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Investigating fetal growth restriction and perinatal risks in appropriate for gestational age infants: using cohort and within-sibling analyses
Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Pediatrics, McGill University Faculty of Medicine, Montreal QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal QC, Canada.
Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Neonatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-1024-5602
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2019 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 126, no 7, p. 842-850Article in journal (Refereed) Published
Abstract [en]

Objective: Fetal growth restriction refers to fetuses that fail to reach their growth potential. Studies within siblings may be useful to disclose fetal growth restriction in appropriate for gestational age (AGA) infants. We analysed associations between birthweight percentiles and perinatal risks in AGA infants, using both population-based and within-sibling analyses.

Design: Population-based cohort study. Setting and sample Using nation-wide Swedish registries (1987-2012), we identified 2 134 924 singleton AGA births (10th-90th birthweight percentile for gestational age), of whom 1 377 326 were full siblings.

Methods: Unconditional Poisson regression was used for population analyses, and conditional (matched) Poisson regression for within-sibling analyses. We estimated associations between birthweight percentiles and stillbirth, neonatal mortality, and morbidity, using incidence rate ratios (IRRs) with 95% confidence intervals (CIs).

Results: Stillbirth and neonatal mortality risks declined with increasing birthweight percentiles, but the declines were larger in within-sibling analyses. Compared with the reference group (40th to <60th percentile), IRRs (95% CIs) of stillbirth for the lowest and highest percentile groups (10th to <25th and 75th-90th percentiles, respectively) were 1.87 (1.72-2.03) to 0.76 (0.68-0.85) in population analysis and 2.60 (2.27-2.98) and 0.43 (0.36-0.50) in within-sibling analysis. Neonatal morbidity risks in term non-malformed infants with low birthweight percentiles were generally only increased in within-sibling analyses.

Conclusion: Using birthweight information from siblings may help to define fetal growth restriction in AGA infants.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019. Vol. 126, no 7, p. 842-850
Keywords [en]
Fetal growth, neonatal morbidity, neonatal mortality, sibling analysis, stillbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:oru:diva-74403DOI: 10.1111/1471-0528.15563ISI: 000467586100007PubMedID: 30472773Scopus ID: 2-s2.0-85059260757OAI: oai:DiVA.org:oru-74403DiVA, id: diva2:1318581
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0073 2017-00134The Karolinska Institutet's Research FoundationAvailable from: 2019-05-28 Created: 2019-05-28 Last updated: 2019-05-28Bibliographically approved

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Ludvigsson, Jonas F.

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