PEDIATRICS Vol. 82 No. 1 July 1988, pp. 83-90
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Congenital Malformations and Intrauterine Growth Retardation: A Population Study

Muin J. Khoury MD, PhD1, J. David Erickson DDS, PhD1, José F. Cordero MD, MPH1, and Brian J. McCarthy MD1

1 From the Birth Defects and Genetic Diseases Branch, Division of Birth Defects and Developmental Disabilities, Center for Environmental Health and Injury Control, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta

The relationship between congenital malformations and intrauterine growth retardation was investigated using data from the population-based Metropolitan Atlanta Congenital Defects Program. Between 1970 and 1984, the system ascertained 13,074 infants with major structural malformations diagnosed in the first year of life and born to metropolitan Atlanta residents. These infants were classified as having intrautenine growth retardation if their birth weight was below the race-, sex-, and gestational age-specific tenth percentile limits for all Atlanta births. Overall, the frequency of intrauterine growth retardation among malformed infants was 22.3% (relative risk 2.6). Of 48 defect categories evaluated, 46 were associated with excess intrauterine growth retardation, most notably chromosomal anomalies (eg, 83.7% for infants with trisomy 18, relative risk 46) and anencephaly (73.3%, relative risk 25). Only a few isolated defects (such as isolated polydactyly, pylonic stenosis, and congenital hip dislocation) were not associated with excess intrauterine growth retardation. Among infants with multiple malformations, the frequency of intrauterine growth retardation increased markedly with increasing number of defects—from 20% for infants with two defects to 60% for infants with nine or more defects. The relationship between malformations and intrauterine growth retardation can be explained by one or more of three mechanisms: (1) intrauterine growth retardation can be a secondary disturbance to the presence of malformations; (2) intrauterine growth retardation can predispose the fetus to malformations; and (3) intrauterine growth retardation can coexist with malformations because of common etiologic factors. Because the risk of a major defect diagnosed in the first year increases from 3.3% for infants without intrauterine growth retardation to 8.0% for infants with intrauterine growth retardation, the presence of intrauterine growth retardation may help in the prenatal and neonatal detection of congenital malformations.

Key Words: congenital malformation • intrauterine growth retardation

Submitted on May 26, 1987
Accepted on August 6, 1987




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