The Impact of Race-Ethnicity on the Antenatal Detection of Small for Gestational Age Infants

Abstract

Objective: To examine differences in the antenatal detection rate of small for gestational age (SGA) infants among several race-ethnicity groups and determine whether perinatal outcomes differ in antenatally detected versus undetected SGA infants according to race-ethnicity. Methods: A retrospective cohort study was conducted at a single tertiary care center that evaluated all deliveries of SGA infants >23 weeks gestation between January 2016-January 2020. Race and ethnicity were self-reported and categorized as non-Hispanic White, non-Hispanic Black, Hispanic, or Asian. The medical charts of those eligible were reviewed and the primary study outcomes were analyzed using multivariable logistic regression analyses with accompanying point estimates and 95% confidence intervals. Results: A total of 526 childbearing persons satisfied our predefined inclusion criteria. The predominant race-ethnicity group was non-Hispanic White who comprised 50% of the study population. Antenatal detection rate of SGA was found to be 38%. The detection rate, while not statistically different, ranged from 28-40% according to race-ethnicity with Asians having the lowest detection rates. Higher rates of preterm birth, labor induction, and lower median birthweights were observed in antenatally detected versus undetected SGA pregnancies. However, no significant differences were observed with regards to perinatal outcomes when antenatally detected versus undetected SGA was compared according to race-ethnicity. Conclusions: Antenatal detection may not be the primary solution to improving racial and ethnic disparities among SGA infants. Additional investigation to identify, address, and improve disparities in other areas of perinatal medicine is necessary to provide more equitable care. Further work to investigate the barriers to antenatal detection of SGA is warranted as an avenue for improving perinatal outcomes.