ArticleEuropean journal of epidemiology2021
The limits of small-for-gestational-age as a high-risk category.
Article in European journal of epidemiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 2 of them syntheses that pooled it.
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Who cites it
45 citing papers in PubMed, 2 syntheses or guidelines pooled it, 79 citations in OpenAlex.
- Development and validation of prediction models for fetal growth restriction and birthweight: an individual participant data meta-analysis.Health technology assessment (Winchester, England) · 2024Pooled it
- Deprived areas and adverse perinatal outcome: a systematic review.Archives of gynecology and obstetrics · 2024Pooled it
- Prenatal exposure to wildfire fine particulate matter and fetal growth outcomes in the United States: Findings from the ECHO Cohort.Environmental epidemiology (Philadelphia, Pa.) · 2026Article
- Impact of SGA, AGA, and LGA birthweight subclassification on NICU mortality risk identification: a cohort study.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Development and validation of a predictive nomogram for cesarean delivery in term singleton pregnancies complicated by small for gestational age undergoing labor induction.Scientific reports · 2026Article
- Inhaled vitamin A mitigates hyperoxia-induced acute and chronic lung damage in a neonatal rat model of bronchopulmonary dysplasia.American journal of respiratory cell and molecular biology · 2026Article
- The effect of culturally tailored continuity of midwifery care on perinatal outcomes for women having a first Nations baby in Victoria, Australia: a prospective non-randomised translational study.EClinicalMedicine · 2026Article
- Lifelong cognitive and motor outcomes after being born small for gestational age or with fetal growth restriction.World journal of clinical pediatrics · 2026Review
- A Nationwide Study of Pyruvate Dehydrogenase Complex Deficiency in Sweden: Epidemiology, Genotype-Phenotype Correlations, and Survival.Neurology · 2026Article
- Elevated catecholamine derivatives homovanillic acid and vanillylmandelic acid in the plasma and amniotic fluid of growth-restricted fetal sheep.Pediatric research · 2026Article
- Correlation between umbilical cord concentration of the growth hormone-IGF axis and small for gestational age: A single-center retrospective, observational study.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Risk factors for developmental delays in small for gestational age children at age of 24-36 months.European child & adolescent psychiatry · 2026Article
- Establishment and validation of a prediction model for small vulnerable newborns: a retrospective study.Journal of global health · 2025Article
- Development and validation of super learner models to predict small and large for gestational age in the second generation.Scientific reports · 2025Article
- Predicting low birth weight risks in pregnant women in Brazil using machine learning algorithms: data from the Araraquara cohort study.BMC pregnancy and childbirth · 2025Article
- [Impact of different treatment attitudes on survival and risk factors for poor clinical outcomes in extremely preterm infants: a retrospective real-world study].Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics · 2025Article
- Pregnancy-Associated Maternal Mortality Within One Year After Childbirth: Population-Based Cohort Study.BJOG : an international journal of obstetrics and gynaecology · 2025Article
- Impacts of Vehicle Emission Regulations and Local Congestion Policies on Birth Outcomes Associated with Traffic Air Pollution.Research report (Health Effects Institute) · 2025Article
- Food insecurity during pregnancy and associated perinatal outcomes: a scoping review.Epidemiologic reviews · 2025Article
- Fetal and Maternal Factors Predictive of Primary Cesarean Delivery at Term in a Low-Risk Population: NICHD Fetal Growth Studies-Singletons.American journal of perinatology · 2025Article
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5 authors at 5 institutions in 3 countries.
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Abstract
SGA (small for gestational age) is widely used to identify high-risk infants, although with inconsistent definitions. Cut points range from 2.5th to 10th percentile of birthweight-for-gestational age. We used receiver operator characteristic curves (ROC) to identify the cut point with maximum sensitivity and specificity (Youden Index), and the area under the curve (AUC), which assesses overall discriminating power. Analysis was conducted on 3,836,034 US births (2015) and 292,279 Norwegian births (2010-14). Birthweight percentiles were calculated using exact birthweights at each week of gestational age, and then summarized across gestational ages. We also conducted a companion analysis of gestational age itself to consider the predictive power of gestational week of birth. Outcomes were neonatal mortality and cerebral palsy, both strongly associated with birthweight. Birthweight percentiles performed poorly in all analyses. The AUC for birthweight percentiles as a discriminator of neonatal mortality was 60% (where 50% is no better than a coin-toss). At such low discrimination, the Youden Index provides no useful SGA cut point. Results in Norway were virtually identical, with an AUC of 58%. The AUC with cerebral palsy as the outcome was even lower, at 54%. In contrast, gestational age had an AUC of 85% as a predictor of neonatal mortality, with < 37 weeks as the optimum cut point. SGA provides surprisingly poor identification of at-risk infants, while gestational age performs well. Similar results in two countries that differ in mean birthweight, percent preterm, and neonatal mortality suggest robustness across populations.
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