Risk stratification for small for gestational age for the Brazilian population: a secondary analysis of the Birth in Brazil study

Abstract Risk-stratification screening for SGA has been proposed in high-income countries to prevent perinatal morbidity and mortality. There is paucity of data from middle-income settings. The aim of this study is to explore risk factors for SGA in Brazil and assess potential for risk stratificatio...

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Autores principales:	Renato T. Souza, Matias C. Vieira, Ana Paula Esteves-Pereira, Rosa Maria Soares Madeira Domingues, Maria Elisabeth Lopes Moreira, Edson Vieira da Cunha Filho, Jane Sandall, Jose G. Cecatti, Maria do Carmo Leal, Marcos Augusto Bastos Dias, Dharmintra Pasupathy
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2020
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f6e2290591344be98141112ee6e6d0eb
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spelling	oai:doaj.org-article:f6e2290591344be98141112ee6e6d0eb2021-12-02T17:41:17ZRisk stratification for small for gestational age for the Brazilian population: a secondary analysis of the Birth in Brazil study10.1038/s41598-020-71252-y2045-2322https://doaj.org/article/f6e2290591344be98141112ee6e6d0eb2020-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-020-71252-yhttps://doaj.org/toc/2045-2322Abstract Risk-stratification screening for SGA has been proposed in high-income countries to prevent perinatal morbidity and mortality. There is paucity of data from middle-income settings. The aim of this study is to explore risk factors for SGA in Brazil and assess potential for risk stratification. This population-based study is a secondary analysis of Birth in Brazil study, conducted in 266 maternity units between 2011 and 2012. Univariate and multivariate logistic regressions were performed, and population attributable fraction estimated for early and all pregnancy factors. We calculated absolute risk, odds ratio, and population prevalence of single or combined factors stratified by parity. Factors associated with SGA were maternal lupus (ORadj 4.36, 95% CI [2.32–8.18]), hypertensive disorders in pregnancy (ORadj 2.72, 95% CI [2.28–3.24]), weight gain < 5 kg (ORadj 2.37, 95% CI [1.99–2.83]), smoking at late pregnancy (ORadj 2.04, 95% CI [1.60–2.59]), previous low birthweight (ORadj 2.22, 95% CI [1.79–2.75]), nulliparity (ORadj 1.81, 95% CI [1.60–2.05]), underweight (ORadj 1.61, 95% CI [1.36–1.92]) and socioeconomic status (SES) < 5th centile (ORadj 1.23, 95% CI [1.05–1.45]). Having two or more risk factors (prevalence of 4.4% and 8.0%) was associated with a 2 and fourfold increase in the risk for SGA in nulliparous and multiparous, respectively. Early and all pregnancy risk factors allow development of risk-stratification for SGA. Implementation of risk stratification coupled with specific strategies for reduction of risk and increased surveillance has the potential to contribute to the reduction of stillbirth in Brazil through increased detection of SGA, appropriate management and timely delivery.Renato T. SouzaMatias C. VieiraAna Paula Esteves-PereiraRosa Maria Soares Madeira DominguesMaria Elisabeth Lopes MoreiraEdson Vieira da Cunha FilhoJane SandallJose G. CecattiMaria do Carmo LealMarcos Augusto Bastos DiasDharmintra PasupathyNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 10, Iss 1, Pp 1-9 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Renato T. Souza Matias C. Vieira Ana Paula Esteves-Pereira Rosa Maria Soares Madeira Domingues Maria Elisabeth Lopes Moreira Edson Vieira da Cunha Filho Jane Sandall Jose G. Cecatti Maria do Carmo Leal Marcos Augusto Bastos Dias Dharmintra Pasupathy Risk stratification for small for gestational age for the Brazilian population: a secondary analysis of the Birth in Brazil study
description	Abstract Risk-stratification screening for SGA has been proposed in high-income countries to prevent perinatal morbidity and mortality. There is paucity of data from middle-income settings. The aim of this study is to explore risk factors for SGA in Brazil and assess potential for risk stratification. This population-based study is a secondary analysis of Birth in Brazil study, conducted in 266 maternity units between 2011 and 2012. Univariate and multivariate logistic regressions were performed, and population attributable fraction estimated for early and all pregnancy factors. We calculated absolute risk, odds ratio, and population prevalence of single or combined factors stratified by parity. Factors associated with SGA were maternal lupus (ORadj 4.36, 95% CI [2.32–8.18]), hypertensive disorders in pregnancy (ORadj 2.72, 95% CI [2.28–3.24]), weight gain < 5 kg (ORadj 2.37, 95% CI [1.99–2.83]), smoking at late pregnancy (ORadj 2.04, 95% CI [1.60–2.59]), previous low birthweight (ORadj 2.22, 95% CI [1.79–2.75]), nulliparity (ORadj 1.81, 95% CI [1.60–2.05]), underweight (ORadj 1.61, 95% CI [1.36–1.92]) and socioeconomic status (SES) < 5th centile (ORadj 1.23, 95% CI [1.05–1.45]). Having two or more risk factors (prevalence of 4.4% and 8.0%) was associated with a 2 and fourfold increase in the risk for SGA in nulliparous and multiparous, respectively. Early and all pregnancy risk factors allow development of risk-stratification for SGA. Implementation of risk stratification coupled with specific strategies for reduction of risk and increased surveillance has the potential to contribute to the reduction of stillbirth in Brazil through increased detection of SGA, appropriate management and timely delivery.
format	article
author	Renato T. Souza Matias C. Vieira Ana Paula Esteves-Pereira Rosa Maria Soares Madeira Domingues Maria Elisabeth Lopes Moreira Edson Vieira da Cunha Filho Jane Sandall Jose G. Cecatti Maria do Carmo Leal Marcos Augusto Bastos Dias Dharmintra Pasupathy
author_facet	Renato T. Souza Matias C. Vieira Ana Paula Esteves-Pereira Rosa Maria Soares Madeira Domingues Maria Elisabeth Lopes Moreira Edson Vieira da Cunha Filho Jane Sandall Jose G. Cecatti Maria do Carmo Leal Marcos Augusto Bastos Dias Dharmintra Pasupathy
author_sort	Renato T. Souza
title	Risk stratification for small for gestational age for the Brazilian population: a secondary analysis of the Birth in Brazil study
title_short	Risk stratification for small for gestational age for the Brazilian population: a secondary analysis of the Birth in Brazil study
title_full	Risk stratification for small for gestational age for the Brazilian population: a secondary analysis of the Birth in Brazil study
title_fullStr	Risk stratification for small for gestational age for the Brazilian population: a secondary analysis of the Birth in Brazil study
title_full_unstemmed	Risk stratification for small for gestational age for the Brazilian population: a secondary analysis of the Birth in Brazil study
title_sort	risk stratification for small for gestational age for the brazilian population: a secondary analysis of the birth in brazil study
publisher	Nature Portfolio
publishDate	2020
url	https://doaj.org/article/f6e2290591344be98141112ee6e6d0eb
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Risk stratification for small for gestational age for the Brazilian population: a secondary analysis of the Birth in Brazil study

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