Subclassification of Small for Gestational Age Children with Persistent Short Stature: Growth Patterns and Response to GH Treatment

Abstract

Aim: We determined whether subclassification of short small for gestational age (SGA) children according to birth anthropometrics could delineate different patterns in gestation, delivery, postnatal growth, response to growth hormone (GH) treatment and parental height. Methods: 201 short SGA children were divided into three groups, SGA_L, SGA_L+W and SGA_L+W+HC, according to birth length (L), weight (W) and head circumference (HC) ≤–2.00 standard deviation score (SDS). Results: SGA_L+W+HC children were born after the shortest gestational age and more often by caesarean section than SGA_L children (36.3 vs. 38.1 weeks, 68.4 vs. 24.4%). SGA_L+W children had an intermediate pattern and experienced most gestational hypertension (p = 0.01). At birth, SGA_L+W+HC children were shorter than SGA_L or SGA_L+W (–4.12 vs. –2.67 and –3.72 SDS, p ≤ 0.001). During the first 3 years of life, SGA_L+W+HC children exhibited an increased growth in height (0.98 SDS) and HC (1.28 SDS) than SGA_L (height, –0.06 SDS; HC, –0.30 SDS) and SGA_L+W (height, 0.62 SDS; HC, –0.31 SDS). However, HC SDS remained smaller for SGA_L+W+HC than the other groups at age 3. The groups did not differ in growth response during GH treatment. SGA_L children tended to have shorter parents and target height than SGA_L+W+HC children. Conclusions: Our study shows that subclassification of short SGA children might be a useful method for investigating SGA children as the subgroups revealed a different gestation, delivery and postnatal growth pattern. Response to GH treatment was not different between the groups.

Glucocorticoid receptor gene haplotypes are not associated with birth anthropometry, blood pressure, glucose and insulin concentrations, and body composition in subjects born small for gestational age

“…Differences in catch-up growth were found between SGA children with only small birth length, SGA children with a small birth length and a low birth weight, and SGA children with a small birth length, a low birth weight, and a small head circumference (34). In the future it might be interesting to investigate whether GR gene polymorphisms have different effects in these subgroups.…”

“…Recently, subgroups within the SGA group have been described in a study by Ester et al (34). Differences in catch-up growth were found between SGA children with only small birth length, SGA children with a small birth length and a low birth weight, and SGA children with a small birth length, a low birth weight, and a small head circumference (34).…”

Preditores clínicos do ganho estatural do primeiro ano de tratamento com dose fixa de hormônio de crescimento em crianças nascidas pequenas para idade gestacional

“…Essa ausência de diferentes respostas também é observada por alguns autores (26), recomendando-se a utilização dessas subclassificações apenas para investigação etiológica, uma vez que estariam relacionadas a condições de gestação e poderiam influenciar o tipo de parto e de crescimento pós-natal (27).…”

Is the Response to Growth Hormone in Short Children Born Small for Gestational Age Dependent on Genetic or Maternal Factors?

“…Several attempts have been started to identify subgroups associated with specific growth patterns. Children with subnormal length, weight and head circumference at birth are born with the lowest gestational age and are shorter than children with only reduced length and weight or only length [27] . During the first 3 years, the spontaneous increase in height SDS was greater in the first group, but head circumference remained smaller [27] .…”