Fetal growth at different gestational periods and risk of impaired childhood growth, low childhood weight and obesity: a prospective birth cohort study

Abstract

Objective To examine the longitudinal associations of fetal growth with adverse child growth outcomes and to assess whether maternal metabolic factors modify the associations. Design Prospective cohort study. Setting Born in Guangzhou Cohort Study, China. Population A total of 4818 mother–child pairs. Methods Fetal growth was assessed according to estimated fetal weight (EFW) from 22 weeks of gestation until birth and the measurement of the birthweight. Fetal growth Z‐scores were computed from random effects in the multilevel linear spline models to represent fetal size in early pregnancy (22 weeks of gestation) and growth in mid‐pregnancy (22–27 weeks of gestation), early third trimester (28–36 weeks of gestation) and late third trimester (≥37 weeks of gestation). Main outcome measures Z‐scores for childhood stunting, low weight, overweight or obesity, length/height for age (LAZ/HAZ), weight for age (WAZ) and body mass index for age (BMIZ) at the age of 3 years. Adjusted associations were examined using multiple Poisson or linear regression models. Results Increased Z‐scores of fetal size in early pregnancy and growth in mid‐pregnancy and early third trimester were associated with a higher risk of childhood overweight or obesity (risk ratios 1.25–1.45). Fetal growth in each period was negatively associated with stunting and low weight, with the strongest associations observed for fetal size in early pregnancy and growth in mid‐pregnancy. The results for continuous outcomes (LAZ/HAZ, WAZ and BMIZ) were similar. The associations of fetal growth with overweight or obesity in childhood were stronger among mothers who were underweight and who were overweight or obese than among mothers of normal weight. Conclusions Accelerated fetal growth before 37 weeks of gestation is associated with children who are overweight or obese, whereas the critical period for stunting and low weight occurs before 28 weeks of gestation. Tweetable abstract Fetal growth during different periods is differentially associated with childhood stunting, underweight and overweight or obesity.

Associations of Longitudinal Fetal Growth Patterns With Cardiometabolic Factors at Birth

“…Well-trained and licensed ultrasonographers in GWCMC conducted these ultrasound measurements. As our previous study shows (15), the mean error of EFW estimation ([EFW − birth weight]/birth weight × 100%) is low (about 4%), and the correlation between two consecutive measurements of fetal biometric parameters performed within a week was high (r > 0.95). These results indicate good quality of the ultrasound data.…”

“…The resulting random effects from the models denote individual deviations from average size in early pregnancy (i.e., 22 weeks) and the average growth velocities in the three gestational intervals, which were converted into sex-specific z -scores before further analyses. More information on the modeling process can be found in our previous report ( 15 ). The same modeling approach was applied to generate AC and FL z -scores based on ultrasound measurements.…”

“…Based on our previous study (15) and other studies (16)(17)(18), a multilevel linear spline model was used to evaluate the patterns of fetal growth in different gestational periods. Briefly, a fractional polynomial model was first used to determine the best-fitting curve for fetal size (including EFW and birth weight) by gestational age for the whole sample.…”

Associations between cord blood metabolic factors and early-childhood growth and overweight and obesity

“…On the basis of the DOHaD theory, we speculated that fetal programming continued to play an important role in the growth patterns during the period of early childhood. Population-based cohort studies confirmed that fetal growth at different gestational periods was significantly associated with risks of impaired childhood growth, stunting, and obesity ( 26 , 27 ). Increased fetal growth at each period was negatively associated with stunting and underweight at the age of 3 years ( 26 ).…”

“…Population-based cohort studies confirmed that fetal growth at different gestational periods was significantly associated with risks of impaired childhood growth, stunting, and obesity ( 26 , 27 ). Increased fetal growth at each period was negatively associated with stunting and underweight at the age of 3 years ( 26 ). Conversely, intrauterine growth restriction infants were more prone to developing stunting when they were followed up to 18 months ( 27 ).…”