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Most obstetric clinics have a program for the identification of small-for-gestational age (SGA) fetuses because of the increased risk of fetal complications that they present. We have a structured model for the identification and follow-up of SGA pregnancies. We aimed to determine whether the recognition of SGA antepartum improves fetal outcome.All pregnancies at Malmö University Hospital from 1990 to 1998 (n = 26 968) were reviewed. SGA fetuses identified prior to delivery (n = 681) were compared with those not identified (n = 573). Also, all pregnancies with SGA fetuses were compared with those appropriate-for-gestational age (AGA) (n = 24 585). The risk of serious fetal complications (hypoxic encephalopathy grade 2 or 3, intracranial hemorrhage, Apgar score4 at 5 min, neonatal convulsions, umbilical pH7.0, cerebral palsy, mental retardation, stillbirth, intrapartum or infant death) was assessed with cross-tabulation and logistic regression analysis, adjusted for gestational age and degree of SGA.When compared with SGA fetuses identified before delivery (54%), SGA fetuses not identified before delivery were characterized by a four-fold increased risk of adverse fetal outcome (odds ratio, 4.1; 95% CI, 2.5-6.8). Similarly, compared with AGA fetuses, SGA fetuses were associated with a four-fold increased risk of serious fetal complications.A structured antenatal surveillance program for fetuses identified as SGA results in a lower risk of adverse fetal outcome, compared with cases of SGA fetuses not identified antepartum.

To investigate the effects of maternal smoking during pregnancy on the development of preeclampsia (PE).The study comprised two populations with singleton pregnancies, one collected from 1990 to 1994 at the Malmö University Hospital (Malmö series, n=14,510) and the other from the National Birth Registry of Sweden 1993 (National series, n=113,211). Women with PE (n=281 and n=2,865, respectively) were compared to those without PE, delivered in 1993 (n=2,811 and n=110,346, respectively). The subgroups of women who had PE associated with preterm birth (n=58 and n=693, respectively) were compared with the same control groups in both series.Multiple logistic regression analysis showed that, in comparison with non-smokers, moderate smokers (1-9 cigarettes per day) were characterized by a lower incidence of PE (odds ratio (OR) 0.4; 95% confidence interval (CI) 0.22-0.60), and PE associated with preterm birth (OR 0.1; 95% CI 0.01-0.67). The corresponding figures in the validating National series were also significantly lower for moderate smokers (OR 0.6; 95% CI 0.5-0.7 and OR 0.6; 95% CI 0.5-0.8, respectively).Moderate smoking during pregnancy seems to protect against the development of PE and PE associated with preterm birth. Nicotine might be the agent responsible for this protective effect.