Identification of newborn babies with fetal growth restriction remains a problem both from the multi-factorial aspect of fetal growth and from statistical definition. Besides the usual terms: ‘Small for gestational age’ (SGA) and intrauterine growth retardation (IUGR), often used synonymously, the term ‘fetal growth retardation’ was recently introduced in reference to the genetic growth potential of infants. From a sample of 72,000 births, we have designed a statistical model in order to estimate the expected birth weight taking into account gestational age, sex, birth rank, maternal age, height and pregravid weight, we then calculated an individual limit of birth weight under that a newborn must be considered as having a ‘fetal growth restriction’ quoted FwGR. This new approach allowed us to identify 2 groups of newborns with FGR, one classically identified as SGA (noted FwGR_I) (3.9%), and the other newly identified as FGR (noted FwGR_II) (1.4%). In contrast, this approach allowed us to identify a group of ‘constitutionally small’ infants according to their constitutional growth potential (1.1%). In other words, among infants usually defined as SGA (5%), 22% appeared in fact to be ‘constitutionally small’ and therefore misclassified. As an initial validation, we observed that the proportion of maternal hypertension during pregnancy was low in the ‘constitutionally small’ infants (close to that of the normal group), and three times higher in the newly identified group FwGR_II than in the normal group. Following these results, it seems to be meaningful to follow-up this new group of FwGR_II infants, in terms of catch-up growth and neurodevelopmental outcome.

The aim of this study was to determine the elements of fatigue in occupations which constitute possible risk factors for the course of a pregnancy, and, in particular, that could cause premature birth. In 1977-1978, a total of 3437 women in France were surveyed after giving birth in two maternity hospitals. One hospital was located in Lyon (a large city) and the other in Haguenau (a small town). Among 1928 working women, it was found that certain occupational categories are more prone to risk of prematurity than others. The authors carried out an analytical breakdown of the job into its diverse components which led them to define five sources of fatigue and to construct an index capable of detecting the strenuous working conditions. There is a significant relationship between the prematurity rate and the number of high fatigue scores observed in the job. When the number of scores varies from 0 to 5 the rate of premature births increases from 2.3% to 11.1%. This relationship remains significant after controlling for confounding factors.

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