TABLE 2 : SGA Infant and Maternal Data
SGA / Total Births (%)**
PC 520 / 6611 ( 7.9 )
C 128 / 3815 ( 3.4 )
LOS Days
14 ± 30
14 ± 24
Male AVE GA Weeks
Cesarean Section
Z Score
53 % |
37 ± 3 |
48 % |
-1.78 |
|
|
|
± 0.48 |
55 % |
36 ± 4 |
48 % |
-1.75 |
|
|
|
± 0.61 |
SGA Infant Data
Apgar 1 min
Apgar 5 min
NICU
Need IV
RDS NAS Anomaly Survive
7 ± 2 8 ± 1 52 % 37 % 59.4 % 10 % 9 % 15 % 96 %
7 ± 2 8 ± 1 51 % 42 % 57 % 18 % 12 % 16 % 93 %
BMI
PC 31,45 ± 7.7
C 32.15 ± 7.7
BMI > 30
Hypoglycemia
Hypertension **
Preeclampsia , HELLP % all hypertension
DM **
GDM % all DM
SGA Maternal Data
Type 1 % all DM **
Type 2 % all DM
Tobacco *
Cannabis **
50 % 30 % 63.3 % 5.3 % 73.6 % 3.8 % 22.6 % 35 % 10 % 16 % 3 % 7 % 0
50 % 41 % 68.3 % 9.4 % 67 % 8.4 % 24.6 % 43 % 19 % 18 % 6 % 9 % 12 %
COVID -19 +
* p < 0.05 ; ** p < 0.01 ; SGA : small for gestational age ; PC : Pre-COVID period , January 1 , 2016-February 29 , 2020 ; LOS : length of stay ; AVE GA : Average gestational age ; NICU : Neonatal intensive care unit ; RDS : respiratory distress syndrome ; NAS : neonatal abstinence syndrome ; BMI : Body mass index ; HELLP : syndrome of hemolysis , elevated liver functions , low platelets ; DM : diabetes mellitus ; GDM : gestational diabetes mellitus ; HEP C : hepatitis C
The proportion of maternal hypertension was higher among mothers in the C cohort but did not reach statistical significance . Maternal substance use varied based on substance . Maternal tobacco use was significantly higher in the C cohort ( p < 0.01 ) as was cannabis use ( p < 0.05 ).
SGA NEWBORN AND MATERNAL CHARACTERISTICS BY COHORT
Table 2 provides newborn and maternal characteristics for the SGA newborns in both cohorts . The proportion of SGA newborns was significantly lower in the C cohort ( 128 , 3.4 %) compared to the PC cohort ( 520 , 7.9 %) ( p < 0.01 ). No significant differences were noted in newborn birth characteristics . Significant differences were noted in select maternal characteristics , including an increased proportion of maternal hypertension in the C cohort ( p < 0.01 ) and GDM ( p < 0.01 ). Significantly fewer mothers reported type 1 DM in the C cohort ( p < 0.001 ). Significantly more mothers reported cannabis ( p < 0.01 ) and tobacco use ( p < 0.01 ). We also noted significantly higher maternal tobacco use in both SGA PC and C cohorts compared to the overall sample ( 16 % vs . 35 %).
IMPACT OF MATERNAL COVID-19 INFECTIONS
During the review period , the percentage of mothers with COVID-19 viral infection was similar in both the LGA ( 8 %) and SGA ( 12 %) cohorts to that percentage of mothers with COVID-19 infection for all births at our children ’ s hospital ( 9 %). However , routine testing for the infection was not part of obstetric care at our institution until after November 2020 . Many of the mothers who tested positive for the virus reported no symptoms , but 47 % of the mothers of LGA infants and 25 % of the mothers of SGA infants noted some degree of illness with their COVID-19 diagnosis .
DISCUSSION
The COVID-19 pandemic has created a unique situation with imposed activity restrictions , particularly for pregnant women . 7 Women have experienced a greater loss of employment and likely increased isolation and restriction of activity during the pandemic . 7 , 8 The consequences of this restriction are not known . Through this chart review , we observed a significantly greater proportion of LGA newborns and fewer SGA newborns among all babies born during the pandemic period . This phenomenon has also been noted by parents and shared through the TikTok social media app with multiple videos . 9 We also observed that the LGA babies were not quite as large during the C period compared to the PC period . It is possible that the C-section rate was higher in the PC period due to higher weights in the LGA babies during the PC period ( Z score 1.83 ± 0.65 vs 1.65 ± 0.71 ).
The nutritional status of women of childbearing age in West Virginia has long been a concern . Even before the pandemic period , mothers have presented with levels of obesity , DM , hypertension , and substance use that are greater than the rest of the nation . 10 , 11 The American College of Obstetricians and Gynecologists ( ACOG ) considers a BMI > 30 kg / m2 as obese , 12 and it is estimated that 20 % of pregnant women in the US are considered obese . 13
Our observations show that well before the current pandemic , obesity has remained associated with the delivery of both LGA and SGA infants . During this pandemic , maternal BMI for both groups has in-
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