Small-for-gestational-age (SGA) children have been the subject of scientific interest over the last century. Since 2013, the 10th percentile for height and/or weight for the corresponding gestational age has been used as a cut-off to define the condition. This specific population group is characterized by multiple early and late complications.
The aim of the present paper is to review the data in the literature regarding the prevalence, early and late complications associated with SGA delivery.
The most commonly used cut-offs for defining an SGA child are the 2,3rd, 3rd, and 10th percentiles. Using a different definition and curves results in a large difference in prevalence. The presented cohort is characterized by a variety of early and late complications. Early complications include mortality, hypoglycemia, and hypothermia. Mortality in this cohort can be several times higher compared to children born adequate for their gestational age (AGA). Hypoglycemia, especially prolonged and unrecognized, can lead to permanent brain damage. Hypothermia was more common in the group of children born SGA compared to those born AGA.
Late complications can develop at any stage of a person’s life. This group includes metabolic disorders, hypertension, precocious puberty, and reduced bone density. To date, an increased cardiovascular risk has been repeatedly demonstrated in adults born SGA. Studies have shown that those born SGA are likely to develop metabolic complications as early as infancy. The most common metabolic disorders are insulin resistance, impaired glucose tolerance and type 2 diabetes mellitus.
Hughes MM, Black RE, Katz J. 2500-g Low Birth Weight Cutoff: History and Implications for Future Research and Policy. Matern Child Health J. 2017 Feb;21(2):283-289. doi: 10.1007/s10995-016-2131-9. PMID: 27449779; PMCID: PMC5290050.
Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr. 1967 Aug;71(2):159-63. doi: 10.1016/s0022-3476(67)80066-0. PMID: 6029463.
Zeve D, Regelmann MO, Holzman IR, Rapaport R. Small at Birth, but How Small? The Definition of SGA Revisited. Horm Res Paediatr. 2016;86(5):357-360. doi: 10.1159/000449275. Epub 2016 Sep 30. PMID: 27685026.
Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995;854:1-452. PMID: 8594834.
Clayton PE, Cianfarani S, Czernichow P, Johannsson G, Rapaport R, Rogol A. Management of the child born small for gestational age through to adulthood: a consensus statement of the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society. J Clin Endocrinol Metab. 2007 Mar;92(3):804-10. doi: 10.1210/jc.2006-2017. Epub 2007 Jan 2. PMID: 17200164.
Hokken-Koelega ACS, van der Steen M, Boguszewski MCS, Cianfarani S, Dahlgren J, Horikawa R, Mericq V, Rapaport R, Alherbish A, Braslavsky D, Charmandari E, Chernausek SD, Cutfield WS, Dauber A, Deeb A, Goedegebuure WJ, Hofman PL, Isganatis E, Jorge AA, Kanaka-Gantenbein C, Kashimada K, Khadilkar V, Luo XP, Mathai S, Nakano Y, Yau M. International Consensus Guideline on Small for Gestational Age: Etiology and Management From Infancy to Early Adulthood. Endocr Rev. 2023 May 8;44(3):539-565. doi: 10.1210/endrev/bnad002. PMID: 36635911; PMCID: PMC10166266.
Fenton TR. A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr. 2003 Dec 16;3:13. doi: 10.1186/1471-2431-3-13. PMID: 14678563; PMCID: PMC324406.
Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013 Apr 20;13:59. doi: 10.1186/1471-2431-13-59. PMID: 23601190; PMCID: PMC3637477.
Sharma D, Shastri S, Farahbakhsh N, Sharma P. Intrauterine growth restriction - part 1. J Matern Fetal Neonatal Med. 2016 Dec;29(24):3977-87. doi: 10.3109/14767058.2016.1152249. Epub 2016 Mar 7. PMID: 26856409.
Lee AC, Katz J, Blencowe H, Cousens S, Kozuki N, Vogel JP, Adair L, Baqui AH, Bhutta ZA, Caulfield LE, Christian P, Clarke SE, Ezzati M, Fawzi W, Gonzalez R, Huybregts L, Kariuki S, Kolsteren P, Lusingu J, Marchant T, Merialdi M, Mongkolchati A, Mullany LC, Ndirangu J, Newell ML, Nien JK, Osrin D, Roberfroid D, Rosen HE, Sania A, Silveira MF, Tielsch J, Vaidya A, Willey BA, Lawn JE, Black RE; CHERG SGA-Preterm Birth Working Group. 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 Jul;1(1):e26-36. doi: 10.1016/S2214-109X(13)70006-8. Epub 2013 Jun 25. Erratum in: Lancet Glob Health. 2013 Aug;1(2):e76. PMID: 25103583; PMCID: PMC4221634.
Nam HK, Lee KH. Small for gestational age and obesity: epidemiology and general risks. Ann Pediatr Endocrinol Metab. 2018 Mar;23(1):9-13. doi: 10.6065/apem.2018.23.1.9. Epub 2018 Mar 22. PMID: 29609444; PMCID: PMC5894562.
Jensen EA, Foglia EE, Dysart KC, Simmons RA, Aghai ZH, Cook A, Greenspan JS, DeMauro SB. Adverse effects of small for gestational age differ by gestational week among very preterm infants. Arch Dis Child Fetal Neonatal Ed. 2019 Mar;104(2):F192-F198. doi: 10.1136/archdischild-2017-314171. Epub 2018 May 5. PMID: 29730594; PMCID: PMC6335180.
Katz J, Wu LA, Mullany LC, Coles CL, Lee AC, Kozuki N, Tielsch JM. Prevalence of small-for-gestational-age and its mortality risk varies by choice of birth-weight-for-gestation reference population. PLoS One. 2014 Mar 18;9(3):e92074. doi: 10.1371/journal.pone.0092074. PMID: 24642757; PMCID: PMC3958448.
Karlberg J, Albertsson-Wikland K, Baber FM, Low LC, Yeung CY. Born small for gestational age: consequences for growth. Acta Paediatr Suppl. 1996 Oct;417:8-13; discussion 14. doi: 10.1111/j.1651-2227.1996.tb14284.x. PMID: 9055902.
Fujita K, Nagasaka M, Iwatani S, Koda T, Kurokawa D, Yamana K, Nishida K, Taniguchi-Ikeda M, Uchino E, Shirai C, Iijima K, Morioka I. Prevalence of small for gestational age (SGA) and short stature in children born SGA who qualify for growth hormone treatment at 3 years of age: Population-based study. Pediatr Int. 2016 May;58(5):372-6. doi: 10.1111/ped.12859. Epub 2016 Feb 19. PMID: 26617415.
Tamaro G, Pizzul M, Gaeta G, Servello R, Trevisan M, Böhm P, Materassi PMA, Macaluso A, Valentini D, Pellegrin MC, Barbi E, Tornese G. Prevalence of children born small for gestational age with short stature who qualify for growth hormone treatment. Ital J Pediatr. 2021 Apr 1;47(1):82. doi: 10.1186/s13052-021-01026-3. PMID: 33794966; PMCID: PMC8015030.
Йотова В., Ефект от ниските тегло и ръст при раждане върху постнаталния растеж и някои маркери на повишен кардиоваскуларен и метаболитен риск у юноши - Автореферат. София, 2002 г.
Krumova et al., 4th Summer Discussion of Neonatology, 15-18.06.2022, Avignon, France - e-poster
Finken MJJ, van der Steen M, Smeets CCJ, Walenkamp MJE, de Bruin C, Hokken-Koelega ACS, Wit JM. Children Born Small for Gestational Age: Differential Diagnosis, Molecular Genetic Evaluation, and Implications. Endocr Rev. 2018 Dec 1;39(6):851-894. doi: 10.1210/er.2018-00083. Erratum in: Endocr Rev. 2019 Feb 1;40(1):96. PMID: 29982551.
Khalil A, Syngelaki A, Maiz N, Zinevich Y, Nicolaides KH. Maternal age and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol. 2013 Dec;42(6):634-43. doi: 10.1002/uog.12494. PMID: 23630102.
Dejin-Karlsson E, Hanson BS, Ostergren PO, Lindgren A, Sjöberg NO, Marsal K. Association of a lack of psychosocial resources and the risk of giving birth to small for gestational age infants: a stress hypothesis. BJOG. 2000 Jan;107(1):89-100. doi: 10.1111/j.1471-0528.2000.tb11584.x. PMID: 10645867.
Yao XD, Li Y, Jiang H, Ma J, Wen J. COVID-19 pandemic and neonatal birth weight: a systematic review and meta-analysis. Public Health. 2023 Jul;220:10-17. doi: 10.1016/j.puhe.2023.04.009. Epub 2023 Apr 21. PMID: 37201437; PMCID: PMC10121139.
Hekimoğlu B, Aktürk Acar F. Effects of COVID-19 pandemic period on neonatal mortality and morbidity. Pediatr Neonatol. 2022 Jan;63(1):78-83. doi: 10.1016/j.pedneo.2021.08.019. Epub 2021 Oct 27. PMID: 34776364; PMCID: PMC8548836.
Hosagasi NH, Aydin M, Zenciroglu A, Ustun N, Beken S. Incidence of hypoglycemia in newborns at risk and an audit of the 2011 American academy of pediatrics guideline for hypoglycemia. Pediatr Neonatol. 2018 Aug;59(4):368-374. doi: 10.1016/j.pedneo.2017.11.009. Epub 2017 Nov 15. PMID: 29198616.
Крумова Д., Златева Т., Ранкова К., Цочев К., Георгиева Р., Йотова В. Начални резултати от лечението с растежен хормон на ниски малки за гестационната си възраст деца. Известия на Съюза на учените – Варна 2021, 2, 26:27-33. DOI: http://dx.doi.org/10.14748/isuvsme.v26i1.8143
Ewing AC, Ellington SR, Shapiro-Mendoza CK, Barfield WD, Kourtis AP. Full-Term Small-for-Gestational-Age Newborns in the U.S.: Characteristics, Trends, and Morbidity. Matern Child Health J. 2017 Apr;21(4):786-796. doi: 10.1007/s10995-016-2165-z. PMID: 27502090; PMCID: PMC5728417.
Fishel Bartal M, Chen HY, Blackwell SC, Chauhan SP, Sibai BM. Neonatal morbidity in late preterm small for gestational age neonates. J Matern Fetal Neonatal Med. 2021 Oct;34(19):3208-3213. doi: 10.1080/14767058.2019.1680630. Epub 2019 Oct 24. PMID: 31645162.
Murki S, Vardhelli V, Deshabhotla S, Sharma D, Pawale D, Kulkarni D, Kumar P, Kabra NS, Sundaram M, Plakkal N, Mehta A, Tandur B, Chawla D, Sreeram S, Saha B, Suman Rao PN, Kadam S. Predictors of length of hospital stay among preterm infants admitted to neonatal intensive care unit: Data from a multicentre collaborative network from India (INNC: Indian National Neonatal Collaborative). J Paediatr Child Health. 2020 Oct;56(10):1584-1589. doi: 10.1111/jpc.15031. Epub 2020 Jul 13. PMID: 32658357.
Lee E, Lim Z, Malhotra A. Thrombocytopenia in well small for gestational age neonates. Blood Coagul Fibrinolysis. 2019 Apr;30(3):104-110. doi: 10.1097/MBC.0000000000000802. PMID: 30864963.
Sharma D, Shastri S, Sharma P. Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clin Med Insights Pediatr. 2016 Jul 14;10:67-83. doi: 10.4137/CMPed.S40070. PMID: 27441006; PMCID: PMC4946587.
Willemsen RH, de Kort SW, van der Kaay DC, Hokken-Koelega AC. Independent effects of prematurity on metabolic and cardiovascular risk factors in short small-for-gestational-age children. J Clin Endocrinol Metab. 2008;93(2):452-458. doi:10.1210/jc.2007-1913
Iotova V., B. Toshkina, Y.Yotov, I. Stoeva, K.Petrova. V.Tzaneva. Adiponectin is reduced in 10-year-old children born small for gestational age (SGA). Horm Research 2006; 65 (suppl 4): PO2-596, p. 173 /45nd Annual Meeting of ESPE, Rotterdam, The Netherlands, June 30-July 3, 2006/
Maguolo A, Olivieri F, Zusi C, Miraglia Del Giudice E, Morandi A, Maffeis C. The risk of metabolic derangements is higher in children and adolescents with overweight or obesity born small for gestational age. Nutr Metab Cardiovasc Dis. 2021 Jun 7;31(6):1903-1910. doi: 10.1016/j.numecd.2021.02.025. Epub 2021 Mar 4. PMID: 33941428.
Zhao M, Dai H, Deng Y, Zhao L. SGA as a Risk Factor for Cerebral Palsy in Moderate to Late Preterm Infants: a System Review and Meta-analysis. Sci Rep. 2016 Dec 13;6:38853. doi: 10.1038/srep38853. PMID: 27958310; PMCID: PMC5153647.
Lundgren M, Cnattingius S, Jonsson B, Tuvemo T. Intellectual performance in young adult males born small for gestational age. Growth Horm IGF Res. 2004 Jun;14 Suppl A:S7-8. doi: 10.1016/j.ghir.2004.03.004. PMID: 15135769.
Liffner S, Bladh M, Nedstrand E, Hammar M, Martinez HR, Sydsjö G. Men born small for gestational age or with low birth weight do not improve their rate of reproduction over time: a Swedish population-based study. Fertil Steril. 2021 Sep;116(3):721-730. doi: 10.1016/j.fertnstert.2021.05.078. Epub 2021 Jun 27. PMID: 34187702.
van der Steen M, Hokken-Koelega AC. Growth and Metabolism in Children Born Small for Gestational Age. Endocrinol Metab Clin North Am. 2016 Jun;45(2):283-94. doi: 10.1016/j.ecl.2016.01.008. PMID: 27241965.