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Current Pediatric Reviews

Author(s): Vivekanand Natarajan*, Poonam Singh, Nattankali Kannappa Venkatesan Vigneshwar, Michael Leonard Anthony, Shalinee Rao, Swathi Chacham, Jaya Chaturvedi and Sriparna Basu

DOI: 10.2174/1573396318666220705154424

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Maternal and Placental Risk Factors for Small Gestational Age and Fetal Malnutrition

Page: [187 - 196] Pages: 10

  • * (Excluding Mailing and Handling)

Abstract

Aims: This case-control study was conducted to identify maternal and placental risk factors of small-for-gestational-age (SGA) and fetal malnutrition.

Methods: Cases comprised 104 consecutively delivered SGA neonates (determined as per INTERGROWTH- 21st standard). An equal number of next-born gestation and gender-matched appropriatefor- gestational age (AGA) neonates served as controls. Maternal risk factors were enquired, and placentae were evaluated by clinical and histopathological examination. Nutrition of the neonates was assessed by the clinical assessment of nutrition (CAN) score. Univariate and multivariate logistic regression analysis was done to identify the maternal and placental risk factors.

Results: The prevalence of SGA in the present study was 23.9%. Maternal fever [adjusted Odds Ratio (aOR), 95% confidence interval (CI), 16.3 (3.5-124.1); p = 0.001], presence of placental syncytial knots [aOR (95% CI), 2.9 (1.1-9.1); p = 0.04] and placental calcifications [aOR (95% CI), 3(1.1- 8.7); p = 0.03], were identified as independent predictors of SGA using multivariate logistic regression analysis. Malnutrition (SCORE <25) affected 64% of SGA and 16.3% of AGA neonates. The only risk factor significantly associated with malnourished SGA was prematurity, whereas malnourished AGA was significantly associated with prematurity and fetal distress. In-hospital morbidities significantly higher in SGA were perinatal asphyxia, respiratory distress, need for respiratory support, polycythemia, hypoglycemia, and feeding intolerance. Mortality before discharge was 4.8% and 3.8% in SGA and AGA population, respectively (p > 0.05). Neonatal outcomes were comparable among well-nourished, malnourished SGA and AGA groups.

Conclusion: Maternal fever, placental syncytial knots, and calcifications were independent risk factors of SGA, whereas prematurity and fetal distress were responsible for malnutrition.

Keywords: Clinical assessment of nutrition score, fetal malnutrition, maternal, placenta, risk factors, small for gestational age.

Graphical Abstract

[1]
Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr 1967; 71(2): 159-63.
[http://dx.doi.org/10.1016/S0022-3476(67)80066-0] [PMID: 6029463]
[2]
de Onis M, Habicht JP. Anthropometric reference data for international use: Recommendations from a World Health Organization Expert Committee. Am J Clin Nutr 1996; 64(4): 650-8.
[http://dx.doi.org/10.1093/ajcn/64.4.650] [PMID: 8839517]
[3]
Lee AC, Kozuki N, Cousens S, et al. Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21st standard: Analysis of CHERG datasets. BMJ 2017; 358: j3677.
[http://dx.doi.org/10.1136/bmj.j3677] [PMID: 28819030]
[4]
Zhao M, Dai H, Deng Y, Zhao L. SGA as a risk factor for cerebral palsy in moderate to late preterm infants: A systematic review and meta-analysis. Int J Sci Res 2016; 6: 3885-93.
[http://dx.doi.org/10.1038/srep38853]
[5]
Metcoff J. Clinical assessment of nutritional status at birth. Fetal malnutrition and SGA are not synonymous. Pediatr Clin North Am 1994; 41(5): 875-91.
[http://dx.doi.org/10.1016/S0031-3955(16)38836-8] [PMID: 7936778]
[6]
Mehta S, Tandon A, Dua T, Kumari S, Singh SK. Clinical assessment of nutritional status at birth. Indian Pediatr 1998; 35(5): 423-8.
[PMID: 10216623]
[7]
Lee AC, Katz J, Blencowe H, et al. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. Lancet Glob Health 2013; 1(1): e26-36.
[http://dx.doi.org/10.1016/S2214-109X(13)70006-8] [PMID: 25103583]
[8]
Sebastian T, Yadav B, Jeyaseelan L, Vijayaselvi R, Jose R. Small for gestational age births among South Indian women: Temporal trend and risk factors from 1996 to 2010. BMC Pregnancy Childbirth 2015; 15: 7.
[http://dx.doi.org/10.1186/s12884-015-0440-4] [PMID: 25645738]
[9]
Muhammad T, Khattak AA. Shafiq-ur-Rehman, Khan MA, Khan A, Khan MA. Maternal factors associated with intrauterine growth restriction. J Ayub Med Coll Abbottabad 2010; 22(4): 64-9.
[PMID: 22455264]
[10]
Barker DJ. The fetal and infant origins of adult disease. BMJ 1990; 301(6761): 1111.
[http://dx.doi.org/10.1136/bmj.301.6761.1111] [PMID: 2252919]
[11]
Villar J, Cheikh Ismail L, Victora CG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: The newborn cross-sectional study of the INTERGROWTH-21st Project. Lancet 2014; 384(9946): 857-68.
[http://dx.doi.org/10.1016/S0140-6736(14)60932-6] [PMID: 25209487]
[12]
Sheikh M, Saleem M. Modified Kappuswamy scale updated for year 2018. PIJR 2018; 7: 217-8.
[13]
Raman TR, Devgan A, Sood SL, Gupta A, Ravichander B. Low birth weight babies: Incidence and risk factors. Med J Armed Forces India 1998; 54(3): 191-5.
[http://dx.doi.org/10.1016/S0377-1237(17)30539-7] [PMID: 28775472]
[14]
Narang A, Chaudhuri MK, Kumar P. Small for gestational age babies: Indian scene. Indian J Pediatr 1997; 64(2): 221-4.
[http://dx.doi.org/10.1007/BF02752452] [PMID: 10771840]
[15]
RCOG Green‐top guideline no 31. small‐for‐gestational‐ age fetus, investigation and management of the small‐for‐gestational age fetus. London: Royal college of obstetricians and gynaecologists 2013.
[16]
Mavalankar DV, Gray RH, Trivedi CR, Parikh VC. Risk factors for small for gestational age births in Ahmedabad, India. J Trop Pediatr 1994; 40(5): 285-90.
[http://dx.doi.org/10.1093/tropej/40.5.285] [PMID: 7807623]
[17]
Tamura N, Hanaoka T, Ito K, et al. Different risk factors for very low birth weight, term-small-for-gestational-age, or preterm birth in Japan. Int J Environ Res Public Health 2018; 15(2): 369.
[http://dx.doi.org/10.3390/ijerph15020369] [PMID: 29466290]
[18]
Kishore S, Singh M, Jain B, et al. A study to assess prevalence of anaemia among beneficiaries of anaemia mukt Bharat campaign in Uttarakhand. J Family Med Prim Care 2020; 9(3): 1691-4.
[http://dx.doi.org/10.4103/jfmpc.jfmpc_941_19] [PMID: 32509673]
[19]
International Institute for Population Sciences (IIPS) and ICF National Family Health Survey (NFHS-4), 2015-16: India Mumbai: IIPS 2017. Available from: http://rchiips.org/nfhs/
[20]
Biswas S, Ghosh SK. Gross morphological changes of placentas associated with intrauterine growth restriction of fetuses: A case control study. Early Hum Dev 2008; 84(6): 357-62.
[http://dx.doi.org/10.1016/j.earlhumdev.2007.09.017] [PMID: 18093757]
[21]
İskender-Mazman D, Akçören Z, Yiğit Ş, et al. Placental findings of IUGR and non-IUGR. Turk J Pediatr 2014; 56(4): 368-73.
[PMID: 25818955]
[22]
Novac MV, Niculescu M, Manolea MM, et al. Placental findings in pregnancies complicated with IUGR - histopathological and immunohistochemical analysis. Rom J Morphol Embryol 2018; 59(3): 715-20.
[PMID: 30534809]