FETAL GROWTH RESTRICTION AT TERM - MYTH OR REALITY

Objective: To evaluate the morbidity and mortality associated with the small for gestational age (SGA) fetus born at term to an otherwise un complicated pregnancy. Methods: Small for gestational age, singleton n ewborns (birth weight below the tenth percentile for gestational age) born at 37-42 weeks' gestation were identified by medical record disch arge coding. We excluded gestations complicated by structural or chrom osomal abnormalities, maternal diabetes mellitus, preeclampsia, chroni c hypertension, asthma, or renal, endocrine, or autoimmune disease. Th ree low-risk, appropriate for gestational age (AGA) fetuses, matched f or gestational age at delivery, were selected randomly for each SGA fe tus and sen ed as controls. Maternal and neonatal data were abstracted via medical record review. Statistical analysis included chi(2) Fishe r exact test, and analysis of variance. Results: There were 67 newborn s in the study group and 201 in the control group. There were no fetal or neonatal deaths in any of these cases. The maternal age at deliver y, prepregnancy weight, race, smoking status, weight gain during pregn ancy, and neonatal gender did not statistically differ between the two groups. Compared with AGA infants, a larger proportion of SGA newborn s had low I-minute Apgar scores and SGA newborns were more likely to b e admitted to the neonatal intensive care unit, and have respiratory d istress, hypoglycemia, thrombocytopenia, and hyperbilirubinemia. They were also significantly more likely to be delivered by cesarean. Concl usion: The SGA newborn from an uncomplicated pregnancy delivered at te rm has increased neonatal morbidity compared with its AGA counterpart. These results dispute the notion that term growth restriction is a be nign condition. (C) 1998 by The American College of Obstetricians and Gynecologists.