{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T02:02:44Z","timestamp":1791943364806,"version":"4.3.4"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["CM18\/00202"],"award-info":[{"award-number":["CM18\/00202"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["JR19\/00006"],"award-info":[{"award-number":["JR19\/00006"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate whether clinical phenotypes of small\u2010for\u2010gestational\u2010age (SGA) fetuses can be identified and used for adverse perinatal outcome risk stratification to facilitate clinical decision\u2010making.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a multicenter observational cohort study conducted in two tertiary care university hospitals. SGA fetuses were classified according to maternal, fetal and placental conditions using a two\u2010step cluster algorithm, in which fetuses with more than one condition were assigned to the cluster associated with the highest mortality risk. Delivery and perinatal outcomes were compared using chi\u2010square test among SGA clusters, and the associations between outcomes and each cluster were evaluated by calculating odds ratios (OR), adjusted for gestational age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included 17\u2009631 consecutive singleton pregnancies, of which 1274 (7.2%) were defined as SGA at birth according to INTERGROWTH\u201021<jats:sup>st<\/jats:sup> standards. Nine SGA clinical phenotypes were identified using a predefined conceptual framework. All delivery and perinatal outcomes analyzed were significantly different among the nine phenotypes. The whole SGA cohort had a three\u2010times higher risk of perinatal mortality compared with non\u2010SGA fetuses (1.4% <jats:italic>vs<\/jats:italic> 0.4%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). SGA clinical phenotypes exhibited three patterns of perinatal mortality risk: the highest risk was associated with congenital anomaly (8.3%; OR, 17.17 (95%\u2009CI, 2.17\u2013136.12)) and second\u2010 or third\u2010trimester hemorrhage (8.3%; OR, 9.94 (95%\u2009CI, 1.23\u201380.02)) clusters; medium risk was associated with gestational diabetes (3.8%; OR, 9.59 (95%\u2009CI, 1.27\u201372.57)), preterm birth (3.2%; OR, 4.65 (95%\u2009CI, 0.62\u201335.01)) and intrauterine growth restriction (3.1%; OR, 5.93 (95%\u2009CI, 3.21\u201310.95)) clusters; and the lowest risk was associated with the remaining clusters. Perinatal mortality rate did not differ between SGA fetuses without other clinical conditions (54.1% of SGA fetuses) and appropriate\u2010for\u2010gestational\u2010age fetuses (0.1% <jats:italic>vs<\/jats:italic> 0.4%; OR, 0.41 (95%\u2009CI, 0.06\u20132.94); <jats:italic>P<\/jats:italic>\u2009=\u20090.27). SGA combined with other obstetric pathologies increased significantly the risk of perinatal mortality, as demonstrated by the increased odds of perinatal death in SGA cases with gestational diabetes compared to non\u2010SGA cases with the same condition (OR, 24.40 (95%\u2009CI, 1.31\u2013453.91)).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We identified nine SGA clinical phenotypes associated with different patterns of risk for adverse perinatal outcome. Our findings suggest that considering clinical characteristics in addition to ultrasound findings could improve risk stratification and decision\u2010making for management of SGA fetuses. Future clinical trials investigating management of fetuses with SGA should take into account clinical information in addition to Doppler parameters and estimated fetal weight. \u00a9 2021 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23765","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T07:47:47Z","timestamp":1629100067000},"page":"490-496","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical phenotypes for risk stratification in small\u2010for\u2010gestational\u2010age fetuses"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2925-8892","authenticated-orcid":false,"given":"S.","family":"Ruiz\u2010Martinez","sequence":"first","affiliation":[{"name":"Aragon Institute of Health Research (IIS Aragon), Obstetrics Department Hospital Cl\u00ednico Universitario Lozano Blesa  Zaragoza Spain"},{"name":"Red de Salud Materno Infantil y del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII) Subdirecci\u00f3n General de Evaluaci\u00f3n y Fomento de la Investigaci\u00f3n y Fondo Europeo de Desarrollo Regional (FEDER)  Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. L.","family":"Delgado","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Hospital Cl\u00ednico Universitario \u2018Virgen de la Arrixaca\u2019, El Palmar  Murcia Spain"},{"name":"Institute for Biomedical Research of Murcia, IMIB\u2010Arrixaca, El Palmar  Murcia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6795-0367","authenticated-orcid":false,"given":"C.","family":"Paules","sequence":"additional","affiliation":[{"name":"Aragon Institute of Health Research (IIS Aragon), Obstetrics Department Hospital Cl\u00ednico Universitario Lozano Blesa  Zaragoza Spain"},{"name":"Red de Salud Materno Infantil y del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII) Subdirecci\u00f3n General de Evaluaci\u00f3n y Fomento de la Investigaci\u00f3n y Fondo Europeo de Desarrollo Regional (FEDER)  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