The effects of maternal obesity on perinatal outcomes among those born small for gestational age*

Background: Maternal obesity has been associated with higher birth weight. Small for gestational age (SGA) neonates born to obese women may be associated with pathological growth with increased neonatal complications.

Methods: This was a retrospective cohort study of all non-anomalous singleton neonates born in Texas from 2006–2011. Analyses were limited to births between 34 and 42 weeks gestation with birth weight?≤10th percentile. Results were stratified by maternal pre-pregnancy BMI class. The risk for stillbirth, neonatal death, neonatal intensive care unit (NICU) admission and five?minute Apgar scores?<7 were estimated for each obesity class and compared to the normal weight group. Multivariable logistic regression analyses were performed to control for potential confounding variables.

Results: The rate of stillbirth was 1.4/1000 births for normal weight women, and 2.9/1000 among obese women (p?0.001, aOR: 1.83 [1.43, 2.34]). The rate of neonatal deaths among normal weight women was 4.3/1000 births, whereas among obese women it was 4.7/1000 (p?=?0.94, aOR: 1.10 [0.92, 1.30]). A dose-dependent relationship between maternal obesity and stillbirths was seen, but not for other neonatal outcomes.

Conclusion: Among SGA neonates, maternal pre-pregnancy obesity was associated with increased risks for stillbirth, NICU admission and low Apgar scores but not neonatal death.     

Update on the birth weight standard and its diagnostic value in small for gestational age (SGA) infants in China

Objectives: To identify the difference between the current newborn birth weight standard and the previous standard in China, and to evaluate the diagnostic value of newborn birth weight in small for gestational age (SGA) infants.

Methods: A retrospective analysis was conducted of 112?441 delivery cases in 2011, from 39 hospitals at different levels in 14 provinces and autonomous regions. Cases with incomplete data, gestational age?<24 weeks, or severe fetal malformations or fetal death were excluded. Data were recorded and entered on hard paper copies and into an online database. SPSS 18.0 and SAS 9.2 statistical software were used for data analysis.

Results: This study included 109?004 valid cases with an average birth weight of 3226.02?±?525.82?g. Birth weight changed significantly from 1988 for all gestational ages. In preterm infants with gestational age?<37 weeks, birth weight for each gestational week was lower than that in the birth weight standard from 15 cities in China in 1988 (p?+6 weeks showed significantly higher average birth weights compared with the previous birth weight standards (p?Conclusions: The current birth weight standard used in Chinese medical institutions was enacted in 1988. This is not suitable for today’s socioeconomic and clinical requirements, and needs to be updated. Diagnosis of preterm infants with SGA based upon the updated demographic birth weight standard manifested higher accuracy and avoided unnecessary medical interventions. However, the updated demographic birth weight standards were no better diagnostically than the previous standard for full-term infants. Customized birth weight standards from larger sample sizes and multi-center studies will be necessary to determine the appropriate birth weight standards in developing countries.     

The utility of ultrasound in late pregnancy compared with clinical evaluation in detecting small and large for gestational age fetuses in low-risk pregnancies

Objective: To determine the utility of ultrasound (US) in late pregnancy for identifying fetuses with growth disturbances.

Methods: This study was designed as a retrospective study of birth weights over a 12-month period at the Royal Hobart Hospital (RHH) and Barwon Health (BH). Data were collected from the discharge summaries and medical records at both hospitals targeting abnormal fetal weight below 10th percentile (small for gestational age – SGA) and above 90th percentile (large for gestational age – LGA).

Results: There were 4079 study patients from both hospitals. After weight adjustment by gender and gestational age, an abnormal fetal weight was detected in 741 cases (babies over the 90th percentile or below 10th percentile). One hundred and twenty-eight patients with high-risk pregnancies were excluded. Therefore, a total of 613 patients remained that were considered to be low-risk pregnancies with abnormal foetal growth; 305 patients from RHH and 308 from BH. The antenatal detection rate for LGA was 35.9%, at RHH by combination of US and clinical evaluation, while for BH it was 34.8% by clinical evaluation alone (p?=?0.910). The antenatal detection rate for SGA was 36.8% via US and clinical evaluation at RHH and 54.5% by clinical evaluation alone at BH (p?=?0.006).

Conclusion: This study shows no benefit in the use of routine US for the antenatal diagnosis of LGA compared with clinical evaluation in low-risk pregnancies. US evaluation was inferior to clinical evaluation in the antenatal diagnosis of SGA in low-risk pregnancies.     

Gestational age-specific neonatal morbidity among pregnancies complicated by advanced maternal age: a population-based retrospective cohort study

Objective: Compare significant neonatal morbidity frequency differences in advanced maternal age (AMA) versus non-AMA pregnancies, assessing which gestational week is associated with the lowest morbidity risk.

Methods: Population-based retrospective cohort study. Adverse neonatal outcome frequency differences were stratified by each week of gestation. Multivariate logistic regression estimated the relative risk (RR) of composite neonatal morbidity for women aged 35–39, 40–44, 45–49 and 50–55 versus 18–34 years, adjusted sequentially for relevant risk factors.

Results: Neonatal morbidity decreased with each advancing week of term gestation, lowest at 39 weeks for all the groups. Adverse neonatal outcome risk for births to AMA women increased at 40 weeks: 35–39 years _adjRR 1.12 [1.01–1.24] and ≥40 years 1.24 [1.01–1.52]. Each older maternal age category had increased risk for overall neonatal morbidity: 35–39 years _adjRR 1.11 [95% CI 1.08–1.15], 40–44 years 1.21 [95% CI 1.14–1.29] and 45–49 years 1.34 [95% CI 1.05–1.69].

Conclusions: Lowest neonatal morbidity risk is at 39-week gestation with a significantly increased risk observed thereafter, especially in women ≥40 years.     

Ultrasound estimation of fetal weight in small for gestational age pregnancies

Objective.?Approximately half of small for gestational age (SGA) cases are due to maternal or fetal pathology, and may result in significant neonatal morbidity and mortality. The estimated fetal weight (EFW) measurement is the cornerstone of ultrasonographic findings when diagnosing and managing SGA pregnancies. Our objective was to determine the ultrasound accuracy of EFW in SGA pregnancies.

Methods.?A retrospective chart review was performed of all pregnancies complicated by SGA from a single institution (Stanford University) over a 2-year-period (2004–2006). SGA was defined as EFW?≤?10%. 98 neonates whose last ultrasound for EFW occurred within 7 days of delivery were included in the study. The absolute differences between the EFW and birthweight (BW) were analyzed, and the absolute percent errors were calculated as (EFW???BW)/BW?× 100. The mean absolute differences and mean absolute percent errors were analyzed across all gestational ages (GA) and EFWs using one-way analysis of variance.

Results.?The mean absolute percent error for the entire cohort was 8.7% (±6.3%). There was no statistically significant difference in the mean absolute percent error across all GAs (<32 weeks, 32–36 weeks, >36 weeks), and EFWs (<1500?g, 1500–2000?g, >2000?g).

Conclusion.?Ultrasound measurement of EFW in SGA pregnancies is consistent across all GAs and EFW measurements.     

Composite neonatal and maternal morbidities with small- versus appropriate- for gestational age among uncomplicated obese women undergoing repeat cesarean delivery*

Purpose: Our goal was to compare composite neonatal and maternal morbidities (composite neonatal morbidity (CNM), composite maternal morbidity (CMM)) among deliveries with small for age (SGA) versus appropriate for gestational age (AGA; birthweight 10–89%) among obese versus non-obese women undergoing repeat cesarean delivery (CD).

Study design: This is a secondary analysis of a prospective observational study. Women who had elective CD ≥37 weeks were studied. We excluded multiple gestations, fetal anomalies,?>?1 prior CD, and medical diseases. Patients were divided into BMI ≥30 versus <30?kg/m². CNM included respiratory distress syndrome, necrotizing enterocolitis, severe intraventricular hemorrhage, seizure, or death; CMM included transfusion, hysterectomy, operative injury, coagulopathy, thromboembolism, pulmonary edema, or death. Multivariate logistic regression was used to control for confounding factors.

Results: Of 7561 women, we included 65% were obese and 35% were not. SGA rates differed significantly: 8 versus 12% (p?Conclusions: SGA occurred in 8% of low-risk obese women with prior CD. CNM of SGA babies in obese versus non-obese women were similar. Paradoxically, CMM was lower in obese cases, possibly reflecting the caution that obese patients receive preoperatively. Our findings may assist in counseling patients and designing trials.     

Low maternal awareness of fetal movement is associated with small for gestational age infants

Our aim was to identify associations between information given to pregnant women about fetal activity, level of maternal awareness of fetal activity, maternal concern about decreased fetal movement, and pregnancy outcomes. This was a population-based cross-sectional study. Mothers with a singleton delivery were invited to answer an anonymous structured questionnaire before discharge from the delivery unit. Six hundred and ninety-one mothers participated (60.4% of eligible women). Women were highly aware of fetal activity. Yet, 25% did not receive any information from care providers about expected normal fetal activity. Receiving information about fetal activity was associated with increased maternal awareness (odds ratio, 2.0; 95% confidence interval [CI], 1.2-3.4). Low maternal awareness of fetal activity was associated with an increased risk of having a small for gestational age infant (odds ratio, 6.5; 95% CI, 3.5-12.3). Expectations about the normal frequency of fetal movements, as reported by the mothers, varied from 25 kicks/hour to 3 kicks/24 hours. Receiving information about expected fetal activity was associated with maternal concerns about decreased fetal movement, but not with improved outcomes. We conclude that receiving information about expected fetal activity was associated with maternal concerns, but not with improved outcomes.     

Low first-trimester hemoglobin and low birth weight, preterm birth and small for gestational age newborns.

OBJECTIVE: To examine the relationship between first-trimester hemoglobin (Hb) concentration and risk of low birth weight (LBW), preterm birth and small for gestational age (SGA). METHODS: Data were obtained from a population-based prenatal care program in China. A total of 88,149 women who delivered during 1995-2000 and had their Hb measured in the first trimester were selected as study subjects. RESULTS: The prevalence of anemia (Hb<110 g/L) was 22.1% in the first trimester. The risk of LBW, preterm birth and SGA was increased steadily with the decrease of first-trimester Hb concentration. After controlling for confounding factors, women with Hb 80-99 g/L had significantly higher risk for LBW (OR=1.44, 95% CI 1.17-1.78), preterm birth (OR=1.34, 95% CI 1.16-1.55) and SGA (OR=1.13, 95% CI 0.98-1.31) than women with Hb 100-119 g/L. No elevated risk was noted for women with Hb> or =120 g/L. CONCLUSION: Low first-trimester Hb concentration increases the risk of LBW, preterm birth and SGA.     

Long-term endocrine outcome of small for gestational age infants born to mothers with and without gestational diabetes mellitus

Abstract

Small for gestational age (SGA) infants and infants born to mothers with gestational diabetes mellitus (GDM) are at an increased risk for significant morbidity and mortality, mainly metabolic disorders. We aimed to question the long-term endocrine morbidity of SGA infants born to mothers with GDM compared to SGA infants born to non- diabetic mothers. A population-based cohort study was performed to assess the risk for endocrine morbidity among children born SGA to mothers with and without GDM. The main outcome evaluated was endocrine morbidity of the offspring up to the age of 18 years, predefined in a set of ICD-9 codes. Endocrine morbidity included thyroid disease, insulin and non-insulin dependent diabetes mellitus, hypoglycemia, childhood obesity, parathyroid hormone disease, adrenal disease, and sex hormone disease. All SGA infants born between the years 1991 and 2014 and discharged alive from the hospital were included in the study. Multiple pregnancies, infants with congenital malformations or chromosomal abnormalities and mothers lacking prenatal care were excluded from the analysis. Kaplan–Meier survival curve was constructed to compare cumulative endocrine morbidity. A Cox proportional hazards model was conducted to control for confounders. During the study period, 9312 newborn infants met the inclusion criteria, of them 259 SGA infants were born to mothers with GDM and 9053 SGA infants were born to mother without GDM. No significant differences in long-term endocrine morbidity were noted between the groups (0.8% in children born to mothers with GDM vs. 0.5% in children born to non-diabetic mothers, p?=?.62). Likewise, the Kaplan–Meier survival curve did not demonstrate a significantly higher cumulative incidence of endocrine morbidity in offspring of women with GDM (log rank test p=.67). In a Cox regression model, while controlling for ethnicity, hypertensive disorders, preterm birth, and maternal age, delivery of an SGA neonate to mother with GDM was not associated with long-term endocrine morbidity of the offspring (adjusted HR 1.2, 95% confidence interval 0.27–5.00, p=.82). SGA infants born to mothers with GDM are not at an increased risk for long-term endocrine morbidity as compared with SGA infants born to non-diabetic mothers.     

Investigation and management of the small for gestational age fetus

The desire to identify the small for gestational age fetus is due to its association with stillbirth and poorer neonatal outcomes. The difficulty lies in determining which of these babies are just constitutionally small and healthy and which are growth restricted fetuses that are at significant risk of poor outcomes. Fetal growth restriction is often mediated through placental disease and shares a similar aetiological pathway to preeclampsia. Placental malperfusion results in impaired nutrient and oxygen delivery to the fetus. Appropriate risk assessment in early pregnancy and monitoring with symphysis fundal height measurement or ultrasound scans is a crucial part of the screening pathway. There is no effective treatment for growth restriction, so management is based on close monitoring and early delivery. Fetal growth restriction has better defined monitoring and delivery timing guidelines whereas it is more unclear and variable for fetuses considered only to be small for gestational age.     

Antiphosphatidyl serine antibodies are more common in normotensive women with small for gestational age pregnancies

BACKGROUND: Small for gestational age (SGA) babies are more common in women with antiphospholipid antibodies but data are limited about the prevalence of antiphospholipid antibodies in women who have delivered SGA babies. AIM: To determine whether elevated levels of anticardiolipin, antiphosphatidyl serine and/or antibeta2 glycoprotein I antibodies are more common in normotensive women who delivered SGA babies compared with women who delivered appropriate for gestational age babies. METHODS: Case-control study. Cases were normotensive women who delivered an SGA baby (birthweight <10th%) without chromosomal or congenital abnormality. Controls were healthy women who delivered a baby at term with birthweight >10th percentage. RESULTS: A total of 137 women with SGA pregnancies and 290 controls had antiphospholipid antibodies measured. The prevalence of anticardiolipin and antibeta2 glycoprotein I antibodies did not differ between SGA cases and controls. Antiphosphatidyl serine IgG antibodies were more common in women with SGA pregnancies than controls seven (5%) versus five (1.7%), relative risk (RR) 1.84 (1.12-3.03). There was no difference in the prevalence of 'any antiphospholipid antibodies' between SGA 10 (7.2%) and controls 16 (5.6%). There was a trend to more abnormal umbilical Doppler studies in SGA pregnancies with positive antiphospholipid antibodies three (50%) versus 19 (24%), RR 2.9 (0.62-13). CONCLUSIONS: Antiphospholipid antibodies were uncommon in this cohort of SGA pregnancies. Further studies are needed in SGA pregnancies with abnormal umbilical Doppler studies to determine if screening for antiphospholipid antibodies is worthwhile in this severe subgroup.     

Prediction of small for gestational age by logistic regression in twins

BACKGROUND: Small for gestational age (SGA) is one of the major determinants of perinatal mortality and morbidity, and may relate in adult diseases. Early prediction of SGA could be helpful for health care providers and public health workers in guiding antenatal management and prevention. The reported methods of SGA prediction are not satisfactory because the diagnostic performance is poor and the interval between prediction and delivery is too short. AIMS: To establish a SGA prediction model for twin pregnancies based on variables obtainable in early gestation. METHODS: We used a large twin registry United States data (1995-1997). The study subjects were randomly divided into two groups: group 1 to establish the prediction model by logistic regression and group 2 to validate the prediction model. SGA was defined as birth weight for gestational age z scores less than 10th percentiles. Pair of twin was the unit of analysis. Two sets of multiple logistic regression analyses with different outcome measures - one or both twins SGAs and both twins SGAs - were used to establish the prediction model. RESULTS: The sensitivity, specificity, and positive predictive value were 52.3, 62.5, and 21.5%, respectively, at the cutoff value 0.16 in a SGA prediction model based on maternal race, education, marital status, parity, prenatal care visit initiation, cigarette smoking, and paternal race. CONCLUSIONS: A prediction model based on determinants that can be obtained at early gestation might be useful in the management of pregnancies with high risk of SGA in twins.     

Evaluation of carnitine deficit in very low birth weight preterm newborns small for their gestational age

Objective: To verify whether small-for-gestational-age (SGA) preterm newborns represent a special risk group for carnitine deficiency. Secondary outcome includes assessment of longitudinal differences of total carnitine (TC), free carnitine (FC) and acylcarnitines between SGA and appropriate-for-gestational-age (AGA).

Methods: A retrospective study to evaluate carnitine and acylcarnitines profile on 144 very-low-birth weight newborns (VLBW), classified as AGA (n?=?73) and SGA (n?=?71), was performed by tandem mass spectrometry, during their first 5 weeks of life. Carnitine deficiency was defined as FC <40?µmol/L and FC/TC <0.7.

Results: Carnitine deficiency was observed in the two study groups throughout the monitoring period (maximum FC: 36.05?µmol/L in AGA and 32.24?µmol/L in SGA). FC/TC remains under 0.7 in both with progressive improvement. Unlike expected, a comparatively higher value of TC, FC and total acylcarnitines (tAC) was found in SGA during the first 2 weeks, with significant relevance on day 3–5, especially for tAC (p?<?0.001). The only acylcarnitine with persistently lower value in SGA is C5 (p?<?0.05 in first 2 weeks).

Conclusions: A carnitine deficiency was demonstrated in all VLBW. Although birth weight restriction has been suggested as a risk factor for impaired carnitine status, in our study, SGA was not related with higher carnitine deficiency.     

The influence of fetal sex on the antenatal diagnosis of small for gestational age

Objective: We evaluated the influence of fetal sex on the antenatal diagnosis and detection of small for gestational age (SGA).

Methods: The cohort consisted of unselected singleton pregnancies, undergoing routine biometry and cerebroplacental ratio (CPR) assessment at 36 weeks. Locally fitted equations for centiles and Z scores were used. “Ultrasound SGA” was defined as estimated fetal weight (EFW)?Results: Among 4112 pregnancies, there were 235 female “ultrasound SGA” fetuses and 177 male; (odds ratios (OR) 1.502 (1.223???1.845)); the detection rate of SGA at birth was 50.6% and 40.9%, respectively (OR 1.479 (0.980???2.228)). In “ultrasound SGA” girls the abdominal circumference growth velocity (ACGV) between 20 and 36 weeks was less frequently in the lowest decile (OR 0.490 (0.320???0.750)), with no differences in CPR.

Conclusions: Females are more commonly diagnosed as SGA; those diagnosed may be at less risk than males.     

Hydramnios and small for gestational age are independent risk factors for neonatal mortality and maternal morbidity

Objective The objective was to evaluate the contribution of hydramnios and small for gestational age (SGA) as a combined pathology to maternal and neonatal morbidity and mortality.Methods The study population consisted of 192 SGA neonates with hydramnios, 5,515 SGA neonates with a normal amount of amniotic fluids, 3,714 appropriate for gestational age (AGA) neonates with polyhydramnios and 83,763 AGA neonates with a normal amount of amniotic fluid. A cross-sectional population based study was designed between the four study groups. Multiple logistic regression analysis was used to assess the contribution of these abnormalities and different risk factors to maternal and perinatal complications.Results The combination of hydramnios/SGA was found to be an independent risk factor for perinatal mortality (OR 20.55; CI 12.6–33.4). Congenital anomalies, prolapse of cord, hydramnios, SGA and grand multiparity were also independent risk factors for perinatal mortality. Independent risk factors for neonatal complications were prolapse of umbilical cord (OR 4.13; 95% CI 1.48–11.5), hydramnios/SGA (OR 2.72; 95% CI 1.81–4.07), chronic hypertension (OR 2.45; 95% CI 1.02–5.9), congenital malformations (OR 1.93; 95% CI 1.14–3.24) and SGA (OR 1.47; 95% CI 1.07–2). Significant independent risk factors for medical interventions during labor were fetal distress (OR 198.46; 95% CI 47.27–825.27), GDM Class B–R (OR 21.22; 95% CI 2.34–192.25), GDM class A (OR 4.64; 95% CI 2.62–8.21), severe pregnancy-induced hypertension (PIH; OR 7.74; 95% CI 2.35–25.42), hydramnios (OR 1.95; 95% CI 1.3–2.91), hydramnios/SGA (OR 1.84; 95% CI 1.12–3.02) and malpresentation (OR 1.56; 95% CI 1.32–1.84).Conclusion The combination of hydramnios and SGA is an independent risk factor for perinatal mortality and maternal complications. We suggest that the growth restriction of these fetuses is responsible for the neonatal complications, while the hydramnios contributes mainly to maternal complications.     

Inadequate weight gain in obese women and the risk of small for gestational age (SGA): a systematic review and meta-analysis

Objectives: To examine the association between small for gestational age (SGA) and inadequate gestational weight gain (GWG) in obese women (compared with Institute of Medicine [IOM] guidelines) stratified by obesity classes.

Methods: We conducted a meta-analysis of original researches with sufficient information about inadequate GWG in obese women stratified by obesity classes. SGA as the chief outcome was extracted and assessed in our analysis. MEDLINE and EMBASE were searched through Ovid from 28 May 2009 to 1 December 2015. Quality was assessed using a modified Newcastle–Ottawa scale.

Results: 480 citations were screened and 13 studies (437 512 obese women) were included. Obese women who gained weight below the guidelines had higher risks of SGA than those who gained weight within the guidelines (OR 1.28; 95% CI 1.14–1.43). The same conclusions were also confirmed in Class I, Class II and Class III of obese women: Class I (OR 1.37; 95% CI 1.22–1.54); Class II (OR 1.38; 95% CI 1.24–1.54); Class III (OR 1.25; 95% CI 1.14–1.36).

Conclusions: From our analysis, the guidelines of IOM can be applied to all the classes of obesity. More accurate boundaries for each obesity class should be established to evaluate the maternal and fetal risks. Diverse populations are thus necessary for more studies in the future.     

Predicting small for gestational age in the first trimester of pregnancy using maternal ophthalmic artery Doppler indices

Objective: To assess the capacity of maternal ophthalmic Doppler indices for predicting small for gestational age (SGA) newborns in the first trimester of pregnancy.

Methods: We performed a prospective observational cohort study involving 499 singleton pregnancies during the first trimester scan (11–14 weeks). The following maternal ophthalmic Doppler indices were assessed: pulsatility index (PI), first diastolic peak velocity (PD1) and peak ratio (PR)?=?PD1/peak systolic velocity. We considered SGA all newborns with weight below 10th percentile. We used chi-square test (χ²) to compare the groups. We used area under receiver operating characteristics (ROC) curves with 95% confidence intervals (CI) and detection rate of 5% of false positive of each maternal ophthalmic Doppler index and the mean uterine artery PI for prediction SGA.

Results: 27 (5.4%) patients delivered SGA newborns, 12 (2.4%) patients developed preeclampsia (PE) and delivered SGA newborns, and 460 had uneventful pregnancies (controls). We observed significant difference of PI and PR between SGA (SGA and SGA+PE) and control groups, p?=?0.043 and p?=?0.014, respectively. To 5% of false positive, the detection rate of SGA (SGA and SGA+PE groups) using PI, PD1 and PR were 14.8, 3.7, 14.8, 16.7, 16.7 and 16.7%, respectively. Mean uterine PI was significantly higher in the SGA+PE group (p?=?0.003).

Conclusion: The isolated use of maternal ophthalmic Doppler indices or in combination with uterine artery Doppler, in the first trimester of pregnancy, was not efficient to predict SGA newborns.     

The association between customised small for gestational age infants and pre-eclampsia or gestational hypertension varies with gestation at delivery

OBJECTIVES: (1) To describe the association between small for gestational age (SGA) infants and pre-eclampsia (PE) and gestational hypertension (GH) and (2) to determine how this association changes with gestational age at delivery using customised centiles to classify infants as SGA. DESIGN: A retrospective observational study. SETTING: National Women's Hospital, a Tertiary Referral Centre in Auckland, New Zealand. POPULATION: A total of 17 855 nulliparous women delivering between 1992 and 1999. METHODS: A comparison of the number of women with a customised SGA infant, PE and GH according to gestational age at delivery. MAIN OUTCOME MEASURES: The incidence of SGA infants (defined as birthweight <10th customised centile), PE and GH at <34, 34-36(+6) and > or =37 weeks. RESULTS: A total of 1847 (10.3%) infants were SGA, 520 (2.9%) women had PE and 1361 (7.6%) had GH. SGA, PE and GH all occurred more commonly with increasing gestation at delivery with 85%, 62% and 90% of cases delivered at term. In women delivering SGA infants, coexisting PE was more likely to occur among those delivered preterm than at term (38.6% at <34 weeks [relative risk, RR 10.2 95%CI 7.3-14.4], 22.4% at 34-36(+6) weeks [RR 6.0 95%CI 4.1-8.6] and 3.8% at > or =37 weeks [OR 1.0]). Women with preterm PE were more likely to have a SGA infant than women with term PE (57.1% at <34 weeks [RR 3.1 95%CI 2.3-4.2], 31.7% at 34-36(+6) weeks [RR 1.7 95%CI 1.2-2.5]) and 18.3% at > or =37 weeks [OR 1.0]). There was a similar association between GH and SGA infants as gestation advanced (57.6% at <34 weeks [RR 4.8 95%CI 3.4-6.6], 30.5% at 34-36(+6) weeks [RR 2.5 95%CI 1.8-3.5] and 12.1% > or =37 weeks [OR 1.0]). CONCLUSIONS: SGA infants and PE are more likely to coexist in preterm births compared with term births. This is likely to reflect the degree of placental involvement in each disease process.