The Catch Up of Small for Gestational Age: Breast Milk Is It the Best?

Abstract

Small for gestational age (SGA) is defined as a birth weight below the 10th percentile for gestational age. We can distinguish two categories of SGA: the first group is constitutionally programmed to be small despite a favorable maternal environment, the second group has a growth restriction due to a maternal condition leading to placental insufficiency. The burden of fetal growth-restricted (FGR) SGA is higher in resource-poor countries, and children born FGR SGA have a higher risk of mortality and morbidity during the neonatal period and beyond. To overcome this underweight and therefore the higher rate of early and late morbimortality, it seems logical that the weight gain in the first months of life (catch up phenomenon) have the optimal speed. Exclusive breastfeeding from birth until six months of age should be encouraged for all infants, including SGA infants, but the supplementation with standard formula or fortified formula until the 6th month of life is it not justified for an optimal catch up? Many authors believe that the “catch up” phenomenon would be the major etiological factors of obesity, cardiovascular disease, and metabolic syndrome in the future. It was demonstrated in many research that, SGA children who received fortified formula or standard formula whatever the reason, showed faster weight gain in the first months of life, which was related to increased body fat later in life. It was also revealed in several studies that, when exclusively breastfed, SGA achieved a catch-up growth slower, suggesting that the human milk can be the reference nutriment for healthy growth without nutritional impairment in children born SGA with effects persisting until adulthood.