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Am J Perinatol 2018; 35(07): 695-702
DOI: 10.1055/s-0037-1608791
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Population-Specific Birthweight Curves on Disparities in Perinatal Mortality in Small-for-Gestational Age Pregnancies

Jacob C. Larkin
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Ashley I. Naimi
2   Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
› Author Affiliations Funding This project is supported by NIH grant K12HD063087 (J.C.L.).
Further Information

Publication History

24 August 2017

14 October 2017

Publication Date:
13 December 2017 (online)

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Abstract

Objective To determine the effect of adopting sex or race/ethnicity-specific birthweight curves on small-for-gestational age (SGA)-associated mortality rates for specific populations.

Materials and Methods Analyzing 20,095,735 singleton pregnancies, we compared rates of perinatal death associated with SGA in distinct sex and racial/ethnic groups when SGA was defined using nonspecific, sex-specific, and race/ethnicity-specific birthweight curves.

Results With use of a nonspecific birthweight curve, the rate of perinatal death was higher for SGA males (20.4/1,000 [95% confidence interval (CI), 20.1, 20.7]) than SGA females [14.6/1,000 (95% CI, 14.4, 14.8)]. With a sex-specific curve, this disparity was reduced, measuring 17.7/1,000 (95% CI, 17.4, 17.9) for SGA males and 16.3/1,000 (95% CI, 16.1, 16.6) for females. Using a nonspecific birthweight curve, perinatal death rates were higher for non-Hispanic blacks (20.4/1,000 [95% CI, 20.0, 20.8]) than for all other racial/ethnic groups (15.9/1,000 [95% CI, 15.7, 16.1]). This difference increased with use of a race-specific birthweight curve: perinatal mortality was 29.7/1,000 (95% CI, 29.0, 30.3) for SGA blacks and 14.7/1,000 (95% CI, 14.6, 14.9) for all other racial/ethnic groups.

Conclusion Population-based differences in SGA-associated mortality are reduced with adoption of a sex-specific birthweight curve, but widen with use of a race/ethnicity-specific curve. These findings highlight the importance of outcomes analysis in the selection of diagnostic criteria for SGA.

Keywords

fetal growth restriction - small for gestational age - neonatal mortality - stillbirth - perinatal mortality - racial disparities

Supplementary Material

 

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