Neonatal sex and maternal factors associated with small‐for‐gestational‐age neonates: A nationwide population‐based study

• Published in: Health science reports Vol. 7; no. 9; pp. e70093 - n/a
• Main Authors: Fu, Pei‐Han, Yu, Chia‐Hung, Chung, Hao‐Wei, Wu, Pei‐Hua, Huang, Chiao‐Yun, Liang, Fu‐Wen
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.09.2024; John Wiley and Sons Inc; Wiley
• Subjects: Anemia; Asthma; Birth weight; Chronic illnesses; Codes; Females; Gestational age; Gestational diabetes; Hemorrhage; Hypertension; Infections; Kidney diseases; live birth; Mortality; Mothers; Multiple births; National health insurance; neonate; newborn; Newborn babies; Obstetrics; Original Research; Population; Preeclampsia; Regression analysis; Risk factors; small‐for‐gestational‐age; Socioeconomic factors; Socioeconomic status; Thyroid gland; Taiwan; risk factors; neonate; newborn; live birth; small‐for‐gestational‐age
• ISSN: 2398-8835; 2398-8835
• DOI: 10.1002/hsr2.70093

Background and Aims Small‐for‐gestational‐age (SGA) newborns have a higher risk of morbidity and mortality. Recognizing the risk factors for SGA helps raise early awareness of the issue and provides valuable insights for both healthcare providers and pregnant women. We aimed to identify determinants of SGA using population‐based databases in Taiwan. Methods Data were retrieved from the National Health Insurance, Birth Reporting, and Maternal and Child Health databases for this nationwide case‐control study. Live births between 20 and 44 weeks of gestation from 2005 to 2014 were enrolled and linked to their mothers to determine maternal conditions during pregnancy. For every SGA newborn, four controls matched by gestational age and birth year were randomly selected. Multivariable logistic regression was used to identify risk factors for SGA, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) accounting for potential confounders and interaction terms. Results A total of 158,405 live SGA births were identified, with 623,584 controls randomly selected. Independent risk factors for SGA included maternal age <20 years (aOR 1.68, 95% CI 1.62, 1.75); female sex in newborns (aOR 1.28, 95% CI 1.27, 1.30); socioeconomic deprivation (aOR 1.29, 95% CI 1.21, 1.38); hypertension (aOR 1.6, 95% CI 1.52, 1.67); kidney disorders (aOR 1.29, 95% CI 1.16, 1.44); thyroid disorders (aOR 1.13, 95% CI 1.09, 1.17); systemic lupus erythematosus (aOR 2.59, 95% CI 2.33, 2.89); antiphospholipid syndrome (aOR 2.08, 95% CI 1.64, 2.64); gestational hypertension (aOR 1.69, 95% CI 1.61, 1.76); pre‐eclampsia (aOR 3.12, 95% CI 3.01, 3.25); and antepartum hemorrhage (aOR 1.05, 95% CI 1.03, 1.07) after adjustment for other covariates. Conclusions SGA was associated with younger maternal age, female newborns, underlying comorbidities, and obstetric conditions. Gestational hypertension and pre‐eclampsia were significant risk factors affecting infants of both sexes and all age groups and could mask the effects of maternal age and infant sex. Key points What's known Maternal medical history of hypertension, renal disease, autoimmune diseases, and obstetric conditions, including perinatal bleeding, placental abruption, and pre‐eclampsia, could be associated with small‐for‐gestational‐age (SGA). What's new Interaction analysis revealed that gestational hypertension and pre‐eclampsia are powerful factors with significant effects in all age groups and infants of both sexes. Meanwhile, age and sex may be risk factors for SGA only in a population without gestational hypertension or pre‐eclampsia. What the clinical implications of this study are The results imply that gestational hypertension and pre‐eclampsia should be given higher priority when addressing the issue of SGA.