Antenatal diagnosis of early-onset small for gestational age: absolute and relative risks of adverse outcomes
Bibliographic record
Abstract
OBJECTIVE: To determine the absolute and relative risks of adverse maternal, perinatal, and longer-term child outcomes for pregnancies with antenatally detected early-onset small for gestational age fetuses, compared with baseline population rates. STUDY DESIGN: We linked ultrasound data from pregnancies with antenatally detected, nonanomalous, early-onset small for gestational age fetuses (estimated fetal weight and/or abdominal circumference <10th percentile at 16+0-31+6 weeks) from our tertiary referral center with provincial health and education databases. We compared risks of adverse pregnancy (eg, stillbirth, gestational hypertension/preeclampsia, cesarean section) and child outcomes (eg, infant death, intensive care unit admission, composite neonatal morbidity, cerebral palsy, Early Development Index score, and Ministry of Education special needs designation at school entry age) among pregnancies with early-onset small for gestational age fetuses to the general population of births in British Columbia, Canada. We calculated relative risks and absolute risk differences with 95% confidence intervals. RESULTS: Among 581 pregnancies with nonanomalous early-onset small for gestational age fetuses, risk ratios for adverse pregnancy outcomes ranged from 4-fold higher for gestational hypertension/preeclampsia (95% confidence interval: 3.8-5.1) to 10-fold higher for stillbirth (95% confidence interval: 5.6-16.6), compared with the rest of the 359,602 nonanomalous births in the province. These relative risks corresponded to 16.5 per 100 excess cases (95% confidence interval: 13.1-19.8) and 2.2 per 100 excess cases (95% confidence interval: 0.9-3.6), respectively. Risks of neonatal complications were similarly elevated (eg, composite neonatal morbidity was 31-fold higher). While Ministry of Education special needs designation was 3-fold higher (95% confidence interval: 2.1-5.6), corresponding to 7 per 100 excess cases (95% confidence interval: 2.0-11.5), there was only a trend toward a higher risk of cerebral palsy. CONCLUSION: Risks of adverse maternal and childhood outcomes are elevated in pregnancies with early-onset small for gestational age fetuses. Presenting these risks in relative and absolute terms from baseline population risks may facilitate clinical counseling and risk comprehension.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".