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Social gradient of birthweight in England assessed using the INTERGROWTH-21st gestational age-specific standard
  1. Jane E Hirst1,
  2. Hannah Ellin Knight2,
  3. Eric O Ohuma3,4,
  4. Terence Dwyer5,
  5. Benjamin D Hennig6,
  6. Aris T Papageorghiou1,
  7. Leila Cheikh Ismail7,
  8. José Villar1,
  9. Stephen H Kennedy1
  1. 1 Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
  2. 2 Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
  3. 3 Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
  4. 4 Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
  5. 5 The George Institute for Global Health UK, University of Oxford, Oxford, UK
  6. 6 Faculty of Life and Environmental Sciences, University of Iceland, Reykjavik, Iceland
  7. 7 Clinical Nutrition and Dietetics Department, University of Sharjah College of Health Sciences, Sharjah, UAE
  1. Correspondence to Dr Jane E Hirst, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK; jane.hirst{at}


Objective To determine the socioeconomic gradient of birthweights in England with reference to the prescriptive INTERGROWTH-21st Birthweight Standard.

Design National cross-sectional study using data from Hospital Episode Statistics.

Setting National Health Service in England.

Participants All singleton babies, live born between 34 weeks’ gestation and 42 weeks’ gestation, between 1 April 2011 and 31 March 2012.

Main outcome measures Birthweight distribution of babies with a birthweight of <10th centile or >90th centile, that is, small for gestational age (SGA) or large for gestational age (LGA) using Index of Multiple Deprivation quintiles as a proxy for socioeconomic status.

Results Of 508 230 babies born alive between 1 April 2011 and 31 March 2012, 38 838 (7.6%) were SGA and 81 026 (15.9%) were LGA. Median birthweight was 3405 g, median z-score was 0.25 (SD 1.06). Birthweight z-score demonstrated a social gradient, from 0.26 (SD 1.1) in the most deprived areas to 0.53 (1.0) in the least deprived. Women in the most deprived areas were twice as likely to have SGA babies using the INTERGROWTH-21st chart (OR 1.94; 95% CI 1.87 to 2.01) compared with those in the least deprived areas. If all women had the same rate of SGA equivalent to those living in the least deprived areas, approximately 12 410 (30%) fewer babies would be born SGA in England each year.

Conclusions This study gives a measure of the social gradient in singleton SGA and LGA babies across England using an international standard of newborn size at birth.

  • birthweight
  • socioeconomic
  • small for gestational age
  • large for gestational age
  • England

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  • Contributors JEH, SHK, HEK, ATP, EOO and JV devised the original concept. JEH wrote the original manuscript draft with subsequent conceptual and editing input from HEK, EOO, LCI, ATP, TD, JV, BDH and SHK. HEK and EOO performed the analysis. BDH performed the cartographic analysis and interpretation. All authors approved the final version prior to submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.