Small-for-gestational-age fetuses: a heterogeneous group requiring reassessment of clinical outcomes
Sidelnikova M.D., Kan N.E., Tyutyunnik V.L., Soldatova E.E., Domanskaya M.A.
Objective. To investigate the association between antenatal small-for-gestational-age (SGA) status and adverse perinatal outcomes in term neonates.
Materials and methods. This retrospective cohort study included 200 pregnant women who delivered at the
V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology (2020–2025). The study group (n=100) comprised women with singleton term pregnancies complicated by an SGA fetus, while the comparison group (n=100) included women with normally grown fetuses. Clinical and anamnestic characteristics, pregnancy and delivery outcomes, and early neonatal complications were also evaluated. Statistical analyses were performed using JASP software (Student's t-test, Mann–Whitney U test, chi-square test, Fisher's exact test, univariable and multivariable logistic regression; p<0.05).
Results. SGA status was significantly associated with an increased risk of adverse perinatal outcomes. The incidence of the composite adverse outcome was significantly higher in the SGA group (24%) than in the control group (8%) (p=0.002). Neonates with SGA demonstrated a marked trend toward higher rates of cephalohematoma formation, central nervous system (CNS) disorders, and infectious-inflammatory conditions. In the univariable logistic regression analysis, SGA increased the risk of adverse outcomes by 3.6-fold (odds ratio [OR]=3.63; 95% confidence interval [CI]: 1.54–8.55; p=0.003). Multivariable analysis adjusted for maternal age confirmed that SGA remained an independent predictor of adverse outcomes (adjusted OR=3.62; 95% CI: 1.52–8.62; p=0.004).
Conclusion. SGA is an independent risk factor for adverse perinatal outcomes and warrants reconsideration of traditional views regarding its clinical significance due to the heterogeneity of the population and challenges associated with its diagnosis.
Authors' contributions. Sidelnikova M.D., Kan N.E., Tyutyunnik V.L., Soldatova E.E., Domanskaya M.A. – the study conception and design, data acquisition, literature review, data processing and analysis, statistical analysis, drafting of the manuscript, editing of the manuscript.
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study.
Ethical Approval. The study was reviewed and approved by the Research Ethics Committee of the V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia.
Generative Artificial Intelligence. No artificial intelligence tools were used in the preparation of this manuscript.
Patient Consent for Publication. All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement. The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Sidelnikova M.D., Kan N.E., Tyutyunnik V.L., Soldatova E.E., Domanskaya M.A.
Small-for-gestational-age fetuses: a heterogeneous group requiring reassessment of clinical outcomes.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (6): 92-100 (in Russian)
https://dx.doi.org/10.18565/aig.2026.23
Keywords
small-for-gestational-age fetus
fetal growth restriction
perinatal outcomes
References
- Министерство здравоохранения Российской Федерации. Клинические рекомендации. Недостаточный рост плода, требующий предоставления медицинской помощи матери (задержка роста плода). М.; 2025. 73 c. [Ministry of Health of the Russian Federation. Clinical guidelines. Insufficient fetal growth requiring medical care for the mother (fetal growth retardation). Moscow; 2025. 73 p. (in Russian)].
- Ruiz-Martinez S., Delgado J.L., Paules C., Cavallaro A., De Paco C., Villar J. et al. Clinical phenotypes for risk stratification in small-for-gestational-age fetuses. Ultrasound Obstet. Gynecol. 2022; 59(4): 490-6. https://dx.doi.org/10.1002/uog.23765
- Giouleka S., Tsakiridis I., Mamopoulos A., Kalogiannidis I., Athanasiadis A., Dagklis T. Fetal growth restriction: a comprehensive review of major guidelines. Obstet. Gynecol. Surv. 2023; 78(11): 690-708. https://dx.doi.org/10.1097/OGX.0000000000001203
- Devaguru A., Gada S., Potpalle D., Dinesh Eshwar M., Purwar D. The prevalence of low birth weight among newborn babies and its associated maternal risk factors: a hospital-based cross-sectional study. Cureus. 2023; 15(5): e38587. https://dx.doi.org/10.7759/cureus.38587
- Saccone G., Gragnano E., Ilardi B., Marrone V., Strina I., Venturella R. et al. Maternal and perinatal complications according to maternal age: a systematic review and meta-analysis. Int. J. Gynaecol. Obstet. 2022; 159(1): 43-55. https://dx.doi.org/10.1002/ijgo.14100
- Yang L., Feng L., Huang L., Li X., Qiu W., Yang K. et al. Maternal factors for intrauterine growth retardation: systematic review and meta-analysis of observational studies. Reprod. Sci. 2023; 30(6): 1737-45. https://dx.doi.org/10.1007/s43032-021-00756-3
- Larsen M.L., Krebs L., Hoei-Hansen C.E., Kumar S. Assessment of fetal growth trajectory identifies infants at high risk of perinatal mortality. Ultrasound Obstet. Gynecol. 2024; 63(6): 764-771. https://dx.doi.org/10.1002/uog.27610
- Mohammad N., Sohaila A., Rabbani U., Ahmed S., Ahmed S., Ali S.R. Maternal predictors of intrauterine growth retardation. J. Coll. Physicians Surg. Pak. 2018; 28(9): 681-5. https://dx.doi.org/10.29271/jcpsp.2018.09.681
- Relph S., Coxon K., Vieira M.C., Copas A., Healey A., Alagna A. et al. Effect of the growth assessment protocol on the DEtection of small for GestatioNal age fetus: process evaluation from the DESiGN cluster randomised trial. Implement. Sci. 2022; 17(1): 60. https://dx.doi.org/10.1186/s13012-022-01228-1
- Mendoza M., Hurtado I., Bonacina E., Garcia-Manau P., Serrano B., Tur H. et al. Individual risk assessment for prenatal counseling in early-onset growth-restricted and small-for-gestational-age fetuses. Acta Obstet. Gynecol. Scand. 2021; 100(3): 504-12. https://dx.doi.org/10.1111/aogs.14032
- Гасымова Ш.Р., Тютюнник В.Л., Кан Н.Е., Волочаева М.В., Донников А.Е. Клинико-анамнестические факторы риска и прогностические модели развития задержки роста плода. Акушерство и гинекология. 2024; 10: 52-9. https://dx.doi.org/10.18565/aig.2024.166 [Gasimova Sh.R., Tyutyunnik V.L., Kan N.E., Volochaeva M.V., Donnikov A.E. Clinical and anamnestic risk factors and prognostic models for the development of fetal growth retardation. Obstetrics and Gynecology. 2024; (10): 52-9 (in Russian). https://dx.doi.org/10.18565/aig.2024.166].
- Song P. Re: Prognostic value of angiogenic markers in pregnancy with fetal growth restriction. Ultrasound Obstet. Gynecol. 2024; 63(6): 840. https://dx.doi.org/10.1002/uog.27674
Received 26.01.2026
Accepted 20.05.2026
About the Authors
Maria D. Sidelnikova, obstetrician-gynecologist at the 1st Obstetric Physiological Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, +7(903)220-45-13, m_sidelnikova@oparina4.ru,https://orcid.org/0000-0002-0805-4703
Natalia E. Kan, Professor, Dr. Med. Sci., Honored Scientist of the Russian Federation, Deputy Director General for Research – Director of the Institute of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow,
Ac. Oparina str., 4, kan-med@mail.ru, Researcher ID: B-2370-2015, SPIN: 5378-8437, Authors ID: 624900, Scopus Author ID: 57008835600,
https://orcid.org/0000-0001-5087-5946
Victor L. Tyutyunnik, Professor, Dr. Med. Sci., Honored Doctor of the Russian Federation, Leading Researcher at the Center of Scientific and Clinical Researches,
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow,
Ac. Oparina str., 4, tioutiounnik@mail.ru, Researcher ID: B-2364-2015, SPIN: 1963-1359, Authors ID: 213217, Scopus Author ID: 56190621500,
https://orcid.org/0000-0002-5830-5099
Ekaterina E. Soldatova, PhD, Researcher at the Institute of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, katerina.soldatova95@bk.ru, https://orcid.org/0000-0001-6463-3403
Maria A. Domanskaya, clinical resident, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, mdomanskaya@yandex.ru, https://orcid.org/0009-0007-8882-5603
Corresponding author: Maria D. Sidelnikova, m_sidelnikova@oparina4.ru
Similar Articles
