The tendency to repeat gestational age and birth weight in successive births, related to perinatal survival

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Abstract
Perinatal death risk was studied in relation to the tendency for mothers to carry their fetuses to similar gestational ages and birth weights in successive pregnancies. The data for this study are derived from all 635,140 births in Norway during a 10-yr period (1967-1976). Those babies that were born similar in age and size to their elder siblings ran the lowest risk of perinatal death, e.g., the perinatal mortality rate (PMR) for 2nd-birth babies weighing 2501-3000 g is 9.1/1000 births if the 1st baby weighed 3000 g or less. But the PMR is 50% higher, 13.3/1000 births, when the 1st baby weighed 3001-3500 g. If the 1st baby weighed more than 3500 g, then the PMR is 3 1/2 times greater, 32.1/1000 births. In addition to gestational age and birth weight, the Medical Birth Registry of Norway also records measurements of crown-heel length. The length data show that babies at greatest risk for perinatal mortality tend to be relatively long and thin rather than symmetrically developed, e.g., the PMR for 2nd babies weighing 2501-3000 g who were disproportionately long (> 46 cm) was 4.6 times greater than the PMR for the average length babies of the same birth weight. Investigation of cause-specific mortality rates showed that most categories were increased for the higher risk babies. Congenital malformation was the principal contributor to deaths of the relatively short babies. Placenta praevia, abruptio placentae and complications of the umbilical cord were the principal contributors to the mortality of the relatively long babies. Apparently, any deviation from the expected growth pattern for a fetus of a multiparous mother should raise concern about an increased risk for the remainder of her pregnancy and delivery.

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