Risk stratification for small for gestational age for the Brazilian population: a secondary analysis of the Birth in Brazil study

• Published in: Scientific reports Vol. 10; no. 1; pp. 14725 - 9
• Main Authors: Souza, Renato T., Vieira, Matias C., Esteves-Pereira, Ana Paula, Domingues, Rosa Maria Soares Madeira, Moreira, Maria Elisabeth Lopes, da Cunha Filho, Edson Vieira, Sandall, Jane, Cecatti, Jose G., do Carmo Leal, Maria, Dias, Marcos Augusto Bastos, Pasupathy, Dharmintra
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 07-09-2020; Nature Publishing Group; Nature Portfolio
• Subjects: 692/308; 692/308/174; 692/499; 692/700/478/2772; Birth Weight - physiology; Brazil; Carcinogenesis; Datasets; Female; Fetal Diseases - etiology; Gestational Age; Head & neck cancer; Humanities and Social Sciences; Humans; Industrial advertising; Infant, Low Birth Weight - physiology; Infant, Newborn; Infant, Newborn, Diseases - etiology; Infant, Small for Gestational Age - physiology; Medical prognosis; mRNA; multidisciplinary; Parity - physiology; Parturition - physiology; Population studies; Pregnancy; Premature Birth - etiology; Risk Assessment; Risk Factors; Risk reduction; Science; Science (multidisciplinary); Secondary analysis; Small for gestational age; Socioeconomics; Squamous cell carcinoma; Stillbirth; Brazil
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-71252-y

Risk-stratification screening for SGA has been proposed in high-income countries to prevent perinatal morbidity and mortality. There is paucity of data from middle-income settings. The aim of this study is to explore risk factors for SGA in Brazil and assess potential for risk stratification. This population-based study is a secondary analysis of Birth in Brazil study, conducted in 266 maternity units between 2011 and 2012. Univariate and multivariate logistic regressions were performed, and population attributable fraction estimated for early and all pregnancy factors. We calculated absolute risk, odds ratio, and population prevalence of single or combined factors stratified by parity. Factors associated with SGA were maternal lupus (OR
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4.36, 95% CI [2.32–8.18]), hypertensive disorders in pregnancy (OR
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2.72, 95% CI [2.28–3.24]), weight gain < 5 kg (OR
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2.37, 95% CI [1.99–2.83]), smoking at late pregnancy (OR
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2.04, 95% CI [1.60–2.59]), previous low birthweight (OR
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2.22, 95% CI [1.79–2.75]), nulliparity (OR
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1.81, 95% CI [1.60–2.05]), underweight (OR
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1.61, 95% CI [1.36–1.92]) and socioeconomic status (SES) < 5th centile (OR
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1.23, 95% CI [1.05–1.45]). Having two or more risk factors (prevalence of 4.4% and 8.0%) was associated with a 2 and fourfold increase in the risk for SGA in nulliparous and multiparous, respectively. Early and all pregnancy risk factors allow development of risk-stratification for SGA. Implementation of risk stratification coupled with specific strategies for reduction of risk and increased surveillance has the potential to contribute to the reduction of stillbirth in Brazil through increased detection of SGA, appropriate management and timely delivery.