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433: Small for gestational age: Is neonatal morbidity related to preeclampsia?

      Objective

      Diagnosis of small for gestational age (SGA) newborns often occurs in the setting of pre-eclampsia (PreE) due to placental insufficiency. However, it is unclear whether the poor outcomes associated with SGA are caused by co- existing PreE, or simply related to the early gestational age (GA) at which these neonates deliver.

      Study Design

      This is a secondary analysis of a prospective multi-center study designed to evaluate the role of placental growth factor in predicting PreE. Women were included in the parent study if they presented with concern for developing PreE. In our analysis, all women from the parent study with singleton, non-anomalous pregnancies who delivered a neonate with SGA were included. Women who developed PreE were compared to those who did not. The primary outcome was composite neonatal morbidity and mortality (Table 1). Secondary outcomes included respiratory distress syndrome (RDS), 5-minute Apgar score < 4, arterial cord gas pH less than 7.1, and cesarean delivery. Univariate analysis was performed to compare characteristics and outcomes between the groups. To control for GA, the groups were compared after stratification (i.e. delivery before vs after 32 weeks GA). Finally, multivariate logistic regression models were fit to determine adjusted odds ratios associated with PreE and GA at delivery for each outcome.

      Results

      Of the 337 women that delivered an SGA neonate, 258 (77%) had PreE and 79 (23%) did not. The two groups had similar maternal age, BMI, rates of chronic hypertension, and pre-gestational diabetes. Women that developed PreE were more likely to be nulliparous, African American, or have pre-existing renal disease. Women that developed PreE delivered at earlier gestational ages (33 vs. 36 weeks, p < 0.01) with higher rates of composite neonatal morbidity (12% vs. 4%, p < 0.01) and Cesarean delivery (65% vs. 51%, p = 0.02, Table 1). However, after stratification by gestational age, there were no differences in any of these outcomes (Table 2). By multivariate analysis, PreE did not contribute to neonatal morbidity (OR = 1.3, 95% CI 0.3 – 6.9). Instead, decreasing GA at delivery was strongly associated with neonatal morbidity (OR = 0.6, 95% CI 0.5 – 0.7).

      Conclusion

      Among SGA newborns, GA at delivery, not concomitant PreE, is associated with neonatal morbidity. Risk of RDS, low Apgars scores, and Cesarean delivery are also independent of PreE.
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