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.
Click to read the study in PLOS Medicine
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