Original article| Volume 38, ISSUE 6, P529-537, June 2016

Neurodevelopment in full-term small for gestational age infants: A nationwide Japanese population-based study



      To investigate neurological development in small for gestational age (SGA) infants, with a focus on full-term SGA infants.


      We analyzed data from a large, Japanese, nationwide, population-based longitudinal survey started in 2001. We restricted the study to participants born before 42 weeks of gestation (n = 46,563). Parents were asked questions about motor and language development when the children were 2.5 years old, and about behavioral development at 5.5 years. We analyzed the relationships between SGA status and development by logistic regression. Odds ratios (ORs) and 95% confidence intervals (95% CI) were calculated for each outcome for full-term and preterm births, adjusting for potential infant- and parent-related confounding factors. We also calculated the population-attributable fractions to estimate the public impact of SGA births.


      SGA full-term children were more likely to demonstrate developmental delays at 2.5 years, e.g., being unable to walk alone (OR 3.0, 95% CI: 1.7, 5.3), compose a two-phrase sentence (OR 1.5, 95% CI: 1.2, 1.8), or use a spoon to eat (OR 1.5, 95% CI: 1.1, 1.9). SGA status also had some degree of negative impacts on behavioral problems at 5.5 years among term children, e.g., being unable to listen without fidgeting (OR 1.2, 95% CI: 1.1, 1.3), or remain patient (OR 1.1, 95% CI: 1.0, 1.2). The public health impacts were comparable between full-term and preterm SGA children at 2.5 years.


      SGA is a risk factor for developmental delay, even in full-term infants, with non-negligible public health impacts.


      ADHD (attention-deficit/hyperactivity disorder), AGA (appropriate for gestational age), CI (confidence interval), MHLW (Japanese Ministry of Health, Labour and Welfare), OR (odds ratio), PAF (population-attributable fraction), SGA (small for gestational age)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Brain and Development
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Longo S.
        • Bollani L.
        • Decembrino L.
        • Di Comite A.
        • Angelini M.
        • Stronati M.
        Short-term and long-term sequelae in intrauterine growth retardation (IUGR).
        J Matern Fetal Neonatal Med. 2013; 26: 222-225
        • Lundgren E.M.
        • Tuvemo T.
        Effects of being born small for gestational age on long-term intellectual performance.
        Best Pract Res Clin Endocrinol Metab. 2008; 22: 477-488
        • Guellec I.
        • Lapillonne A.
        • Renolleau S.
        • Charlaluk M.-L.
        • Roze J.-C.
        • Marret S.
        • et al.
        Neurologic outcomes at school age in very preterm infants born with severe or mild growth restriction.
        Pediatrics. 2011; 127: e883-e891
        • Morsing E.
        • Asard M.
        • Ley D.
        • Stjernqvist K.
        • Marsál K.
        Cognitive function after intrauterine growth restriction and very preterm birth.
        Pediatrics. 2011; 127: e874-e882
        • De Jesus L.C.
        • Pappas A.
        • Shankaran S.
        • Li L.
        • Das A.
        • Bell E.F.
        • et al.
        Outcomes of small for gestational age infants born at <27 weeks’ gestation.
        J Pediatr. 2013; 168 (e1–3): 55-60
        • Arcangeli T.
        • Thilaganathan B.
        • Hooper R.
        • Khan K.S.
        • Bhide A.
        Neurodevelopmental delay in small babies at term: a systematic review.
        Ultrasound Obstet Gynecol. 2012; 40: 267-275
        • Matte T.D.
        • Bresnahan M.
        • Begg M.D.
        • Susser E.
        Influence of variation in birth weight within normal range and within sibships on IQ at age 7 years: cohort study.
        BMJ. 2001; 323: 310-314
        • Stoknes M.
        • Andersen G.L.
        • Dahlseng M.O.
        • Skranes J.
        • Salvesen K.Å.
        • Irgens L.M.
        • et al.
        Cerebral palsy and neonatal death in term singletons born small for gestational age.
        Pediatrics. 2012; 130: e1629-e1635
        • Yorifuji T.
        • Kubo T.
        • Yamakawa M.
        • Kato T.
        • Inoue S.
        • Tokinobu A.
        • et al.
        Breastfeeding and behavioral development: A nationwide longitudinal survey in Japan.
        J Pediatr. 2014; 164: 1019-1025
        • Kato T.
        • Yorifuji T.
        • Inoue S.
        • Yamakawa M.
        • Doi H.
        • Kawachi I.
        Associations of preterm births with child health and development: Japanese population-based study.
        J Pediatr. 2013; 163: e4
        • Itabashi K.
        • Fujimura M.
        • Kusuda S.
        • Tamura M.
        • Hayashi T.
        • Takahashi T.
        • et al.
        Adoption of new reference value for birth size according to gestational age (in Japanese).
        J Jpn Pediatr Soc. 2010; 114: 1271-1293
      1. Committee on newborn, Japan Pediatric Society. Revision of new reference value for birth size according to gestational age (in Japanese). J Jpn Pediatr Soc 2010; 114:1771–806.

        • Porta M.
        A dictionary of epidemiology.
        5th ed. Oxford University Press, New York2008
        • Carruth B.R.
        • Skinner J.D.
        Feeding behaviors and other motor development in healthy children (2–24 months).
        J Am Coll Nutr. 2002; 21: 88-96
        • Roth S.
        • Chang T.C.
        • Robson S.
        • Spencer J.A.
        • Wyatt J.S.
        • Stewart A.L.
        The neurodevelopmental outcome of term infants with different intrauterine growth characteristics.
        Early Hum Dev. 1999; 55: 39-50
        • Savchev S.
        • Sanz-Cortes M.
        • Crouz-Martines R.
        • Arranz A.
        • Botet F.
        • Gratacos E.
        • et al.
        Neurodevelopmental outcome of full-term small-for-gestational-age infants with normal placental function.
        Ultrasound Obstet Gynecol. 2013; 42: 201-206
      2. The Japanese society of child health [Japanese Edition Denver II] (in Japanese). Tokyo: Nihon shouniijisyuppansya; 2008.

        • Yang S.
        • Platt R.W.
        • Kramer M.S.
        Variation in child cognitive ability by week of gestation among healthy term births.
        Am J Epidemiol. 2010; 171: 399-406
        • Sommerfelt K.
        • Andersson H.W.
        • Sonnander K.
        • Ahlsten G.
        • Ellertsen B.
        • Markestad T.
        • et al.
        Behavior in term, small for gestational age preschoolers.
        Early Hum Dev. 2001; 65: 107-121
        • Cornforth C.M.
        • Thompson J.M.D.
        • Robinson E.
        • Waldie K.E.
        • Pryor J.E.
        • Clark P.
        • et al.
        Children born small for gestational age are not at special risk for preschool emotion and behaviour problems.
        Early Hum Dev. 2012; 88: 479-485
        • Ogino T.
        • Hattori J.
        • Abiru K.
        • Nakano K.
        • Oka E.
        • Ohtsuka Y.
        Symptoms related to ADHD observed in patients with pervasive developmental disorder.
        Brain Dev. 2005; 27: 345-348
        • Cappa M.
        • Bizzarri C.
        • Vollono C.
        • Petroni A.
        • Banni S.
        Endocr Dev. 2011; 20: 149-160
        • Heinonen K.
        • Räikkönen K.
        • Pesonen A.-K.
        • Andersson S.
        • Kajantie E.
        • Eriksson J.G.
        Behavioural symptoms of attention deficit/hyperactivity disorder in preterm and term children born small and appropriate for gestational age: a longitudinal study.
        BMC Pediatr. 2010; 10: 91