Risk factors for SGA fetus /neonate

Risk factors for SGA fetus /neonate

1Methods of screening for the SGA fetus/neonate include:In the 1 and 2 trimesters: Medical and obstetric history and examinationMaternal serum screening Uterine artery Doppler In the 2 and 3 trimester : Abdominal palpation and measurement or symphysis fundal height (SFH)HistoryAll women should be assessed at booking for risk factors for a SGA fetus / neonate to identify those who require increased surveillance. Women who have a major risk factor (OR>2) should be referred for serial ultrasound measurement of fetal size and assessment of wellbeing with artery doppler from 26-28 weeks of pregnancy. Women who have three or more minor risks factors should be referred for uterine artery Doppler 20-24 weeks of gestation. Risk factors Previous pregnancy historyPrevious SGA OR: 3.9Previous stillbirth OR: 6.4Previous preeclampsia OR: 1.31pregnancy interval 60 months OR: 1.29Women that have previously had a SGA neonate have at least twofold increased risk of a subsequent SGA neonate. The risk is increased further after two SGA births. Women with a prior history of other placenta mediated disease are also at increased risk of a subsequent SGA neonate, include: Prior preeclampsia and prior stillbirth particular those with a history of previous preterm unexplained stillbirth due to the association with FGR.

pregnancy interval < 6 month OR:1.26 > 60 month OR:1.29Maternal medical conditionsDiabetes and vascular diseaseOR6Moderate and severe renal impairment (especially with hypertension)OR 5.3Antiphospholipid syndromeOR 6.22Chronic hypertensionOR 2.5Systemic lupus erythematosis (SlE)Certain types of congenital heart dis. (Particular cyanotic congenital heart dis.)(there are no papers reporting OR)AsthmaThyroid diseaseInflammatory bowel diseaseDepressionOther maternal risk factors Maternal Age 35 years OR 1.4Maternal age 40 years OR 3.2Nulliparity OR 1.89Social deprivation Body mass indexBMI30OR:1.5Daily vigorous exercise OR:3.3Vaginal bleeding during the 1 trimester OR: 2.6

ContinueMaternal exposure to domestic violence during pregnancy OR: 1.53Low maternal weight gain Moderate alcohol intake Cigarette smoking (dose dependent )1-10/day OR 1.5411 /day OR 2.21Drug use (most significant with cocaine) OR 3.23Caffeine consumption 300mg per day in the 3 trimester Low fruit intake pre-pregnancy OR 1.9 (high green leafy vegetable intake pre-pregnancy to be protective) IVF singleton pregnancy OR 1.6

Maternal SGA OR: 2.64Paternal SGAOR: 3.47Major risk factors (OR>2) should prompt referral for serial ultrasound measurement of fetal size and assessment of wellbeing with umblical artery Doppler . The presence of multiple minor risk factors is likely to constitute a significant risk for the birth of a SGA neonate and there is a rationale for further screening using uterine artery Doppler at 20 weeks Current pregnancy complications /developmentsPoint estimate and 95% CIEstimate measureDefinition of risk2.6(1.2-5.6)AORHeavy bleeding similar to menses 34+ 2.1(1.5-2.9)AOREchogenic bowel 62+2.26(1.22-4.18)AORPreeclampsia 8+ 1.3(1.3-1.4)

2.5(2.3-2.8)RR

RRMild17

Severe 17+ 1.3-4.1OR rangePlacental abruption 615.6(2.5-12.2)ORUnexplained APH 44+4.9(1.9-12.6)ORLow maternal weight gain 13+1.9(1.3-2.8)OR Caffeine 300 mg/day in third trimester 402.6OR PAPP-A2.5 MoM or 3MoM)Inhibin A (2 MoM)Low unconjugated Estriol (50.5 MoM)Combined triple test2nd trimester DS markers have limited predictive accuracy for SGAA low level (