Does the Geography of Gestation Impact Baby Size

Health Reports
Why are babies in Canada getting smaller?

by Shiraz El Adam, Jennifer A. Hutcheon, Chris McLeod and Kim McGrail

Release date: Jan 19, 2022

DOI: https://www.doi.org/10.25318/82-003-x202200100001-eng

On this page

• Abstruse
• What is already known on this subject?
• What does this study add together?
• Introduction
• Methods
• Data analysis
• Results
• Word
• Appendix
• References

Abstract

Introduction

Recent evidence from the Us and Canada suggests an unexplained increase in pocket-size-for-gestational-age (SGA) births (<10th percentile). This study aimed to identify reasons for the recent increase in SGA births in Canada.

Data and methods

Using Canada's Vital Statistics - Birth Database, the report population included all singleton live births, 2000 to 2016, inclusive. Temporal changes in nascency weight (grams), birth weight for gestational age z-scores, and SGA births were examined. Multivariable logistic regression was used to determine if the increased risk of an SGA birth over fourth dimension was eliminated or attenuated by adjusting for selected private and sociodemographic factors that have previously been associated with SGA births.

Results

There were five,941,820 singleton live births in Canada between 2000 and 2016. Mean nativity weight for all births decreased from 3,442 grams in 2000, to 3,367 grams in 2016, while SGA nativity increased from 7.2% in 2000 to 8.0% in 2016. The multivariable model showed higher odds of SGA birth among births to parents born outside of Canada, unmarried women, older women, nulliparous women and women residing in low income neighborhoods. After adjusting for sociodemographic factors, the rough 12% increase in odds of SGA birth in 2016 compared to 2000 (95% Conviction Interval (CI): [10 to xiv%]) was attenuated, merely not eliminated (adjusted odds ratio for agenda time 1.08 (95% CI: [one.06, 1.ten])).

Interpretation

This report identified a subtract in fetal size in Canada between 2000 and 2016. The rise in SGA births in Canada was explained only partly as a result of concurrent changes in the demography of childbirth.

Keywords

Small-for-gestational-age births, birth weight, infant wellness, maternal and fetal medicine

Authors

Shiraz El Adam (shirazeladam.publichealth@gmail.com) is with the Schoolhouse of Population and Public Health, the University of British Columbia, Vancouver, British Columbia, Canada. Jennifer A. Hutcheon is with the Section of Obstetrics and Gynaecology, the University of British Columbia, B.C. Children's & Women'southward Hospital, Vancouver, British Columbia, Canada. Chris McLeod is with the Occupational and Environmental Health Division, Partnership for Work, Health and Condom, School of Population and Public Health, the University of British Columbia, Vancouver, B.C. Kim McGrail is with the Centre for Health Services and Policy Research, School of Population and Public Health, the University of British Columbia, Vancouver, British Columbia, Canada.

What is already known on this subject?

• A recent increase in the number and proportion of small-for-gestational-historic period (SGA) births—an important indicator of infant wellness—has been observed in Canada and the Us. The reasons for this ascension are unclear. Changes in demographic factors, such equally increasing immigration, fewer births per woman and advanced maternal age were hypothesized to be responsible.

What does this study add?

• This study investigated trends in nascency weight and SGA births among all singleton live births in Canada from 2000 to 2016. Changes in the demography of childbirth explained some, but not all, of the increasing trend in SGA births betwixt 2008 and 2016.

Introduction

Small-for-gestational-age (SGA) birth, defined as a birth weight below the tenth percentile of a reference population by sexual activity and gestational age, ^{Note 1} is usually monitored as a public health indicator because of its role as a proxy for fetal growth restriction. SGA infants are at an increased adventure of neonatal complications including hypothermia, hypoglycemia, hyperglycaemia, hypocalcaemia, polycythemia, jaundice, feeding difficulties, feed intolerance, necrotizing enterocolitis, late onset sepsis and pulmonary haemorrhage equally well every bit baby death. ^{Note 2} The life-long health risks associated with minor size at birth include increased risks of dumb neurodevelopment, psychological or emotional distress, and non-communicable diseases. ^{Annotation 3 Note 4 Notation 5 Notation vi}

Studies from a number of international jurisdictions have reported an increment in nascency weight over time, and a decrease in the proportion of SGA births. ^{Notation seven Note eight Note 9 Note 10 Note xi Note 12} For example, a study from Canada on births from 1978 to 1996 constitute that babies born at, or beyond, term were getting bigger due to increases in maternal anthropometry (various measurements of size), reduced cigarette smoking and changes in sociodemographic factors. ^{Notation 13}

More recent evidence, however, suggests that this tendency may have reversed. A recent study in the Usa indicated a 29.9% increase in term SGA births betwixt 2002 and 2011. ^{Note 14} Similarly, a Canadian perinatal health report published in 2017 reported an increment in the proportion of SGA births from 8.2 per 100 singleton live births (95% CI: [eight.one–8.iii]) in 2008 to nine.1 (95% CI: [ix.0–9.ii]) per 100 in 2014. ^{Note 15} Decreases in mean nascence weight in the United States have been explained by a shift to younger gestational age at birth post-obit an increased use of labour consecration, but this does not explicate the increment in SGA births, which is standardized for gestational age. ^{Note 16} The reason(southward) for these increases in SGA births remains unclear.

In Canada, the demography of childbirth has changed over time due to increased clearing, ^{Notation 17} delayed childbirth ^{Notation xviii} and change in the income earning limerick of couple families over time. ^{Notation 19} Changes in these factors could increase the risk of minor infants through physiological pathways (advanced maternal age and variations in anthropometry by country of nativity), ^{Note xx} equally well as psycho-social and textile pathways (immigration, acculturation, neighborhood income and community size). ^{Note 21 Note 22}

The objective of this study was to identify reasons for the recent ascent in SGA births in Canada; specifically, the part of demographic factors including maternal and paternal place of birth, marital relation, maternal age, number of liveborn children a mother has, community size and neighborhood income quintile of maternal residence. The changing census of childbirth in Canada was hypothesized to be responsible for the contempo increase in SGA births.

Methods

This research was exempt from Research Ethics Board review because it is based on information that are legally accessible to the public and appropriately protected by law through Statistics Canada (Commodity 2.2 and 2.4 for exemptions).

Report design

This report employed a cross-sectional panel study pattern.

Data sources

Statistics Canada's Vital Statistics - Birth Database was used, which contains information from all alive births in Canada. In addition to individual-level characteristics, this dataset contains sociodemographic variables from Statistics Canada census files (such equally neighborhood income quintile and community size) that are linked to each birth's postal code through the Postal Code Conversion File and Postal Code Conversion File Plus (PCCF+). ^{Note 23}

Written report population

The study population was drawn from all singleton alive births in Canada born between 2000 and 2016, inclusive. The study excludes stillbirths, twins and higher-lodge multiples, births with gestational historic period less than 22 weeks or greater than 43 weeks, births with nascency weights less than 300 grams or more than 5 999 grams, births to women who were not residents of Canada, and births with missing information on nascency weight, pregnancy duration or sexual practice.

SGA nativity was defined using Wellness Canada'south birth weight for gestational age reference charts developed by Kramer et al. in 2001. ^{Note 24} These reference charts were based on all Canadian alive births (excluding Ontario) between January 1, 1994, and Dec 31, 1996. ^{Note i} Gestational week-specific and sex-specific means and standard deviations of birth weight from the reference charts were used to generate a gestational-historic period and sex-specific z-score for each nascency in this cohort using the formula:

$$\begin{array}{c}Z-Score=[\underset{\_}{observ\mathrm{eastward}dbirth\mathrm{due\; west}eight–kea\mathrm{northward}birthw\mathrm{east}ight\left(inref\mathrm{due\; east}rencechart\right)}]\\ SD\left(inreferencechart\right)\end{array}$$

SGA births were defined equally infants with a z-score of less than -i.28, which corresponds to the 10th percentile assuming a standard normal distribution.

Individual and contextual factors and measurements

The mother/father's geographic birth place were ii separate categorical variables created by regrouping the mother/father'south country of birth into Canadian-born and continent specific geographical sub-regions (Canada, N America excluding Canada, Primal America, Caribbean and Bermuda, South America, Western Europe, Eastern Europe, Northern Europe, Southern Europe, Western Africa, Eastern Africa, Northern Africa, Central Africa, Southern Africa, Westward Central Asia and the Middle East, East asia, Southeast Asia, Southern Asia, Oceania/Antarctica and adjacent islands, and missing/unknown) using the Statistical Classification of Countries and Areas of Interest for Social Statistics (SCCAI, 2017). This standard was adult by Statistics Canada for social statistics and based on the International Standard for land codes (ISO 3166-1: 2013). ^{Notation 25} The missing/unknown category independent any parental place of birth that did non match 1 of the subregions above or had a missing value for female parent/begetter's country of birth. Maternal historic period at delivery was categorized every bit younger than 20, xx to 24, 25 to 29, 30 to 34, 35 to 39, 40 years or older, and unknown. The number of liveborn children indicates the number of children e'er liveborn to the mother, previous to, and including, this birth outcome. This excludes fetal deaths or stillbirths. Marital relation was categorized as single, married and other. Due to inconsistencies in reporting categories across provinces, the "other" category contained a mix of partnered and non-partnered women (widowed, divorced, separated, common-law, not-married and unknown) and therefore express interpretability.

Customs size was categorized as n=i,250,000 +; 500,000 to ane,249,999; 100,000 to 499,999; 10,000 to 99,999; < ten,000; and missing, based on the size of the mother'southward community of residence. The neighborhood income per single person equivalent describes the household size-adapted measure out of household income based on census summary data at the smallest reporting surface area (n = ~400 to 700 individuals) and using person-equivalents implied by the low-income cutting-offs established by Statistics Canada. ^{Notation 23} Those two variables were based on census year 2006 for births between 2000 and 2008 (PCCF+ versions 5E), 2009 ((PCCF+ versions 5J3) and 2010 (PCCF+ versions 5K0); on census yr 2011 (PCCF+ versions 6D) for births betwixt 2011 and 2015; and on census year 2016 (PCCF+ versions 7A) for births in 2016.

Data assay

Temporal trends in mean nascency weight and charge per unit of SGA nativity were summarized descriptively using means with standard deviations or frequencies and proportions, and plotted over fourth dimension by year of nascence. Temporal trends in mean birth weight z-scores were also examined to identify underlying trends in nascence weights while accounting for changes over time in the timing of delivery.

Logistic regression was used to quantify the increased odds of SGA birth over time, compared with the yr 2000 every bit a reference. A multivariable regression model that included selected individual and sociodemographic factors previously associated with SGA birth ^{Annotation 2 Note 26} was used to determine if the increased take a chance of SGA birth over time was eliminated or attenuated by inclusion of these variables. Aside from the main independent variable, these selected factors were included equally confounders, due to their association with birth year (changes in socio-demographic factors over fourth dimension), and their known association with an increased risk of an SGA nascency. ^{Note 2 Note 26} Missing and/or unknown values were entered as a carve up category for each variable in the model. A sensitivity analysis including adjustment for maternal province/territory of residence was further explored in Appendix Tabular array A. Analyses were conducted using Stata version 13.i (StataCorp, 2013).

Results

At that place were five,941,820 singleton live births in Canada betwixt 2000 and 2016. Of these, 449,015 (7.6%) were small for being of gestational age. As shown in Figure 1, the proportion of SGA births increased throughout the study period, from 7.2% in 2000 to 8.0% in 2016. This corresponded with a 12% increase (95% CI: [1.10, 1.14]) in the odds of SGA nativity in 2016 compared with 2000 (Table 1). In absolute measures, there were vi,595 more than SGA newborns in 2016 compared to 2000. The distribution of all singleton births and SGA births by nascency year, as well as specific maternal characteristics can be institute in Appendix Tabular array B.

Data table for Figure i



Information tabular array for Effigy 1
Tabular array summary
This tabular array displays the results of Data table for Figure i. The data is grouped past Yr (actualization as row headers), Alberta , British Columbia , Ontario , Quebec and Canada , calculated using Number of SGA births per 100 singleton births (pct) units of mensurate (appearing every bit cavalcade headers).

Yr	Alberta	British Columbia	Ontario	Quebec	Canada
	Number of SGA births per 100 singleton births (percent)
2000	seven.7	6.5	7.six	7.1	7.2
2001	7.viii	7.0	vii.viii	vii.3	7.iv
2002	vii.4	vii.0	seven.8	vii.4	7.iv
2003	7.four	half dozen.8	vii.8	7.2	seven.3
2004	seven.5	6.7	vii.6	6.8	7.1
2005	7.6	half dozen.8	7.9	7.2	seven.4
2006	7.9	6.8	seven.9	7.4	7.5
2007	7.viii	6.7	seven.8	seven.iv	vii.4
2008	7.v	6.4	7.half-dozen	6.ix	7.i
2009	seven.9	half dozen.8	7.8	seven.v	7.v
2010	7.9	6.seven	eight.two	vii.5	7.7
2011	8.3	seven.1	8.1	8.0	vii.viii
2012	8.4	6.9	8.0	vii.v	7.vii
2013	eight.8	six.8	8.1	7.7	seven.9
2014	8.viii	6.8	8.2	seven.eight	vii.9
2015	8.8	half dozen.8	8.ii	vii.8	vii.9
2016	eight.9	7.0	viii.4	7.vi	eight.0
Notation: SGA = Small-scale-for-gestational-age. Source: Statistics Canada's Vital Statistics - Birth Database (VSBD).



Tabular array 1
Multiple logistic regression model results for a small-for-gestational-age nascence using all singleton live births in Canada (2000 to 2016)
Table summary
This table displays the results of Multiple logistic regression model results for a small-for-gestational-age nascence using all singleton alive births in Canada (2000 to 2016) Small-for-gestational-historic period births, N = 5,941,820 and N = v,941,815 (appearing as column headers).

	Small-for-gestational-historic period births
	N = 5,941,820		North = 5,941,815			N = five,941,815
	N	Relative (percent)	Crude odds ratio	Lower spring (95% confidence interval)	Upper bound (95% conviction interval)	Adjusted odds ratio	Lower bound (95% conviction interval)	Upper bound (95% confidence interval)
Twelvemonth (reference: 2000)	318,510	5.36	Annotation...: not applicable	Note...: not applicative	Note...: not applicable	Annotation...: not applicable	Notation...: non applicable	Note...: not applicable
2001	322,260	5.42	1.03	one.01	1.05	1.03	1.01	ane.05
2002	317,480	5.34	1.03	1.01	one.05	one.03	1.01	1.05
2003	323,305	five.44	ane.01	0.99	ane.03	1.00	0.98	1.02
2004	324,685	5.46	0.99	0.97	1.01	0.98	0.96	0.99
2005	331,060	5.57	i.02	1.01	1.04	1.01	0.99	1.03
2006	342,725	v.77	1.04	1.03	one.06	1.03	1.01	1.05
2007	355,885	5.99	i.03	one.01	1.05	i.02	1.00	i.04
2008	365,660	6.fifteen	0.99	0.97	one.01	0.97	0.96	0.99
2009	367,595	6.xix	1.05	ane.03	1.06	1.03	1.01	1.05
2010	364,175	half-dozen.13	ane.06	1.05	1.08	1.02	1.00	1.04
2011	361,590	6.09	1.09	i.07	ane.11	ane.08	1.06	one.ten
2012	368,960	half dozen.21	i.07	ane.05	ane.09	1.05	1.03	1.07
2013	367,140	6.18	1.10	1.08	i.12	1.07	1.05	1.09
2014	370,955	half dozen.24	ane.10	1.08	1.12	1.08	1.06	1.10
2015	369,290	vi.22	one.11	1.09	one.13	1.08	1.06	one.ten
2016	370,545	6.24	ane.12	1.10	1.14	1.08	one.06	one.ten
Maternal birth place (reference: Canada)	4,293,520	72.26	Notation...: non applicable	Note...: non applicable	Note...: non applicable	Note...: not applicable	Notation...: not applicable	Note...: not applicable
North America, excluding Canada	61,460	i.03	0.94	0.91	0.97	ane.03	1.00	1.07
Central America	63,630	1.07	1.08	1.05	1.11	1.x	1.06	one.14
Caribbean area and Bermuda	81,170	1.37	one.71	1.67	1.75	1.xl	i.36	one.44
South America	69,880	i.eighteen	1.45	1.41	1.49	1.29	1.25	1.33
Western Europe	46,010	0.77	one.02	0.98	i.06	1.04	1.00	1.08
Eastern Europe	94,130	i.58	0.94	0.91	0.96	0.97	0.93	1.00
Northern Europe	54,280	0.91	i.05	ane.02	ane.09	1.thirteen	ane.09	1.16
Southern Europe	45,960	0.77	i.04	1.01	ane.08	one.04	ane.00	1.09
Western Africa	34,320	0.58	one.63	1.57	one.68	1.49	1.42	1.57
Eastern Africa	55,100	0.93	1.53	1.49	1.58	one.34	1.29	ane.twoscore
Northern Africa	78,330	i.32	one.10	1.07	i.xiii	1.10	i.05	one.xvi
Fundamental Africa	15,880	0.27	1.x	1.04	1.17	1.08	1.00	1.17
Southern Africa	9,690	0.16	1.31	one.22	one.41	1.36	1.26	i.47
W Central Asia and the Eye Eastward	137,920	2.32	1.32	one.29	1.34	one.27	1.23	1.31
Eastern Asia	205,470	iii.46	one.37	1.35	1.40	one.13	one.09	1.sixteen
Southeast Asia	189,810	3.19	i.87	1.85	1.90	one.xxx	ane.27	1.33
Southern Asia	299,780	v.05	ii.31	ii.29	2.34	1.76	1.71	1.81
Oceania/Antarctica and adjacent islands	13,990	0.24	1.54	1.46	1.63	1.47	1.39	one.56
Missing/unknown	91,490	ane.54	1.31	1.28	ane.34	i.15	1.12	1.17
Paternal birth place (reference: Canada)	three,955,970	66.58	Notation...: not applicable	Note...: not applicable	Note...: not applicable	Note...: non applicable	Note...: non applicable	Annotation...: non applicable
N America, excluding Canada	62,240	1.05	1.00	0.96	1.03	1.03	i.00	1.06
Key America	62,990	1.06	one.11	1.07	1.fourteen	one.13	1.09	i.17
Caribbean and Bermuda	98,090	1.65	i.64	1.60	1.67	1.33	1.thirty	one.37
South America	64,710	1.09	1.49	1.45	1.53	1.31	one.27	1.36
Western Europe	53,090	0.89	1.00	0.97	1.04	0.98	0.95	i.02
Eastern Europe	77,440	1.30	0.95	0.93	0.98	i.01	0.97	1.05
Northern Europe	68,790	1.16	0.94	0.91	0.97	0.95	0.92	0.98
Southern Europe	56,330	0.95	one.09	1.06	1.xiii	1.12	1.08	1.sixteen
Western Africa	38,700	0.65	i.52	i.47	ane.57	1.16	1.11	1.22
Eastern Africa	53,530	0.ninety	i.53	one.48	i.57	1.27	1.21	i.32
Northern Africa	85,450	1.44	1.13	1.10	ane.xvi	1.12	1.07	1.17
Central Africa	16,880	0.28	one.10	1.04	1.17	1.04	0.96	1.12
Southern Africa	10,080	0.17	ane.19	1.11	ane.28	1.14	i.05	1.24
W Fundamental Asia and the Middle Due east	146,770	ii.47	i.33	1.30	1.35	i.20	i.17	1.24
Eastern asia	168,820	2.84	1.44	1.42	1.47	1.34	1.30	1.38
Southeast Asia	150,310	two.53	2.11	ii.08	two.fifteen	1.75	one.71	1.80
Southern Asia	297,370	5.00	ii.36	2.33	2.38	i.54	one.50	1.58
Oceania/Antarctica and side by side islands	16,690	0.28	1.47	i.39	1.54	one.33	1.26	ane.41
Missing/unknown	457,590	7.lxx	1.50	1.48	1.51	ane.29	1.27	1.thirty
Marital status (reference: married)	3,643,615	61.32	Note...: not applicable	Note...: not applicable	Note...: non applicative	Note...: not applicable	Note...: not applicable	Notation...: not applicative
Unmarried	1,711,600	28.81	ane.17	one.xvi	one.17	1.27	1.26	i.28
Other	586,600	9.87	ane.15	1.14	1.16	i.23	one.22	1.25
Maternal age (reference: 25 to 29 years)	1,799,935	30.29	Note...: not applicable	Note...: non applicative	Note...: not applicable	Note...: not applicable	Note...: not applicable	Note...: not applicable
Less than 20	231,355	3.89	1.24	1.22	1.26	0.96	0.94	0.98
20 to 24	903,870	15.21	1.17	1.xvi	one.18	1.06	1.05	1.07
30 to 34	one,916,675	32.26	0.93	0.92	0.93	1.02	ane.01	ane.02
35 to 39	906,910	xv.26	0.96	0.95	0.97	ane.09	1.08	1.ten
More than or equal to 40	182,695	3.07	1.09	1.07	1.eleven	1.21	1.eighteen	ane.23
Missing/unknown	375	0.01	ane.xl	one.00	one.96	i.23	0.88	1.73
Number of live-born children (reference: 1)	2,645,905	44.53	Notation...: not applicative	Annotation...: not applicable	Annotation...: not applicable	Annotation...: not applicative	Annotation...: not applicable	Note...: not applicable
ii	ii,091,475	35.20	0.57	0.56	0.57	0.57	0.56	0.57
3	786,105	13.23	0.55	0.54	0.55	0.54	0.53	0.54
4	254,640	4.29	0.57	0.56	0.58	0.55	0.54	0.56
v or more than	161,080	2.71	0.lx	0.59	0.61	0.57	0.56	0.59
Missing/unknown	2,610	0.04	one.06	0.94	1.21	0.97	0.85	ane.x
Community size (reference: 1,250,000 or more)	ii,087,340	35.13	Annotation...: not applicable	Note...: not applicable	Notation...: not applicable	Annotation...: not applicative	Notation...: not applicable	Note...: not applicable
500,000 to 1,249,999	1,083,340	18.23	0.90	0.89	0.91	one.02	1.01	one.03
100,000 to 499,999	971,725	sixteen.35	0.79	0.79	0.80	0.96	0.95	0.97
ten,000 to 99,999	689,165	11.60	0.78	0.78	0.79	0.98	0.97	0.99
Less than ten,000 (rural)	1,061,010	17.86	0.75	0.74	0.75	0.97	0.96	0.98
Missing/unknown	49,235	0.83	0.77	0.75	0.fourscore	1.04	0.99	1.08
Neighborhood income quintile (reference: 1 (everyman))	972,640	sixteen.37	Note...: not applicable	Note...: not applicable	Notation...: not applicable	Note...: non applicative	Note...: not applicative	Note...: non applicable
two	ane,333,820	22.45	0.90	0.89	0.91	0.95	0.94	0.96
3	i,174,880	19.77	0.82	0.81	0.82	0.91	0.xc	0.92
4	i,163,790	xix.59	0.75	0.75	0.76	0.88	0.87	0.89
5 (highest)	1,160,445	19.53	0.70	0.70	0.71	0.85	0.85	0.86
Missing/unknown	136,245	2.29	0.83	0.81	0.85	0.90	0.88	0.93
... not applicable Note: Due to vetting procedures at Statistics Canada's Research Data Centres, univariate descriptives were rounded to the nearest 5 or 10 where needed. As a result, some rows may not sum to the total. Sources: Statistics Canada's Vital Statistics - Birth Database (VSBD).

Mean birth weight decreased from 3 442 grams (95% CI: [3440,3444]) in 2000, to three 367 grams (95% CI: [3365, 3369]) in 2016. When stratifying by sex, a female birth in 2016 (mean nascence weight: 3 383 grams (95% CI: [3380, 3386]) weighed on average 73 grams less than that in 2000 (hateful birth weight: 3 310 grams (95% CI: [3307, 3312]), while a male nativity in 2016 (three 421 grams (95% CI: [3419, 3424])) weighed on average 78 grams less than in 2000 (three 499 grams (95% CI: [3496, 3502])).

Temporal trends in mean birth weight z-scores are plotted in Figure 2. Between 2000 and 2016, the mean birth weight z-score for male person, female and all births combined appeared to follow a similar declining trend. Overall, mean birth weight z-scores for female births were consistently higher than those of male births over the entire study period. Over time the mean z-score for all births decreased from 0.12 (95% CI: [0.11, 0.12]) in 2000 to 0.01 (95% CI: [0.01, 0.01]) in 2016.

Data table for Effigy 2



Data table for Figure ii
Table summary
This table displays the results of Data table for Figure 2 Means z-score for all female births , Means z-score for all male births and Means z-score for all births (appearing as column headers).

	Means z-score for all female births	Means z-score for all male births	Means z-score for all births
2000	0.13	0.11	0.12
2001	0.11	0.09	0.10
2002	0.xi	0.09	0.10
2003	0.ten	0.08	0.09
2004	0.11	0.09	0.ten
2005	0.09	0.06	0.07
2006	0.08	0.05	0.06
2007	0.07	0.05	0.06
2008	0.09	0.07	0.08
2009	0.06	0.04	0.05
2010	0.05	0.03	0.04
2011	0.04	0.02	0.03
2012	0.05	0.03	0.04
2013	0.03	0.02	0.03
2014	0.02	0.01	0.02
2015	0.02	0.00	0.01
2016	0.02	0.00	0.01
Source: Statistics Canada'due south Vital Statistics - Birth Database (VSBD). Nascency weight z-score = [observed birth weight – mean birth weight (in reference chart)] SD (in reference nautical chart)

Results from the multivariable model showed that, as expected, odds of an SGA nativity were college among births to parents built-in exterior of Canada, single women, older women, nulliparous women and women with a lower neighborhood income residence (Table ane and Effigy 3A,3B). In dissimilarity, although the association between community size and an SGA birth was statistically pregnant, information technology was small in magnitude. Adjusting for these sociodemographic factors attenuated the temporal increase in SGA birth, but a statistically meaning increase in the odds of an SGA birth (at a 95% confidence level) remained for the menstruum from 2009 to 2016. For instance, subsequently adjustment for sociodemographic factors, an 8% increase in the odds of SGA nativity in 2016 remained (95% CI: [1.06, 1.10]), attenuated from a crude odds ratio of one.12 (95% CI: [1.10, i.fourteen]).

Data table for Figure 3



Information table for Figure three
Table summary
This tabular array displays the results of Data table for Figure 3 Fig 3A: Univariate Logistic Regression and Fig 3B: Multivariate Logistic Regression (appearing as cavalcade headers).

	Fig 3A: Univariate Logistic Regression Data table for Figure 3 Note‡			Fig 3B: Multivariate Logistic Regression Information table for Figure 3 Annotation‡‡
SGA nascency	Crude odds ratio	Lower bound [95% confidence interval]	Upper bound [95% confidence interval]	Adjusted odds ratio	Lower bound [95% conviction interval]	Upper bound [95% confidence interval]
Twelvemonth (Reference: 2000)	1	1	1	1	1	1
2001	1.03	ane.01	1.05	1.03	1.01	one.05
2002	1.03	one.01	1.05	1.03	1.01	one.05
2003	1.01	0.99	1.03	one	0.98	1.02
2004	0.99	0.97	1.01	0.98	0.96	0.99
2005	1.02	i.01	i.04	1.01	0.99	1.03
2006	one.04	1.03	1.06	1.03	i.01	i.05
2007	1.03	1.01	i.05	1.02	1	i.04
2008	0.99	0.97	1.01	0.97	0.96	0.99
2009	1.05	i.03	one.06	1.03	1.01	1.05
2010	1.06	one.05	1.08	ane.02	1	1.04
2011	1.09	1.07	one.xi	i.08	1.06	1.one
2012	ane.07	1.05	1.09	1.05	1.03	1.07
2013	one.ane	ane.08	1.12	1.07	i.05	1.09
2014	i.one	i.08	1.12	i.08	1.06	1.1
2015	one.11	1.09	1.thirteen	i.08	1.06	i.1
2016	one.12	one.1	1.14	1.08	ane.06	1.one
Maternal Birth Place (reference: Canada)	1	1	i	1	1	1
North America, excluding Canada	0.94	0.91	0.97	1.03	1	one.07
Central America	ane.08	1.05	one.11	ane.1	1.06	i.14
Caribbean and Bermuda	i.71	1.67	ane.75	1.4	1.36	ane.44
S America	i.45	i.41	1.49	i.29	1.25	ane.33
Western Europe	1.02	0.98	1.06	one.04	1	one.08
Eastern Europe	0.94	0.91	0.96	0.97	0.93	i
Northern Europe	one.05	1.02	one.09	1.thirteen	ane.09	1.sixteen
Southern Europe	1.04	1.01	1.08	i.04	one	1.09
Western Africa	ane.63	1.57	one.68	1.49	ane.42	ane.57
Eastern Africa	1.53	1.49	1.58	ane.34	1.29	one.iv
Northern Africa	i.1	1.07	1.13	1.i	1.05	1.sixteen
Central Africa	1.i	1.04	1.17	1.08	1	i.17
Southern Africa	1.31	1.22	one.41	1.36	1.26	one.47
Westward Cardinal Asia and the Middle East	1.32	1.29	1.34	i.27	1.23	1.31
East asia	1.37	one.35	1.4	i.thirteen	1.09	1.16
Southeast Asia	1.87	1.85	1.nine	1.3	1.27	ane.33
Southern Asia	2.31	2.29	ii.34	1.76	i.71	1.81
Oceania/Antarctica and Next Islands	ane.54	1.46	1.63	1.47	ane.39	1.56
Marital condition (reference: married)	ane	1	1	1	1	one
Single	1.17	1.16	1.17	i.27	1.26	1.28
Other	1.xv	1.14	1.16	1.23	ane.22	1.25
Maternal age (reference: 25 to 29 years)	ane	1	i	ane	1	i
<20	one.24	one.22	1.26	0.96	0.94	0.98
twenty to 24	1.17	1.xvi	i.18	1.06	ane.05	ane.07
30 to 34	0.93	0.92	0.93	1.02	1.01	1.02
35 to 39	0.96	0.95	0.97	ane.09	i.08	ane.one
> or = 40	ane.09	1.07	1.11	1.21	ane.18	1.23
Neighborhood income quintile (ref.: one (lowest))	1	1	1	1	1	1
2	0.ix	0.89	0.91	0.95	0.94	0.96
3	0.82	0.81	0.82	0.91	0.9	0.92
four	0.75	0.75	0.76	0.88	0.87	0.89
5 (highest)	0.7	0.vii	0.71	0.85	0.85	0.86
Note‡ Univariate models were performed on each independent variable separately Return to notation‡ referrer Note‡‡ Multivariable model further adjusted for paternal place of birth, number of liveborn childrren always born, and community size Render to annotation‡‡ referrer Source: Statistics Canada's Vital Statistics' Births Database (VSBD).

Give-and-take

Main findings

In this study, the extent to which demographic factors such as increased immigration, decreasing numbers of births per woman and increasing maternal historic period at nascency may be responsible for the previously-reported ^{Note 15} increase in the proportion of SGA births in Canada was investigated. This has likewise been reported in the United States. ^{Notation fourteen} The rise was only partially explained past changes in contextual factors such as births to parents born outside Canada, older women, unmarried women, nulliparous women and lower neighborhood income residence.

Results from univariate and multivariable regression analyses showed a more pronounced increase in the odds of an SGA birth in Canada after 2008. Adjusting for the irresolute demography of birth attenuated these odds but in the latter part of the report period. Parental nativity place and number of liveborn children were well-nigh strongly associated with SGA birth, with upwards to 136% higher odds for certain regions of parental birth place.

These findings are consequent with contempo changes in Canada (immigration and delayed childbirth) ^{Annotation 17 Note 18} equally well equally the known testify regarding their association with SGA births. Using place of birth as an indicator for ethnicity and clearing can business relationship for the physiological factors related to ethnicity (anthropometry) also as the social and cultural factors that contribute to these disparities. Information technology can also be explained through pathological differences between ethnicities (such as higher rates of gestational diabetes mellitus (GDM) among South Asian and South-E Asian mothers) ^{Note 27} and other social and cultural factors related to immigration (such as lifestyle, civilization and acculturation). ^{Note 28}

Findings of this study likewise show a pocket-sized reduction in the hateful nascency weight of Canadian singleton births betwixt 2000 and 2016, suggesting a potential subtract in fetal size over time. These results were consistent even subsequently using birth weight z-scores to isolate changes over time in nascency weight from changes in the timing of delivery (i.east., younger gestational ages at commitment due to the increased apply of obstetric interventions such equally induction of labour). ^{Notation 29}

Birth weight trends in this study are consistent with contempo findings in the United States, ^{Note xiv Note xxx} Nihon ^{Note 31} and Germany, ^{Note 32} merely differ from trends in England, Wales ^{Note 33} and China. ^{Note 34} In Germany, these trends could not be explained by simultaneous changes in the rates of primiparity, smoking and gestational diabetes. ^{Note 32} Similarly, in the Usa, a decrease in fetal growth among U.S., term, singleton births was also not explained by changes in maternal and baby characteristics, obstetric practices or gestational length. ^{Note thirty} Alternatively, in England and Wales, a recent report using births from 1986 to 2012 showed that babies have get heavier over the past three decades. ^{Note 33} In addition, the incidence of SGA births in Guangzhou, China, decreased significantly betwixt 2001 and 2015. ^{Note 34}

Although this report was unable to examine the contribution of factors such as maternal smoking and maternal anthropometry, these factors are unlikely to explicate the temporal rise in SGA births. Contempo evidence from the province of Ontario showed a subtract in the prevalence of maternal smoking between 1995 and 2010. ^{Note 35} Additionally, the prevalence of obesity in Canada between 1985 and 2011, has increased from 6.1% to 18.3%. Bear witness from these studies would suggest a reduction in SGA births, not the reverse.

The utilise of assisted reproductive applied science (Art) increased in Canada during our study period, and births occurring through ART are known to take, on average, higher risks of adverse birth outcomes, including SGA births. ^{Note 39} Although the increased use of Art may take contributed to the trends observed in our written report, its impact was likely modest as the ART births only make up a small fraction of all births (ane.36% of all births or 5,031 singleton births) in 2012. ^{Notation 36}

Finally, when looking at the rate at which SGA births increased over time, a more pronounced upward trend between 2008 and 2016 was notable. This trend may be influenced by larger underlying economic factors. ^{Annotation 37}

Following the global fiscal crunch in 2008, Canada suffered from an economical recession. ^{Annotation 38} The negative furnishings of an economical recession on maternal health has been well documented in literature. These effects tin influence the financial and psychological wellbeing of an entire household also as an individual. A study looking at the touch of economic recessions on maternal and baby mortality institute substantial and statistically pregnant increases in maternal mortality in Canada with decreases in gross domestic production betwixt 1950 to 1966. ^{Notation 39} The World Health Organization'southward conceptual framework of social determinants of infant bloodshed ^{Note 40} outlines many pathways that connect larger macroeconomic factors—such equally an economical recession—to agin nascency outcomes. The important factors connected to agin birth outcomes in a menstruation of economic recession are unemployment, income, stress and psychosocial wellbeing. ^{Note 41}

Strengths and limitations

This report focused on understanding the role of changes in the demography of childbearing women in Canada, rather than individual medical factors, as large population-based shifts were hypothesized to have the most likely impact on the risk of SGA nascence. Although at that place have been increases in some medical hazard factors associated with SGA nativity during the study period, such as preeclampsia, ^{Note 42}GDM, pre-gestational diabetes ^{Annotation 22} and Fine art, these weather are not common enough to have likely acquired the population-level rises in SGA birth—because of their relatively low prevalence. However, a cumulative consequence of multiple medical weather condition associated with an increased risk of SGA cannot be ruled out.

Despite the widespread employ of the Canadian reference charts for evaluating adverse nativity outcomes in Canada, using different reference charts such every bit the INTERGROWTH-21st Project standard may have resulted in smaller differences over time. A contempo Canadian report evaluated SGA and large-for-gestational-age (LGA) births betwixt 2002 and 2012, using both the INTERGROWTH-21st Project standard and the Canadian reference. ^{Annotation 43} The authors concluded that the centile distribution of the INTERGROWTH-21st newborn standard is left-shifted compared with the Canadian reference, leading to lower proportions of SGA births and college proportions of LGA births in comparison with the Canadian reference. Therefore, based on these results, and assuming the centile cut-offs for identifying these high take chances subpopulations remained unchanged, the use of the INTERGROWTH-21st Project standard in this study may have resulted in narrower absolute temporal changes over time.

Due to data limitations, factors such every bit pre-pregnancy body mass alphabetize (BMI), pregnancy weight gain and maternal smoking could non be controlled for. However, as the temporal changes in pre-pregnancy BMI, pregnancy weight proceeds and smoking would be expected to have decreased—non increased—the SGA rate, these are unlikely to have acquired the increment in SGA birth observed in this study.

Additionally, hateful birth-weight measurements tend to be driven by term births, and examining gestational-age subgroups was beyond the scope of these analyses. However, reporting on nativity weight in addition to SGA birth facilitates international comparisons. Another limitation pertains to the secondary use of administrative data for health intendance research. Since the data are collected for authoritative (nascency registration) rather than research purposes, the selection and quality of data collection is not under the researcher'southward control and hence can be difficult to validate. ^{Notation 44} Nevertheless, there is no reason to suspect changes in the accuracy of nascence weight measurement over time.

Despite these limitations, this written report uses all Canadian singleton births without exclusions to provinces or territories, thereby representing complete geographic multifariousness. In addition to using complete national datasets, this is the first descriptive report on SGA temporal trends in Canada to report on a written report period spanning 17 years of information—from 2000 to 2016

Almost of the literature to date have used a two year study period, ^{Note 26} or at the well-nigh ten years. ^{Notation xv} The report population of these studies is often limited to ane province or excludes Quebec. ^{Annotation 15}

Conclusions

This written report institute that infants in Canada have gotten smaller betwixt 2000 and 2016, a tendency which was explained only partly as a result of concurrent changes in important take chances factors such equally an increase in maternal and paternal immigration (parental place of birth outside Canada), delayed childbirth (advanced maternal age), an increase in starting time-fourth dimension mothers (number of liveborn children), an increase in non-married women, or variations in community size and neighborhood income quintile of maternal residence.

These results could be of potential concern since SGA births accept long been used every bit an indicator of infant health, and have a strong association with short-term and long-term health and economic consequences. The findings of this written report strengthen findings from similar studies in the United States, Germany and Japan, where a decrease in fetal growth remained unexplained even later on controlling for known maternal and contextual run a risk factors.

Identifying whether the increment in SGA births was due to an increase in "constitutionally minor" or growth-restricted newborns can aid allocate advisable and necessary health resources. This calls for further enquiry and clinical investigation through up-to-date linked clinical and social data considering distinguishing physiological from pathological growth brake is known to be specifically challenging in large population studies. ^{Note 45} There is a demand for an improved understanding of these trends by exploring other medical, environmental and economical factors.

Appendix



Table A
Sensitivity analysis: Multiple logistic regression model results for a small-for-gestational-age birth using all singleton live births in Canada (2000 to 2016) including adjustment for maternal province/territory of residence
Tabular array summary
This table displays the results of Sensitivity analysis: Multiple logistic regression model results for a small-for-gestational-age birth using all singleton live births in Canada (2000 to 2016) including adjustment for maternal province/territory of residence SGA birth (N = 5,941,815) (appearing equally column headers).

	SGA nativity (Northward = 5,941,815)
	Adjusted odds ratio	Lower bound (95% confidence interval)	Upper bound (95% confidence interval)
Year (reference 2000)
2001	i.03	ane.01	1.05
2002	1.03	1.01	1.05
2003	1.00	0.98	1.02
2004	0.97	0.96	0.99
2005	1.01	0.99	1.03
2006	1.03	1.01	ane.05
2007	one.01	1.00	i.03
2008	0.97	0.95	0.99
2009	i.03	i.01	one.05
2010	1.02	1.00	1.04
2011	1.07	i.05	1.09
2012	one.04	1.02	1.06
2013	1.07	1.05	1.09
2014	1.07	1.05	1.09
2015	1.07	1.05	ane.09
2016	1.08	i.06	ane.10
Maternal nascency place (reference: Canada)
North America, excluding Canada	i.04	i.00	1.07
Primal America	ane.09	i.05	1.13
Caribbean and Bermuda	one.38	1.34	i.42
South America	1.27	1.23	i.31
Western Europe	1.04	1.01	1.09
Eastern Europe	0.96	0.93	0.99
Northern Europe	ane.thirteen	ane.10	1.17
Southern Europe	ane.04	1.00	i.08
Western Africa	1.47	1.39	1.55
Eastern Africa	one.33	one.27	1.38
Northern Africa	1.10	1.05	ane.xv
Central Africa	1.08	0.99	1.17
Southern Africa	ane.37	1.26	ane.47
Due west Central Asia and the Middle Due east	i.26	one.23	1.30
East asia	1.14	ane.11	1.17
Southeast Asia	one.29	1.26	i.32
South asia	i.76	1.71	1.81
Oceania/Antarctica and adjacent islands	one.52	1.43	1.61
Missing/unknown	i.xv	ane.13	1.18
Paternal birth place (reference: Canada)
N America, excluding Canada	1.04	i.01	1.07
Central America	1.12	1.08	1.16
Caribbean and Bermuda	1.31	ane.28	1.35
South America	1.30	1.26	ane.34
Western Europe	0.99	0.95	1.02
Eastern Europe	one.00	0.97	1.04
Northern Europe	0.96	0.93	0.99
Southern Europe	i.11	1.07	1.16
Western Africa	ane.15	1.10	i.21
Eastern Africa	1.26	1.20	1.31
Northern Africa	1.11	1.06	1.17
Central Africa	i.04	0.96	1.12
Southern Africa	one.15	1.06	i.24
Westward Central Asia and the Middle East	1.20	ane.17	1.24
Eastern Asia	i.34	ane.thirty	i.39
Southeast Asia	i.76	1.71	ane.80
South asia	ane.54	ane.fifty	1.58
Oceania/Antarctica and adjacent islands	1.37	one.30	1.45
Missing/unknown	1.28	1.26	1.xxx
Marital status (reference: married)
Single	1.29	1.28	one.31
Other	1.23	ane.22	i.24
Maternal age (reference: 25 to 29 years)
Less than 20	0.95	0.93	0.97
20 to 24	1.05	1.04	1.06
25 to 29	Note...: not applicable	Annotation...: not applicable	Note...: not applicable
xxx to 34	1.02	1.01	i.03
35 to 39	1.10	ane.09	1.11
More than than or equal to 40	1.22	i.19	ane.24
Missing/unknown	1.23	0.87	1.72
Number of live-built-in children (reference: 1)
two	0.57	0.56	0.57
3	0.53	0.53	0.54
four	0.55	0.54	0.56
5 or more	0.57	0.56	0.58
Missing/unknown	0.97	0.86	1.10
Community size (reference: 1,250,000 or more)
500,000 to i,249,999	0.92	0.91	0.93
100,000 to 499,999	0.94	0.93	0.95
ten,000 to 99,999	0.95	0.94	0.96
<Less than 10,000 (rural)	0.93	0.92	0.94
Missing/unknown	0.99	0.95	i.04
Neighborhood income quintile (reference: 1 (everyman))
two	0.95	0.94	0.96
iii	0.91	0.90	0.92
4	0.88	0.87	0.89
5 (highest)	0.86	0.85	0.86
Missing/unknown	0.xc	0.87	0.92
Maternal province/territory of residence (reference: Ontario)
Newfoundland and Labrador	0.91	0.88	0.94
Prince Edward Island	0.89	0.85	0.95
Nova Scotia	1.12	1.10	1.14
New Brunswick	i.02	0.99	1.04
Quebec	0.98	0.97	0.99
Manitoba	one.03	one.01	i.05
Saskatchewan	i.02	1.00	1.04
Alberta	1.16	1.15	1.18
British Columbia	0.84	0.83	0.85
Yukon	0.78	0.seventy	0.87
Northwest Territories	0.72	0.66	0.79
Nunavut	0.74	0.68	0.80
... not applicable Note: SGA = Modest-for-gestational-age. Source: Statistics Canada'south Vital Statistics - Nascence Database (VSBD).



Appendix Table B
Distribution of all births and small-for-gestational-age (SGA) births past maternal characteristics in 2000 and 2016
Tabular array summary
This table displays the results of Distribution of all births and pocket-size-for-gestational-age (SGA) births by maternal characteristics in 2000 and 2016. The information is grouped by Characteristics (actualization equally row headers), Birth year, All births in 2000 (N=318,510), All births in 2016 (Due north=370,545), SGA births in 2000 (North=22,985) and SGA births in 2016 (North=29,580), calculated using number and pct units of measure (appearing as column headers).

Characteristics	Nativity twelvemonth
	All births in 2000 (N=318,510)		All births in 2016 (N=370,545)		SGA births in 2000 (N=22,985)		SGA births in 2016 (North=29,580)
	Number of singleton live births in 2000	Proportion of all singleton alive births in 2000	Number of singleton Live births in 2016	Proportion of all singleton live births in 2016	Number of SGA births in 2000	Proportion of all SGA births in 2000	Number of SGA births in 2016	Proportion of all SGA births in 2016
	number	percent	number	percentage	number	percentage	number	percent
Maternal historic period
Less than twenty	17,190	v.40	8,380	2.30	1,585	6.xc	820	2.80
20 to 24	58,265	eighteen.30	44,145	11.xc	4,915	21.40	three,880	xiii.10
25 to 29	98,500	30.xc	106,465	28.70	6,835	29.70	viii,605	29.10
30 to 34	93,265	29.30	131,985	35.threescore	6,015	26.twenty	ix,965	33.70
35 to 39	43,640	13.70	66,020	17.80	iii,010	13.10	five,200	17.60
More than or equal to twoscore	vii,610	ii.forty	13,550	3.70	625	2.70	1,110	three.80
Missing/unknown	45	0.00	0	0.00	5	0.00	0	0.00
Number of liveborn children
1	142,825	44.80	159,785	43.x	12,980	56.fifty	17,060	57.70
2	111,365	35.00	131,310	35.twoscore	half dozen,335	27.sixty	viii,015	27.x
iii	42,550	13.xl	50,755	thirteen.lxx	ii,410	10.50	2,835	nine.60
iv	13,575	4.30	17,035	4.60	790	3.40	950	3.twenty
five or more	8,150	2.60	eleven,400	3.x	470	two.00	695	2.40
Missing/unknown	45	0.00	255	0.10	5	0.00	thirty	0.ten
Mother'southward nascency identify
Canada	240,035	75.36	253,435	68.40	15,640	68.03	17,690	59.80
North America, excluding Canada	3,820	1.20	3,565	0.96	220	0.96	240	0.81
Central America	2,790	0.88	three,940	1.06	190	0.83	260	0.88
Caribbean and Bermuda	v,330	1.67	4,385	1.eighteen	560	two.44	470	1.59
South America	iii,325	one.04	iv,435	1.twenty	320	1.39	410	1.39
Western Europe	2,545	0.fourscore	3,335	0.xc	150	0.65	200	0.68
Eastern Europe	iii,790	1.19	6,070	1.64	240	one.04	380	1.28
Northern Europe	iv,295	1.35	2,375	0.64	280	1.22	170	0.57
Southern Europe	3,715	i.17	two,340	0.63	240	i.04	180	0.61
Western Africa	925	0.29	3,645	0.98	80	0.35	410	1.39
Eastern Africa	2,640	0.83	four,360	one.18	270	1.17	450	one.52
Northern Africa	1,645	0.52	6,700	1.81	120	0.52	480	1.62
Central Africa	410	0.13	1,650	0.45	40	0.17	130	0.44
Southern Africa	460	0.fourteen	575	0.sixteen	30	0.thirteen	50	0.17
Westward Central Asia and the Middle East	five,290	1.66	xi,615	iii.13	440	1.91	1,060	3.58
Eastern Asia	9,360	2.94	16,015	4.32	830	3.61	1,540	5.21
Southeast Asia	9,790	3.07	13,920	three.76	ane,110	4.83	1,710	5.78
Southern Asia	12,645	3.97	21,150	5.71	1,730	7.53	3,140	10.62
Oceania/Antarctica and adjacent islands	920	0.29	705	0.19	100	0.43	50	0.17
Missing/unknown	4,775	1.50	6,330	one.71	400	ane.74	570	1.93
Father'due south nascency place
Canada	223,315	seventy.xi	238,240	64.29	13,980	60.81	16,290	55.07
Northward America, excluding Canada	3,660	1.15	3,770	one.02	200	0.87	280	0.95
Key America	2,715	0.85	4,080	1.10	180	0.78	280	0.95
Caribbean and Bermuda	5,940	1.86	five,915	1.threescore	640	2.78	570	1.93
S America	3,145	0.99	4,170	one.13	310	1.35	370	1.25
Western Europe	2,855	0.xc	iii,920	1.06	160	0.70	280	0.95
Eastern Europe	3,390	1.06	five,060	1.37	200	0.87	320	ane.08
Northern Europe	four,815	1.51	3,530	0.95	280	1.22	230	0.78
Southern Europe	four,920	1.54	2,805	0.76	320	ane.39	200	0.68
Western Africa	1,125	0.35	four,075	i.10	90	0.39	430	1.45
Eastern Africa	2,680	0.84	4,185	ane.xiii	260	i.13	410	1.39
Northern Africa	1,955	0.61	7,165	one.93	130	0.57	520	i.76
Central Africa	470	0.15	1,755	0.47	twoscore	0.17	140	0.47
Southern Africa	460	0.14	650	0.eighteen	xxx	0.13	fifty	0.17
Due west Central Asia and the Center East	6,065	ane.90	12,285	three.32	490	2.13	1,080	3.65
East asia	8,365	2.63	xiii,265	3.58	740	3.22	1,300	4.39
Southeast Asia	vii,955	2.50	eleven,020	2.97	980	4.26	i,470	4.97
South asia	12,860	4.04	21,480	5.eighty	one,730	7.53	three,160	10.68
Oceania/Antarctica and adjacent islands	965	0.30	i,015	0.27	110	0.48	70	0.24
Missing/unknown	xx,860	6.55	22,160	5.98	2,110	9.18	2,150	seven.27
Marital relation
Unmarried	85,845	27.00	111,435	thirty.10	7,175	31.twenty	ix,305	31.fifty
Married	196,025	61.l	224,895	60.lxx	12,925	56.20	17,625	59.60
Other (widowed, divorced, common-constabulary, unknown)	36,640	11.50	34,215	9.20	2,885	12.60	2,655	9.00
Notes: SGA = pocket-sized-for-gestational-age. Due to vetting procedures at Statistics Canada's Research Information Centres, univariate descriptives were roudned to the nearest five or x where needed. Every bit a result, some rows may non sum to the total. Source: Statistics Canada's Vital Statistics - Nativity Database (VSBD).

ISSN: 1209-1367

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