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Small for Gestational Age: Short Stature and Beyond

Department of Pediatrics (P.S.), Albert Einstein College of Medicine, Bronx, New York 10467; Hôpital Robert Debré (P.C.), 75019 Paris, France; Department of Paediatrics (I.H.), University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 2QQ, United Kingdom; and Baystate Medical Center (E.O.R.), Tufts University School of Medicine, Springfield, Massachusetts 01199

Correspondence: Address all correspondence and requests for reprints to: Professor Paul Saenger, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York 10467. E-mail: PHSaenger{at}aol.com

Depending on the definitions used, up to 10% of all live-born neonates are small for gestational age (SGA). Although the vast majority of these children show catch-up growth by 2 yr of age, one in 10 does not. It is increasingly recognized that those who are born SGA are at risk of developing metabolic disease later in life. Reduced fetal growth has been shown to be associated with an increased risk of insulin resistance, obesity, cardiovascular disease, and type 2 diabetes mellitus. The majority of pathology is seen in adults who show spontaneous catch-up growth as children. There is evidence to suggest that some of the metabolic consequences of intrauterine growth retardation in children born SGA can be mitigated by ensuring early appropriate catch-up growth, while avoiding excessive weight gain. Implicitly, this argument questions current infant formula feeding practices. The risk is less clear for individuals who do not show catch-up growth and who are treated with GH for short stature. Recent data, however, suggest that long-term treatment with GH does not increase the risk of type 2 diabetes mellitus and the metabolic syndrome in young adults born SGA.

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