Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

(SDAS) Etiological Subgroups Of Small-For-Gestational-Age: Differential Child Outcomes

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Project Number: R40MC26816
Grantee: Research Fdn of State University of NY
Department/Center: Pediatrics Behavioral Medicine
Project Date: 04/01/2014

Final Report


Principal Investigator

Xiaozhong Wen, MD, PhD
Assistant Professor
3435 Main St., Bldg. 26 G56 Farber Hall
Buffalo, NY  14214
Phone: (716) 829-6811


  • Perinatal/Infancy (0-12 months)
  • Toddlerhood (13-35 months)
  • Early Childhood (3-5 years)
  • Middle Childhood (6-11 years)


This project will address MCHB Strategic Research Issue #IV, "Promoting the healthy development of MCH populations". It contributes to tailored interventions for children born small-for-gestational-age (SGA). Healthy intrauterine environment and normal fetal growth are critical for promoting healthy child development and lifelong well-being. But about 10% of U.S. children are born SGA,1 due to various genetic and environmental causes. On average, children born SGA have worse physical and cognitive development than children born appropriate-for-gestational-age (AGA),2 and thus may have special needs for healthcare, feeding, and parenting. However, there is a great deal of heterogeneity among SGA newborns, potentially due to different etiology. Current guidelines for clinical management of SGA newborns emphasize intensive growth surveillance and growth hormone therapy for persistent short stature after age 2-3 y.3,4 One limitation of these guidelines is failure to consider that SGA has at least 7 different key prenatal causes: maternal prepregnancy underweight, short stature, smoking during pregnancy, alcohol use, inadequate gestational weight gain, hypertensive conditions, and genital or urinary tract infection, and may need tailored interventions depending on the cause(s). Considering these prenatal causes could allow more accurate prediction of later outcomes among SGA newborns and potentially inform tailored interventions that are more effective than universal intervention. However, this can only be possible with a better understanding of child outcomes of SGA with different etiology. The overall goal of the proposed study is to identify which etiological subgroups of SGA have adverse child outcomes up to age 7 years (y). Guided by a life course framework, we will use data from two U.S. national longitudinal birth cohorts that tracked mother-child dyads from pregnancy to age 5-7 y: 1) The Early Childhood Longitudinal Study - Birth (ECLS-B, N=10,700, SGA 1,431),5,6 2) The Collaborative Perinatal Project (CPP, N=59,500, SGA 4,860).7-9 Our team has access to both datasets, and published 4 peer-reviewed journal articles on maternal and child health using CPP data since 2010.10-13 Aim 1: compare physical (e.g. weight, height, blood pressure) and cognitive (e.g. IQ, achievement) outcomes from birth to age 7 y across etiological subgroups of SGA based on 7 key prenatal risk factors. Aim 2: examine whether the associations between etiological SGA subgroups and child outcomes in the Aim 1 can be modified by postnatal factors including infancy feeding, well-child care, catch-up growth, and parenting. Aim 3: build and validate prediction models for child outcomes among SGA newborns using socio-demographics and prenatal risk factors.


Listed is descending order by year published.

Xie C, Epstein LH, Eiden RD, et al. Stunting at 5 Years Among SGA Newborns. Pediatrics. 2016;137(2):1-10.

Xie C, Epstein LH, Eiden RD, Shenassa ED, Li X, Liao Y, Wen X. Stunting at 5 Years Among SGA Newborns. Pediatrics. 2016 Feb;137(2):1-10. Epub 2016 Jan 15. PubMed PMID: 26772663.

Xie C, Wang Y, Li X, Wen X. Childhood Growth Trajectories of Etiological Subgroups of Large for Gestational Age Newborns [published online December 11 2015]. J Pediatr. 2016;170:60-66.e5.

Xie C, Wang Y, Li X, Wen X. Childhood growth trajectories of etiological subgroups of large-for-gestational-age newborns. J Pediatr, 2015 Dec 11. Epub ahead of print. PMID: 26687713


Low Birthweight, Physical Growth, Cognitive & Linguistic Development, Social & Emotional Development, Pregnancy, Smoking, Nutrition & Diet, Breastfeeding

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