Breech presentation is associated with lower bone mass and area: findings from the Southampton Women’s Survey

Abstract

These results suggest that breech presentation is associated with lower neonatal whole-body BMC and BA, which may relate to altered prenatal loading in babies occupying a breech position; these differences did not persist into later childhood. Modest differences in 4-year hip BMC and BA require further investigation.

Findings of metabolic bone disease in infants with unexplained fractures in contested child abuse investigations: a case series of 75 infants

“…Umbilical cord length is a proxy for fetal movement and thus of bone loading (normal cord length of term infants is 61 cm ± 10 cm = 1 standard deviation [SD]) [35]. Controlled studies using quantitative ultrasound speed of sound (SOS) measurements of the tibia in newborns have shown abnormal bone quality (and thus lower bone strength) in several clinical situations associated with intrauterine confinement and decreased fetal movement including infants with short umbilical cords, twins, infants born in the breech presentation and infants who are large for gestational age [36][37][38][39][40][41].…”

European Society of Biomechanics S.M. Perren Award 2018: Altered biomechanical stimulation of the developing hip joint in presence of hip dysplasia risk factors

“…However, our findings demonstrate that even at this early stage, breech position results in altered fetal biomechanics and hip joint stimulation, and we believe that the differences would be even more pronounced at later gestational ages. Additionally, a longitudinal study with multiple follow-up scans, such has recently been carried out for breech position in neonates, would shed new light on the link between breech and hip dysplasia ( Ireland et al, 2018 ). In the case of oligohydramnios, these fetuses may be growth restricted, which could affect their ability to kick and play a role in the biomechanics characterised here.…”

“…The primary environmental risk factors are fetal breech position ( Muller and Seddon, 1953 ), low amniotic fluid volume (oligohydramnios) ( Hinderaker et al, 1994 ), and neuromuscular disorders ( Homer and Hickson, 2000 ). Furthermore, breech position was recently linked to lower bone mineral content in neonates, persisting in hip up to 4 years of age ( Ireland et al, 2018 ). While not an abnormal intra-uterine condition, primiparous (firstborn) pregnancies also carry a significantly greater risk of DDH when compared to subsequent pregnancies ( Chan et al, 1997 , de Hundt et al, 2012 , Stein-Zamir et al, 2008 , Yiv et al, 1997 ), which may be related to greater uterine muscle tone in primiparity ( Wilkinson, 1963 ).…”

Breech presentation is associated with lower adolescent tibial bone strength

“…The skeletal consequences of this reduced loading are evident at birth, with a ten-fold increase in the incidence of hip dyplasia [16], 10° greater femoral anteversion [17] and greater patellofemoral joint dyplasia [18] in babies born breech than in cephalic or conventional presentation. Bone mass accrual is also affected, with lower neonatal bone mass and area in breech babies [19]. Postnatally, reduced active and locomotory movements [20], a restricted range of joint motion and altered joint position [11,[20][21][22][23] and shorter periods of sustained movements [24] have been observed in breech presentation.…”

“…Effects on motor ability in later life are unclear [21,25], although there may be differences in gait [25]. However, whilst there is some evidence of lower hip bone mass in breech babies in early childhood [19], it is unknown whether these deficits are still evident in later life closer to the time of peak bone mass. Given that around 50% of fetuses are in a breech position at 25 weeks' gestation [26] with 4-5% remaining in breech presentation at birth [27], such deficits could have longer term implications for a large number of otherwise healthy children.…”