National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010

Anne C.C. Lee, Joanne Katz, Hannah Blencowe, Simon Cousens, Naoko Kozuki, Joshua P. Vogel, Linda Adair, Abdullah H. Baqui, Zulfiqar A. Bhutta, Laura E. Caulfield, Parul Christian, Siân E. Clarke, Majid Ezzati, Wafaie Fawzi, Rogelio Gonzalez, Lieven Huybregts, Simon Kariuki, Patrick Kolsteren, John Lusingu, Tanya MarchantMario Merialdi, Aroonsri Mongkolchati, Luke C. Mullany, James Ndirangu, Marie Louise Newell, Jyh Kae Nien, David Osrin, Dominique Roberfroid, Heather E. Rosen, Ayesha Sania, Mariangela F. Silveira, James Tielsch, Anjana Vaidya, Barbara A. Willey, Joy E. Lawn, Robert E. Black

Research output: Contribution to journalArticleResearchpeer-review

580 Citations (Scopus)


Background: National estimates for the numbers of babies born small for gestational age and the comorbidity with preterm birth are unavailable. We aimed to estimate the prevalence of term and preterm babies born small for gestational age (term-SGA and preterm-SGA), and the relation to low birthweight (<2500 g), in 138 countries of low and middle income in 2010. Methods: Small for gestational age was defined as lower than the 10th centile for fetal growth from the 1991 US national reference population. Data from 22 birth cohort studies (14 low-income and middle-income countries) and from the WHO Global Survey on Maternal and Perinatal Health (23 countries) were used to model the prevalence of term-SGA births. Prevalence of preterm-SGA infants was calculated from meta-analyses. Findings: In 2010, an estimated 32·4 million infants were born small for gestational age in low-income and middle-income countries (27% of livebirths), of whom 10·6 million infants were born at term and low birthweight. The prevalence of term-SGA babies ranged from 5·3% of livebirths in east Asia to 41·5% in south Asia, and the prevalence of preterm-SGA infants ranged from 1·2% in north Africa to 3·0% in southeast Asia. Of 18 million low-birthweight babies, 59% were term-SGA and 41% were preterm-SGA. Two-thirds of small-for-gestational-age infants were born in Asia (17·4 million in south Asia). Preterm-SGA babies totalled 2·8 million births in low-income and middle-income countries. Most small-for-gestational-age infants were born in India, Pakistan, Nigeria, and Bangladesh. Interpretation: The burden of small-for-gestational-age births is very high in countries of low and middle income and is concentrated in south Asia. Implementation of effective interventions for babies born too small or too soon is an urgent priority to increase survival and reduce disability, stunting, and non-communicable diseases. Funding: Bill & Melinda Gates Foundation by a grant to the US Fund for UNICEF to support the activities of the Child Health Epidemiology Reference Group (CHERG).

Original languageEnglish
Pages (from-to)e26-e36
Number of pages11
JournalThe Lancet Global Health
Issue number1
Publication statusPublished - 1 Sept 2013
Externally publishedYes

Cite this