{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T00:03:36Z","timestamp":1770509016677,"version":"3.49.0"},"reference-count":19,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2016,2,8]],"date-time":"2016-02-08T00:00:00Z","timestamp":1454889600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["HHSN267200603425C"],"award-info":[{"award-number":["HHSN267200603425C"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess differences in small\u2010for\u2010gestational age (<jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content>) classifications for the detection of neonates with increased perinatal mortality risk among obese women and subsequently assess the association between prepregnancy body mass index (<jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>) status and <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Hospital\u2010based cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Twelve <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content> clinical centres (2002\u201308).<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>A total of 114\u00a0626 singleton, nonanomalous pregnancies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were collected using electronic medical record\u00a0abstraction. Relative risks (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>) with 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> were estimated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content> trends (birthweight\u00a0&lt;\u00a010th centile) classified using population\u2010based (<jats:styled-content style=\"fixed-case\">SGA<jats:sub>POP<\/jats:sub><\/jats:styled-content>), intrauterine (<jats:styled-content style=\"fixed-case\">SGA<jats:sub>IU<\/jats:sub><\/jats:styled-content>) and customised (<jats:styled-content style=\"fixed-case\">SGA<jats:sub>CUST<\/jats:sub><\/jats:styled-content>) references were assessed. The <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content>\u2010associated perinatal mortality risk was estimated among obese women. Using the <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content> method most associated with perinatal mortality, the association between prepregnancy <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content> was estimated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The overall perinatal mortality prevalence was 0.55% and this increased significantly with increasing <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01). Among obese women, <jats:styled-content style=\"fixed-case\">SGA<jats:sub>IU<\/jats:sub><\/jats:styled-content> detected the highest proportion of perinatal mortality cases (2.49%). Perinatal mortality was 5.32 times (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 3.72\u20137.60) more likely among <jats:styled-content style=\"fixed-case\">SGA<jats:sub>IU<\/jats:sub><\/jats:styled-content> neonates than non\u2010<jats:styled-content style=\"fixed-case\">SGA<jats:sub>IU<\/jats:sub><\/jats:styled-content> neonates. This is in comparison with the 3.71\u2010fold (2.49\u20135.53) and 4.81\u2010fold (3.41\u20136.80) increased risk observed when <jats:styled-content style=\"fixed-case\">SGA<jats:sub>POP<\/jats:sub><\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">SGA<jats:sub>CUST<\/jats:sub><\/jats:styled-content> were used, respectively. Compared with women of normal weight, overweight women (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a00.82, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.78\u20130.86) and obese women (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a00.80; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.75\u20130.83) had a lower risk for delivering an <jats:styled-content style=\"fixed-case\">SGA<jats:sub>IU<\/jats:sub><\/jats:styled-content> neonate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Among obese women, the intrauterine reference best identified neonates at risk of perinatal mortality. Based on <jats:styled-content style=\"fixed-case\">SGA<jats:sub>IU<\/jats:sub><\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> SGA<\/jats:styled-content> is less common among obese women but these <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content> babies are at a high risk of death and remain an important group for surveillance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content> is less common among obese women but these <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content> babies are at a high risk of death.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13896","type":"journal-article","created":{"date-parts":[[2016,2,8]],"date-time":"2016-02-08T08:24:01Z","timestamp":1454919841000},"page":"1983-1988","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Comparison of methods for identifying small\u2010for\u2010gestational\u2010age infants at risk of perinatal mortality among obese mothers: a hospital\u2010based cohort study"],"prefix":"10.1111","volume":"123","author":[{"given":"SN","family":"Hinkle","sequence":"first","affiliation":[{"name":"Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"LA","family":"Sjaarda","sequence":"additional","affiliation":[{"name":"Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"PS","family":"Albert","sequence":"additional","affiliation":[{"name":"Biostatistics and Bioinformatics Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P","family":"Mendola","sequence":"additional","affiliation":[{"name":"Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"KL","family":"Grantz","sequence":"additional","affiliation":[{"name":"Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,2,8]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.05.052"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0b013e31815a5494"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.07.049"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1328874"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199801153380302"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.10.889"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0029-7844(95)00386-X"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.06.058"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.181.1.1887021"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.04.035"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2009.02245.x"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2006.109439"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq399"},{"key":"e_1_2_6_15_1","unstructured":"LA Sjaarda 2013 Lecture Baltimore MD"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2012.03.010"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.nutr.24.012003.132249"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2014.03.010"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00025.2014"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2014.06.368"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; 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