{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T10:57:31Z","timestamp":1769597851706,"version":"3.49.0"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T00:00:00Z","timestamp":1690761600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003123","name":"Fetal Medicine Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003123","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>First, to investigate the association between adverse neonatal outcomes and birth weight and gestational age at delivery. Second, to describe the distribution of adverse neonatal outcomes within different risk strata derived by a population stratification scheme based on the midgestation risk assessment for small\u2010for\u2010gestational\u2010age (SGA) neonates using a competing\u2010risks model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective observational cohort study in women with a singleton pregnancy attending a routine hospital visit at 19\u2009+\u20090 to 23\u2009+\u20096\u2009weeks' gestation. The incidence of neonatal unit (NNU) admission for \u2265\u200948\u2009h was evaluated within different birth\u2010weight\u2010percentile subgroups. The pregnancy\u2010specific risk of delivery with SGA\u2009&lt;\u200910<jats:sup>th<\/jats:sup> percentile at &lt;\u200937\u2009weeks was estimated by the competing\u2010risks model for SGA, combining maternal factors and the likelihood functions of <jats:italic>Z<\/jats:italic>\u2010score of sonographically estimated fetal weight and uterine artery pulsatility index multiples of the median. The population was stratified into six risk categories: &gt;\u20091 in 4, &gt;\u20091 in 10 to \u2264\u20091 in 4, &gt;\u20091 in 30 to \u2264\u20091 in 10, &gt;\u20091 in 50 to \u2264\u20091 in 30, &gt;\u20091 in 100 to \u2264\u20091 in 50 and \u2264\u20091 in 100. The outcome measures were admission to the NNU for a minimum of 48\u2009h, perinatal death and major neonatal morbidity. The incidence of each adverse outcome was estimated in each risk stratum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the study population of 40\u2009241 women, 0.8%, 2.5%, 10.8%, 10.2%, 19.0% and 56.7% were in the risk strata &gt;\u20091 in 4, &gt;\u20091 in 10 to \u2264\u20091 in 4, &gt;\u20091 in 30 to \u2264\u20091 in 10, &gt;\u20091 in 50 to \u2264\u20091 in 30, &gt;\u20091 in 100 to \u2264\u20091 in 50 and \u2264\u20091 in 100, respectively. Women in higher\u2010risk strata were more likely to deliver a baby that suffered an adverse outcome. The incidence of NNU admission for \u2265\u200948\u2009h was highest in the &gt;\u20091 in 4 risk stratum (31.9% (95%\u2009CI, 26.9\u201336.9%)) and it gradually decreased until the \u2264\u20091 in 100 risk stratum (5.6% (95%\u2009CI, 5.3\u20135.9%)). The mean gestational age at delivery in SGA cases with NNU admission for \u2265\u200948\u2009h was 32.9 (95%\u2009CI, 32.2\u201333.7)\u2009weeks for risk stratum &gt;\u20091 in 4 and progressively increased to 37.5 (95%\u2009CI, 36.8\u201338.2)\u2009weeks for risk stratum \u2264\u20091 in 100. The incidence of NNU admission for \u2265\u200948\u2009h was highest for neonates with birth weight below the 1<jats:sup>st<\/jats:sup> percentile (25.7% (95%\u2009CI, 23.0\u201328.5%)) and decreased progressively until the 25<jats:sup>th<\/jats:sup> to &lt;\u200975<jats:sup>th<\/jats:sup> percentile interval (5.4% (95%\u2009CI, 5.1\u20135.7%)). Preterm SGA neonates &lt;\u200910<jats:sup>th<\/jats:sup> percentile had significantly higher incidence of NNU admission for \u2265\u200948\u2009h compared with preterm non\u2010SGA neonates (48.7% (95%\u2009CI, 45.0\u201352.4%) <jats:italic>vs<\/jats:italic> 40.9% (95%\u2009CI, 38.5\u201343.3%); <jats:italic>P\u2009&lt;<\/jats:italic>\u20090.001). Similarly, term SGA neonates &lt;\u200910<jats:sup>th<\/jats:sup> percentile had significantly higher incidence of NNU admission for \u2265\u200948\u2009h compared with term non\u2010SGA neonates (5.8% (95%\u2009CI, 5.1\u20136.5%) <jats:italic>vs<\/jats:italic> 4.2% (95%\u2009CI, 4.0\u20134.4%); <jats:italic>P\u2009&lt;<\/jats:italic>\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Birth weight has a continuous association with the incidence of adverse neonatal outcomes, which is affected by gestational age. Pregnancies at high risk of SGA, estimated at midgestation, are also at increased risk for adverse neonatal outcomes. \u00a9 2023 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.26285","type":"journal-article","created":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T18:38:05Z","timestamp":1686249485000},"page":"195-201","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Prediction of adverse perinatal outcome at midgestation"],"prefix":"10.1002","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7969-1435","authenticated-orcid":false,"given":"I.","family":"Papastefanou","sequence":"first","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"},{"name":"Institute of Women and Children's Health School of Life Course and Population Sciences, King's College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Gyokova","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Gungil","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5856-6072","authenticated-orcid":false,"given":"A.","family":"Syngelaki","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"},{"name":"Institute of Women and Children's Health School of Life Course and Population Sciences, King's College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. H.","family":"Nicolaides","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,7,31]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199904223401603"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2003.10.013"},{"issue":"376","key":"e_1_2_8_4_1","first-page":"e1","article-title":"Risk of stillbirth after 37\u2009weeks in pregnancies complicated by small\u2010for\u2010gestational\u2010age fetuses","volume":"208","author":"Trudell AS","year":"2013","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.06.039"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.233"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.1806"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.12.004"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22134"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22129"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.23523"},{"issue":"530","key":"e_1_2_8_12_1","first-page":"e1","article-title":"Competing risks model for prediction of small\u2010for\u2010gestational\u2010age neonates from biophysical markers at 19 to 24\u2009weeks' gestation","volume":"225","author":"Papastefanou I","year":"2021","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.23593"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.23730"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26057"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26210"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16815"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.17066"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.12.318"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0960-7692.2001.00572.x"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(00)00946-7"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(85)90298-4"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19066"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1975.tb00710.x"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1994.04010034.x"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19073"},{"key":"e_1_2_8_27_1","unstructured":"R Development Core Team.R: a language and environment for statistical computing: R Foundation for Statistical Computing Vienna Austria.https:\/\/www.r\u2010project.org\/."}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.26285","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T14:21:37Z","timestamp":1748010097000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.26285"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,31]]},"references-count":26,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1002\/uog.26285"],"URL":"https:\/\/doi.org\/10.1002\/uog.26285","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,31]]},"assertion":[{"value":"2023-04-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}