Etiological Subgroups of Small-for-Gestational-Age: Differential Neurodevelopmental Outcomes

Li, Xiuhong; Eiden, Rina D.; Epstein, Leonard H.; Shenassa, Edmond D.; Xie, Chuanbo; Wen, Xiaozhong

doi:10.1371/journal.pone.0160677

Cited by 7 publications

(4 citation statements)

References 43 publications

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“…Additionally, the smaller twins are growth restricted and consequently small for gestational age (SGA). Children born SGA often suffer from impaired brain development likely resulting in long-term cognitive or motor disabilities [20,21,22]. Hence, being born SGA also negatively affects the neurodevelopmental status of the smaller twin.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Selective Fetal Growth Restriction or Birth Weight Discordance on Long-Term Neurodevelopment in Monochorionic Twins: A Systematic Literature Review

Groene

Tollenaar

Oepkes

et al. 2019

JCM

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The aim of this review was to assess the impact of selective fetal growth restriction (sFGR) and/or birth weight discordance (BWD) on long-term neurodevelopment in monochorionic (MC) twins. Five out of 28 articles assessed for eligibility were included. One article concluded that the incidence of long-term neurodevelopmental impairment (NDI) was higher in BWD MC twins (11/26, 42%) than in BWD dichorionic (DC) (5/38, 13%) and concordant MC twins (6/71, 8%). BWD MC twins had a 6-fold higher risk of cerebral palsy compared to DC twins (5/26, 19% vs. 1/40, 3%, p < 0.05). Another article described a linear relationship between birth weight and verbal IQ scores, demonstrating a 13-point difference for a 1000 gram BWD between the twins, with a disadvantage for the smaller twin (p < 0.0001). Three articles analyzing within-pair differences showed that the smaller twin more frequently demonstrated mild NDI (6/80, 8% vs. 1/111, 1%) and lower developmental test scores (up to 5.3 points) as opposed to its larger co-twin. Although these results suggest that MC twins with sFGR/BWD are at increased risk of long-term NDI as compared to BWD DC or concordant MC twins, with a within-pair disadvantage for the smaller twin, the overall level of evidence is of moderate quality. As only five articles with a high degree of heterogeneity were available, our review mainly demonstrates the current lack of knowledge of the long-term outcomes of MC twins with sFGR/BWD. Insight into long-term outcomes will lead to improved prognostics, which are essential in parent counseling and crucial in the process of forming a management protocol specifically for twins with sFGR to optimally monitor and support their development.

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Section: Discussionmentioning

confidence: 99%

The Impact of Selective Fetal Growth Restriction or Birth Weight Discordance on Long-Term Neurodevelopment in Monochorionic Twins: A Systematic Literature Review

Groene

Tollenaar

Oepkes

et al. 2019

JCM

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“…However, this study did not conduct a mediation analysis to disentangle the direct effect of TSE on neurodevelopment from its indirect effect on preterm birth/low birth weight. Further, prior research indicates that term infants who were exposed to in-utero TSE and who were small for gestational age born have lower reading and math scores at age 5 compared to unexposed children 48 . Other studies on term infants reported lower Bayley scores in areas such as Motor, Cognition, Language, and Adaptive Behavior at age 2 11 , 12 , 37 .…”

Section: Discussionmentioning

confidence: 99%

Prenatal tobacco smoke exposure and risk for cognitive delays in infants born very premature

Mahabee-Gittens,

Harun,

Glover

et al. 2024

Sci Rep

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Prenatal tobacco smoke exposure (TSE) and prematurity are independent risk factors for abnormal neurodevelopment. The objectives were to compare differences in Bayley-III cognitive, language, and motor scores at 2 years corrected age (CA) in 395 infants born very preterm (≤ 32 weeks gestation) with and without prenatal TSE. We performed multivariable linear regression analyses to examine associations between prenatal TSE and neurodevelopmental outcomes and a mediation analysis to estimate direct effects of prenatal TSE on outcomes and indirect effects through preterm birth. In total, 50 (12.6%) infants had prenatal TSE. Infants with prenatal TSE had lower mean [95% CI] Cognitive score (82.8 [78.6, 87.1]) vs. nonexposed infants (91.7 [90.1, 93.4]). In children with and without prenatal TSE, there were significant differences in mean [95% CI] Language scores (81.7 [76.0, 87.4] vs. 92.4 [90.2, 94.6], respectively) and mean [95% CI] Motor scores (86.5 [82.2, 90.7] vs. 93.4 [91.8, 95.0], respectively); scores remained significant after controlling for confounders. Preterm birth indirectly mediated 9.0% of the total effect of prenatal TSE on Cognitive score (P = NS). However, 91% of the remaining total effect was significant and attributable to TSE’s direct harmful effects on cognitive development (β = − 5.17 [95% CI − 9.97, − 0.38]). The significant association is largely due to TSE’s direct effect on cognitive development and not primarily due to TSE’s indirect effect on preterm birth.

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“…27,28 Due to sample size limitations, we did not conduct separate analyses for term and preterm-born children and for SGA children born to mothers with or without a hypertensive disorder of pregnancy, or those who smoked during pregnancy, as prior studies suggested that there are variations in neurodevelopmental outcomes within SGA children. 29 However, we corrected for GA at delivery in our multivariable analysis. Although the association between SGA and lower odds of low IQ score in children persisted despite adjusting for multiple covariates, we acknowledge the possibility of unmeasured residual confounding.…”

Section: Discussionmentioning

confidence: 99%

The Association between Infant Birth Weight, Head Circumference, and Neurodevelopmental Outcomes

et al. 2023

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Objective The aim of this study was to evaluate whether being small for gestational age (SGA) or large for gestational age (LGA) or having a small or large head circumference (HC) at birth is associated with adverse neurodevelopmental outcomes. Study Design This is a secondary analysis of a multicenter negative randomized trial of thyroxine therapy for subclinical hypothyroid disorders in pregnancy. The primary outcome was child intelligence quotient (IQ) at 5 years of age. Secondary outcomes included several neurodevelopmental measures. Associations between the outcomes in children with SGA (<10th percentile) or LGA (>90th percentile) birth weights, using ethnicity- and sex-specific population nomogram as well as nomograms from the National Fetal Growth (NFG) study, were compared with the referent of those with appropriate for gestational age (AGA) birth weight. Similar analyses were performed for HC. Results Using the population nomogram, 90 (8.2%) were SGA and 112 (10.2%) were LGA. SGA neonates were more likely to be born preterm to mothers who were younger, smoked, and were less likely to have less than a high school education, whereas LGA neonates were more likely to be born to mothers who were older and have higher body mass index, compared with AGA neonates. SGA at birth was associated with a decrease in the child IQ at 5 years of age by 3.34 (95% confidence interval [CI], 0.54–6.14) points, and an increase in odds of child with an IQ < 85 (adjusted odds ratio [aOR], 1.9; 95% CI, 1.1–3.2). There was no association between SGA and other secondary outcomes, or between LGA and the primary or secondary outcomes. Using the NFG standards, SGA at birth remained associated with a decrease in the child IQ at 5 years of age by 3.14 (95% CI, 0.22–6.05) points and higher odds of an IQ < 85 (aOR, 2.3; 95% CI, 1.3–4.1), but none of the other secondary outcomes. HC was not associated with the primary outcome, and there were no consistent associations of these standards with the secondary outcomes. Conclusion In this cohort of pregnant individuals with hypothyroid disorders, SGA birth weight was associated with a decrease in child IQ and greater odds of child IQ < 85 at 5 years of age. Using a fetal growth standard did not appear to improve the detection of newborns at risk of adverse neurodevelopment.

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Etiological Subgroups of Small-for-Gestational-Age: Differential Neurodevelopmental Outcomes

Cited by 7 publications

References 43 publications

The Impact of Selective Fetal Growth Restriction or Birth Weight Discordance on Long-Term Neurodevelopment in Monochorionic Twins: A Systematic Literature Review

The Impact of Selective Fetal Growth Restriction or Birth Weight Discordance on Long-Term Neurodevelopment in Monochorionic Twins: A Systematic Literature Review

Prenatal tobacco smoke exposure and risk for cognitive delays in infants born very premature

The Association between Infant Birth Weight, Head Circumference, and Neurodevelopmental Outcomes

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