The Role of Maternal Weight in the Hierarchy of Macrosomia Predictors; Overall Effect of Analysis of Three Prediction Indicators

So far it has not been established which maternal features play the most important role in newborn macrosomia. The aim of this study is to provide assessment of a hierarchy of twenty six (26) maternal characteristics in macrosomia prediction. A Polish prospective cohort of women with singleton pregnancy (N = 912) which was recruited in the years 2015−2016 has been studied. Two analyses were performed: for probability of macrosomia >4000 g (n = 97) (vs. 755 newborns 2500−4000 g); and for birthweight >90th percentile (n = 99) (vs. 741 newborns 10−90th percentile). A multiple logistic regression was used (with 95% confidence intervals (CI)). A hierarchy of significance of potential predictors was established after summing up of three prediction indicators (NRI, IDI and AUC) calculated for the basic prediction model (maternal age + parity) extended with one (test) predictor. ‘Net reclassification improvement’ (NRI) focuses on the reclassification table describing the number of women in whom an upward or downward shift in the disease probability value occurred after a new factor had been added, including the results for healthy and ill women. ‘Integrated discrimination improvement’ (IDI) shows the difference between the value of mean change in predicted probability between the group of ill and healthy women when a new factor is added to the model. The area under curve (AUC) is a commonly used indicator. Results. The macrosomia risk was the highest for prior macrosomia (AOR = 7.53, 95%CI: 3.15−18.00), p < 0.001). A few maternal characteristics were associated with more than three times higher macrosomia odds ratios, e.g., maternal obesity and gestational age ≥38 weeks. A different hierarchy was shown by the prediction study. Compared to the basic prediction model (AUC = 0.564 (0.501−0.627), p = 0.04), AUC increased most when pre-pregnancy weight (kg) was added to the base model (AUC = 0.706 (0.649−0.764), p < 0.001). The values of IDI and NRI were also the highest for the model with maternal weight (IDI = 0.061 (0.039−0.083), p < 0.001), and NRI = 0.538 (0.33−0.746), p < 0.001). Adding another factor to the base model was connected with significantly weaker prediction, e.g., for gestational age ≥ 38 weeks (AUC = 0.602 (0.543−0.662), p = 0.001), IDI = 0.009 (0.004; 0.013), p < 0.001), and NRI = 0.155 (0.073; 0.237), p < 0.001). After summing up the effects of NRI, IDI and AUC, the probability of macrosomia was most strongly improved (in order) by: pre-pregnancy weight, body mass index (BMI), excessive gestational weight gain (GWG) and BMI ≥ 25 kg/m2. Maternal height, prior macrosomia, fetal sex-son, and gestational diabetes mellitus (GDM) occupied an intermediate place in the hierarchy. The main conclusions: newer prediction indicators showed that (among 26 features) excessive pre-pregnancy weight/BMI and excessive GWG played a much more important role in macrosomia prediction than other maternal characteristics. These indicators more strongly highlighted the differences between predictors than the results of commonly used odds ratios.

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A first trimester prediction model for large for gestational age infants: a preliminary study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04127-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Francesca Monari ◽

Daniela Menichini ◽

Ludovica Spano’ Bascio ◽

Giovanni Grandi ◽

Federico Banchelli ◽

...

Keyword(s):

Prediction Model ◽

Gestational Age ◽

Predictive Accuracy ◽

First Trimester ◽

University Hospital ◽

Large For Gestational Age ◽

Aneuploidy Screening ◽

Maternal Characteristics ◽

Targeted Interventions ◽

Increased Risk

Abstract Background Large for gestational age infants (LGA) have increased risk of adverse short-term perinatal outcomes. This study aims to develop a multivariable prediction model for the risk of giving birth to a LGA baby, by using biochemical, biophysical, anamnestic, and clinical maternal characteristics available at first trimester. Methods Prospective study that included all singleton pregnancies attending the first trimester aneuploidy screening at the Obstetric Unit of the University Hospital of Modena, in Northern Italy, between June 2018 and December 2019. Results A total of 503 consecutive women were included in the analysis. The final prediction model for LGA, included multiparity (OR = 2.8, 95% CI: 1.6–4.9, p = 0.001), pre-pregnancy BMI (OR = 1.08, 95% CI: 1.03–1.14, p = 0.002) and PAPP-A MoM (OR = 1.43, 95% CI: 1.08–1.90, p = 0.013). The area under the ROC curve was 70.5%, indicating a satisfactory predictive accuracy. The best predictive cut-off for this score was equal to − 1.378, which corresponds to a 20.1% probability of having a LGA infant. By using such a cut-off, the risk of LGA can be predicted in our sample with sensitivity of 55.2% and specificity of 79.0%. Conclusion At first trimester, a model including multiparity, pre-pregnancy BMI and PAPP-A satisfactorily predicted the risk of giving birth to a LGA infant. This promising tool, once applied early in pregnancy, would identify women deserving targeted interventions. Trial registration ClinicalTrials.gov NCT04838431, 09/04/2021.

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Antepartum Bed Rest: Maternal Weight Change and Infant Birth Weight

Biological Research For Nursing ◽

10.1177/1099800403260307 ◽

2004 ◽

Vol 5 (3) ◽

pp. 177-186 ◽

Cited By ~ 26

Author(s):

Judith A. Maloni ◽

Greg R. Alexander ◽

Mark D. Schluchter ◽

Dinesh M. Shah ◽

Seunghee Park

Keyword(s):

Weight Gain ◽

Birth Weight ◽

Gestational Age ◽

Weight Change ◽

Bed Rest ◽

Institute Of Medicine ◽

Maternal Weight ◽

Race And Gender ◽

Pregnancy Weight ◽

Infant Birth

Despite lack of evidence for effectiveness, obstetricians in the United States prescribe antepartum bed rest for more than 700,000 women per year. However, in nonpregnant samples, bed rest treatment produces weight loss. This study assessed maternal weight change (gain) during antepartum hospitalization for bed rest treatment; compared appropriateness of infant birth weights for gestational age, race, and gender; and determined whether maternal weight change predicted infant birth weight. The convenience sample for this longitudinal study consisted of 141 women with high-risk pregnancies who were treated with hospital bed rest. Weekly rate of pregnancy weight change by body mass index was compared with Institute of Medicine recommendations for rate of pregnancy weight gain. Infant birth weight was compared with current US infant birth weights for matching gestational age, gender, and race. Weekly antepartum weight change was significantly lower than Institute of Medicine recommendations (P < 0.001). Infant birth weights were also significantly lower than the national mean when matched for each infant’s gestational age, race, and gender ( P < 0.001). Maternal weight change predicted infant birth weight ( P = 0.05). Bed rest treatment is ineffective for improving pregnancy weight gain. Lower infant birth weights across all gestational ages suggest that maternal weight loss during bed rest may be associated with an increased risk of fetal growth restriction. A randomized trial comparing women with high-risk pregnancies who are ambulatory with those on bed rest is needed to determine whether bed rest treatment, underlying maternal-fetal disease, or both influence inadequate maternal weight gain and poor intrauterine growth.

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Paternal weight prior to conception and infant birthweight: a prospective cohort study

Nutrition and Diabetes ◽

10.1038/s41387-021-00172-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ravi Retnakaran ◽

Shi Wu Wen ◽

Hongzhuan Tan ◽

Shujin Zhou ◽

Chang Ye ◽

...

Keyword(s):

Cohort Study ◽

Weight Gain ◽

Gestational Weight Gain ◽

Gestational Age ◽

Weight Status ◽

Large For Gestational Age ◽

Maternal Weight ◽

Singleton Pregnancy ◽

Gestational Weight ◽

Unit Increase

Abstract Background/Objective Previous studies have consistently demonstrated that maternal weight status both before and during pregnancy is associated with infant birthweight. However, a fundamental limitation across this literature remains that previous studies have not evaluated the concomitant impact of paternal weight at conception, owing to the paucity of studies in which fathers were assessed prior to pregnancy. Thus, we established a cohort of preconception couples to prospectively evaluate the associations of maternal and paternal weight prior to pregnancy with infant birthweight at delivery. Methods In this prospective observational cohort study, 1292 newly-married women and their partners in Liuyang, China, were assessed at median of 23.3 weeks before a singleton pregnancy, thereby enabling concomitant assessment of preconception maternal and paternal body mass index (BMI) in relation to infant birthweight. Results Mean birthweight was 3294 ± 450 g with 147 neonates (11.4%) born large-for-gestational-age (LGA) and 94 (7.3%) small-for-gestational-age (SGA). After adjustment for maternal and paternal factors prior to conception (age, education, smoking, BMI, household income), length of gestation, total gestational weight gain, gestational diabetes, preeclampsia, and infant sex, it was noted that infant birthweight increased by 42.2 g (95% CI 29.5–54.8; p < 0.0001) per unit increase in maternal pregravid BMI and 10.7 g (95% CI 0.5–20.9; p = 0.04) per unit increase in paternal pregravid BMI. Maternal pregravid BMI explained 6.2% of the variance in birthweight whereas paternal BMI explained only 0.7%. Independent predictors of LGA delivery were maternal pregravid BMI (aOR = 1.91, 95% CI 1.50–2.44), maternal age (aOR = 1.48, 95% CI 1.09–2.00), and gestational weight gain (aOR = 1.80, 95% CI 1.40–2.30). Paternal pregravid BMI was not independently associated with LGA or SGA. Conclusion Paternal BMI prior to conception is associated with infant birthweight but only modestly so, in contrast to the dominant impact of maternal weight.

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Relationships between maternal characteristics and infant birth weight

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-05-2017-0081 ◽

2019 ◽

Vol 32 (4) ◽

pp. 688-697

Author(s):

Maryam Javadi ◽

Sima Rafiei ◽

Fariba Zahedifar ◽

Ameneh Barikani

Keyword(s):

Physical Activity ◽

Birth Weight ◽

Low Birth Weight ◽

Pregnant Women ◽

Gestational Age ◽

Normal Weight ◽

Maternal Weight ◽

Content Type ◽

Maternal Characteristics ◽

Infant Birth

Purpose Nowadays, the importance of infant birth weight (IBW) as a key factor in determining the future of physical and mental development of children is a growing concern. The purpose of this paper is to investigate the relationship between maternal characteristics and IBW among pregnant women who were referred to health centers in Qazvin city in the year 2016. Design/methodology/approach A descriptive-analytical study was conducted among pregnant women in 28–36 weeks of gestation who referred to healthcare centers and facilities affiliated by the Qazvin University of Medical Sciences in April–June 2016. The associations between maternal physical activity, mothers’ socioeconomic status and birth weight were examined by SPSS Software Package version 16 through linear and logistic regression tests. Findings Linear regression modeling suggested that maternal weight (p=0.001), income (p=0.04), gestational age of delivery (p=0.00) and pre-pregnancy BMI (p=0.02) were positively associated with birth weight, while occupational and heavy physical activity (p=0.003 and 0.008, respectively) were negatively associated with IBW. In this study, low birth weight infants are compared to those with normal weight belonged to mothers who have spent more time in doing heavy physical activities (OR=1.11, 95% CI 1.01–1.23). Also infants with low birth weight compared to others in the normal weight category were born from mothers with lower pre-pregnancy BMI (OR=0.65, 95% CI 0.62–0.78), gestational age of delivery (OR=0.82, 95% CI 0.79–0.86), maternal weight (OR=0.86, 95% CI 0.84–0.88) and income (OR=0.79, 95% CI 0.69–0.83). Practical implications The study findings revealed that certain maternal characteristics could play a significant role in IBW. Despite the importance, in most of developing countries (particularly Iran), future mothers are not advised about an appropriate weight gain during pregnancy or the optimal level of physical activity in such a period of time. Therefore, counseling pregnant women and giving them proper information on appropriate perinatal care would be helpful in order to have pregnancies with optimal outcomes. Originality/value The authors applied several statistical methods to analyze IBW among mothers with different maternal characteristics and predict birth weight based on contributing factors.

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A First Trimester Prediction Model for Large for Gestational Age Infants: A Preliminary Study

10.21203/rs.3.rs-398307/v1 ◽

2021 ◽

Author(s):

Francesca Monari ◽

Daniela Menichini ◽

Ludovica Spano’ Bascio ◽

Giovanni Grandi ◽

Federico Banchelli ◽

...

Keyword(s):

Prediction Model ◽

Gestational Age ◽

Predictive Accuracy ◽

Perinatal Outcomes ◽

First Trimester ◽

University Hospital ◽

Large For Gestational Age ◽

Aneuploidy Screening ◽

Maternal Characteristics ◽

Targeted Interventions

Abstract Background: Large for gestational age infants (LGA) have increased risks of adverse short-term perinatal outcomes. This study aims to develop a multivariable prediction model for the risk of giving birth to a LGA baby, by using biochemical, biophysical, anamnestic, and clinical maternal characteristics available at first trimester.Methods: Prospective study that included all singleton pregnancies attending the first trimester aneuploidy screening at the Obstetric Unit of the University Hospital of Modena, in Northern Italy, between June 2018 and December 2019. Results: A total of 503 consecutive women were included in the analysis. The final prediction model for LGA, included multiparity (OR = 2.8, 95%; CI: 1.6 - 4.9, p=0.001), pre-pregnancy BMI (OR = 1.08. 95% CI 1.03 – 1.14, p=0,002) and PAPP-A MoM (OR = 1.43 95% CI 1.08 – 1.90, p=0.013). The area under the ROC curve was 70.5%, indicating a satisfactory predictive accuracy. The best predictive cut-off for this score was equal to -1.378, which corresponds to a 20.1% probability of having a LGA infant. By using such a cut-off, the risk of LGA can be predicted in our sample with sensitivity of 55.2% and specificity of 79.0%.Conclusion: At first trimester, a model including multiparity, pre-pregnancy BMI and PAPP-A satisfactory predicted the risk of giving birth to a LGA infant. This promising tool, once applied early in pregnancy, would identify women for targeted interventions.Trial registration: NCT04838431

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Sonographic Assessment of Amniotic Fluid Volume using Single Deepest Pocket (SDP) among Igbo Women with Uncomplicated Singleton Pregnancies.

10.33798/ajmas2019/00265. ◽

2019 ◽

Vol 2 (1) ◽

pp. 1-18

Author(s):

Chijioke Okeudo ◽

B.U. Ezem

Keyword(s):

Amniotic Fluid ◽

Gestational Age ◽

Cross Sectional Study ◽

Fluid Volume ◽

Singleton Pregnancy ◽

Cross Sectional ◽

South Eastern ◽

Amniotic Fluid Volume ◽

The Mean ◽

Singleton Pregnancies

Background: The amniotic fluid is fundamental for proper fetal development and growth. Ultrasound visualization of the amniotic fluid permits both subjective and objective estimates of the amniotic fluid. Objective: The objective of this study was to determine the reference values of normal single deepest pocket (SDP) – upper and lower limits, mean SDP and variation of the SDP with gestational age among Igbo women of South-Eastern Nigeria extraction carrying uncomplicated singleton pregnancy. Methodology: This was a prospective cross sectional study involving 400 women carrying uncomplicated singleton pregnancies and who were sure of the date of the first day of their last menstrual period. The single deepest pocket / maximum vertical pool were determined once at presentation at the hospital.. The study was conducted from January 1st to December 31st 2015. The second author carried out all the scanning. The SDP was obtained. Results: The womens’ mean and median ages were the same at 28 years. The gestational age range of the pregnancies was 14-41 weeks. The mean SDP was 5.8cm, while the 5th and 95th percentiles were 3.3cm and 8.5cm respectively. There was no difference in the mean SDP in both term and preterm. There was irregular but continuous rise of mean SDP to a peak of 6.8cm at gestational age of 39 weeks. In conclusion, the participants had a mean SDP of 5.8cm. There was also a positive correlation between SDP and Gestational age. We therefore recommend a longitudinal study to assess perinatal outcome and abnormal amniotic fluid volume among Igbo women of South-Eastern Nigeria. Key words: Single Deepest Pocket, Uncomplicated Singleton Pregnancy, Igbo Women.

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Pregnant Women Living with Obesity: A Cross-Sectional Observational Study of Dietary Quality and Pregnancy Outcomes

Nutrients ◽

10.3390/nu13051652 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1652

Author(s):

Margaret Charnley ◽

Lisa Newson ◽

Andrew Weeks ◽

Julie Abayomi

Keyword(s):

Pregnant Women ◽

Maternal Obesity ◽

Maternal Nutrition ◽

Saturated Fatty Acids ◽

Poor Quality ◽

Dietary Quality ◽

Obstetric Outcomes ◽

Dietary Intakes ◽

Singleton Pregnancy ◽

Cross Sectional

Good maternal nutrition is key to optimal maternal and foetal health. A poor-quality diet is often associated with obesity, and the prevalence and severity of maternal obesity has increased significantly in recent years. This study observed dietary intakes in pregnant women living with obesity and assessed the quality of their diet. In total, 140 women with a singleton pregnancy, aged > 18 years and BMI ≥ 35 kg/m2, were recruited from antenatal clinics, weighed and completed food diaries at 16-, 28- and 36-weeks’ gestation. Clinical data were recorded directly from the women’s medical records. Nutrient intake was determined using ‘MicrodietTM’, then compared to Dietary Reference Values (DRVs). Energy intakes were comparable with DRVs, but intakes of sugar and saturated fatty acids were significantly higher. Intake of fibre and several key micronutrients (Iron, Iodine, Folate and Vitamin D) were significantly low. Several adverse obstetric outcomes were higher than the general obstetric population. Women with obesity, often considered ‘over nourished’, may have diets deficient in essential micronutrients, often associated with poor obstetric outcomes. To address the intergenerational transmission of poor health via poor diets warrants a multi-disciplinary approach focusing away from ‘dieting’ onto positive messages, emphasising key nutrients required for good maternal and foetal health.

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Ethnicity-Specific Normative Models of Quadruple Test as a Screening Test for Down Syndrome

Medicina ◽

10.3390/medicina57070651 ◽

2021 ◽

Vol 57 (7) ◽

pp. 651

Author(s):

Praetip Praikaew ◽

Kuntharee Traisrisilp ◽

Chanane Wanapirak ◽

Ratanaporn Sekararithi ◽

Theera Tongsong

Keyword(s):

Quantile Regression ◽

Gestational Age ◽

Cross Sectional Study ◽

Serum Biomarkers ◽

Rank Test ◽

Maternal Weight ◽

Cross Sectional ◽

Inhibin A ◽

Thai Women ◽

Normative Models

Background and Objectives: To establish normative models for median levels of serum biomarkers of the second trimester quad test (alpha-fetoprotein: AFP; free beta-human gonadotropins: hCG; inhibin-A; and unconjugated estriol: uE3) specific to Thai women and to compare multiples of the median (MoMs) derived from ethnicity-specific models and those derived from Caucasian models with ethnic correction. Materials and Methods: A cross-sectional study was undertaken in a tertiary, medical teaching center among low-risk pregnant Thai women between 14 and 21 weeks of gestation to measure the levels of the four serum biomarkers. The measured values of each biomarker were analyzed using the multivariable factorial polynomial technique for quantile regression as a function of gestational age and maternal weight. Results: The Thai-specific normative models for the four biomarkers were generated and available for use. The MoMs of all individuals generated from our models were significantly different from conventional (Caucasian) models with ethnic correction (Wilcoxon signed-rank test; p < 0.0001 for all biomarkers). The MoMs of AFP and hCG from both methods were in agreement, but those from Thai-specific models were significantly higher. However, those of inhibin-A and uE3 were markedly different and ethnic correction was unlikely to be useful. Conclusions: The Thai-specific normative models of the quad test as a function of gestational age and maternal weight were constructed using multivariable factorial polynomial models, better than simple quantile regression or log-linear regression used in earlier decades. The analysis of MoMs supports the use of ethnicity-specific models instead of Caucasian models with ethnic correction.

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Diagnostic accuracy of modified Hadlock formula for fetal macrosomia in women with gestational diabetes and pregnancy weight gain above recommended

Journal of Perinatal Medicine ◽

10.1515/jpm-2021-0013 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Boris Lovrić ◽

Siniša Šijanović ◽

Joško Lešin ◽

Josip Juras

Keyword(s):

Weight Gain ◽

Gestational Diabetes ◽

Diagnostic Accuracy ◽

Area Under The Curve ◽

Fetal Weight ◽

Pregnancy Weight Gain ◽

Singleton Pregnancy ◽

Time Period ◽

Modified Formula ◽

Pregnancy Weight

Abstract Objectives Women with gestational diabetes (GDM) and weight gain during pregnancy above recommended more often give birth to macrosomic children. The goal of this study was to evaluate the diagnostic accuracy of the modified formula for ultrasound assessment of fetal weight created in a pilot study using a similar specimen in comparison to the Hadlock-2 formula. Methods This is a prospective, cohort, applicative, observational, quantitative, and analytical study, which included 213 pregnant women with a singleton pregnancy, GDM, and pregnancy weight gain above recommended. Participants were consecutively followed in the time period between July 1st, 2016, and August 31st, 2020. Ultrasound estimations were made within three days before the delivery. Fetal weights estimated using both formulas were compared to the newborns’ weights. Results A total of 133 fetal weight estimations were made. In comparison to the newborns’ weight modified formula had significantly smaller deviation in weight estimation compared to the Hadlock-2 formula, higher frequency of deviation within 5% of newborns weights (78.2% [95% CI=0.74–0.83] vs. 60.2%), smaller frequency of deviations from 5 to 10% (19.5 vs. 33.8%) and above 10%, which was even more significant among macrosomic children. There were 36/50 (72%) correctly diagnosed cases of macrosomia by modified and 33/50 (66%) by Hadlock-2 formula. Area under the curve (AUC) for the modified formula was 0.854 (95% CI=0.776–0.932), and for the Hadlock-2 formula 0.824 (95% CI=0.740–0.908). The positive predictive value of the modified formula was 81.81%, the negative 97.91%. Conclusions In cases of greater fetal weights, the modified formula showed greater precision.

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Factors associated with small- and large-for-gestational-age in socioeconomically vulnerable individuals in the 100 Million Brazilian Cohort

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqab033 ◽

2021 ◽

Author(s):

Ila R Falcão ◽

Rita de Cássia Ribeiro-Silva ◽

Marcia Furquim de Almeida ◽

Rosemeire L Fiaccone ◽

Natanael J Silva ◽

...

Keyword(s):

Gestational Age ◽

Multinomial Logistic Regression ◽

Mixed Race ◽

Sociodemographic Factors ◽

Reproductive Age ◽

Large For Gestational Age ◽

Maternal Characteristics ◽

Factors Associated ◽

Study Population ◽

Brazilian Populations

ABSTRACT Background Evidence points to diverse risk factors associated with small- (SGA) and large-for-gestational-age (LGA) births. A more comprehensive understanding of these factors is imperative, especially in vulnerable populations. Objectives To estimate the occurrence of and sociodemographic factors associated with SGA and LGA births in poor and extremely poor populations of Brazil. Methods The study population consisted of women of reproductive age (14–49 y), whose last child was born between 2012 and 2015. INTERGROWTH 21st consortium criteria were used to classify weight for gestational age according to sex. Multinomial logistic regression modeling was performed to investigate associations of interest. Results Of 5,521,517 live births analyzed, SGA and LGA corresponded to 7.8% and 17.1%, respectively. Multivariate analysis revealed greater odds of SGA in children born to women who self-reported as black (OR: 1.21; 95% CI: 1.19, 1.22), mixed-race (parda) (OR: 1.08; 95% CI: 1.07, 1.09), or indigenous (OR: 1.11; 95% CI: 1.06, 1.15), were unmarried (OR: 1.08; 95% CI: 1.07, 1.08), illiterate (OR: 1.47; 95% CI: 1.42, 1.52), did not receive prenatal care (OR: 1.57; 95% CI: 1.53, 1.60), or were aged 14–20 y (OR: 1.21; 95% CI: 1.20, 1.22) or 35–49 y (OR: 1.12; 95% CI: 1.10, 1.13). Considering LGA children, higher odds were found in infants born to women living in households with ≥3 inadequate housing conditions (OR: 1.11; 95% CI: 1.10, 1.12), in indigenous women (OR: 1.22; 95% CI: 1.19, 1.25), those who had 1–3 y of schooling (OR: 1.18; 95% CI: 1.17, 1.19), 1–3 prenatal visits (OR: 1.16; CI 95%: 1.14, 1.17), or were older (OR: 1.26; 95% CI: 1.25, 1.27). Conclusions In poorer Brazilian populations, socioeconomic, racial, and maternal characteristics are consistently associated with the occurrence of SGA births, but remain less clearly linked to the occurrence of LGA births.

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