Maternal and Placental Risk Factors for Small Gestational Age and Fetal Malnutrition

Aim: This case-control study was conducted to identify maternal and placental risk fac-tors of small-for-gestational-age (SGA) and fetal malnutrition. Methods: Cases comprised 104 consecutively delivered SGA neonates (determined as per INTER-GROWTH-21st standard). An equal number of next-born gestation and gender-matched appropriate-for-gestational age (AGA) neonates served as controls. Maternal risk factors were enquired, and placentae were evaluated by clinical and histopathological examination. Nutrition of the neonates was assessed by the clinical assessment of nutrition (CAN) score. Univariate and multivariate lo-gistic regression analysis was done to identify the maternal and placental risk factors. Results: The prevalence of SGA in the present study was 23.9%. Maternal fever [adjusted Odds Ra-tio (aOR), 95% confidence interval (CI), 16.3 (3.5-124.1); p = 0.001], presence of placental syncyt-ial knots [aOR (95% CI), 2.9 (1.1-9.1); p = 0.04] and placental calcifications [aOR (95% CI), 3(1.1-8.7); p = 0.03], were identified as independent predictors of SGA using multivariate logistic regres-sion analysis. Malnutrition (SCORE <25) affected 64% of SGA and 16.3% of AGA neonates. The only risk factor significantly associated with malnourished SGA was prematurity, whereas malnour-ished AGA was significantly associated with prematurity and fetal distress. In-hospital morbidities significantly higher in SGA were perinatal asphyxia, respiratory distress, need for respiratory sup-port, polycythemia, hypoglycemia, and feeding intolerance. Mortality before discharge was 4.8% and 3.8% in SGA and AGA population, respectively (p > 0.05). Neonatal outcomes were compara-ble among well-nourished, malnourished SGA and AGA groups. Conclusions: Maternal fever, placental syncytial knots, and calcifications were independent risk fac-tors of SGA, whereas prematurity and fetal distress were responsible for malnutrition.