Contribution of socioeconomic status to the risk of small for gestational age infants – a population-based study of 1,390,165 singleton live births in Finland

BACKGROUND: Small for gestational age (SGA) infants are at increased risk of short- and long-term adverse outcomes. METHODS: Population-based case–control study using data derived from the Finnish Medical Birth Register for the years 1987–2010 (total population of singleton live births n = 1,390,165). The aim was to quantify the importance of risk factors for SGA and describe their contribution to socioeconomic status (SES) disparities in SGA by using logistic regression analysis. RESULTS: Of all the singleton live births (n = 1,390,165), 3.1% (n = 42,702) were classified as SGA (defined as below 2 standard deviations of the sex-specific population reference mean for gestational age). The risk of SGA was 11 − 24% higher in the lower SES groups compared to the highest SES group. Smoking alone made the largest contribution, explaining 41.7 − 50.9% of SES disparities in SGA. The risk of SGA was 2.3-fold and 7% higher among women who smoked or had quit smoking during the first trimester of pregnancy (adjusted odds ratio (aOR) 2.34, 95% CI 2.28-2.42 and aOR 1.07, 95% CI 1.00 − 1.15, respectively) compared with the non-smokers. CONCLUSIONS: SGA is substantially affected by SES. Smoking explained up to 50% of the difference in risk of SGA between high and low SES groups. Quitting smoking during the first trimester of pregnancy resulted in a 7% higher incidence of SGA comparable to that of non-smoking women. Thus, interventional attempts to reduce smoking during pregnancy might help to decrease the socioeconomic gradient of SGA.