformed singleton live births and 2,781,464 full siblings born between January 1, 1973 and December 31, 2012 were examined to study the association between SGA and all-cause mortality between 28 days and less than 18 years of age. SGA was defined as having a birth weight for gestational age less than the 10th percentile. SGA children were first compared with non-SGA children from the population, then to non-SGA siblings. Of the singleton births, 2.1% were born with severe SGA (<3rd percentile), and 5.7% with moderate SGA (3rd to <10th percentile). Researchers found that age-specific all-cause mortality rates were higher in children with severe SGA than in those with non-SGA in both the population (HR 2.58, 95% CI 2.38 to 2.80) and sibling (HR 2.61, 95% CI 2.19 to 3.10) analyses. The associations were strongest within the period of 28 days to <1 year of age (population-based: HR 4.46, 95% CI 3.98 to 5.00; sibling-based: HR 3.41, 95% CI 2.67 to 4.36). Age-specific all-cause mortality rates were also higher in children with moderate SGA (population-based: HR 1.37, 95% CI 1.28 to 1.47; sibling-based: HR 1.38, 95% CI 1.22 to 1.56). The strongest association of severe SGA with cause-specific mortality was death due to infection (population-based: HR 3.19; sibling-based: HR 4.24). In summary, this study indicates that being SGA is associated with an increased risk of childhood death through 18 years of age, and that infection is the most common cause of death.
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