First-trimester fetal size, accelerated growth in utero, and child neurodevelopment in a cohort study

被引:2
作者
Chen, Xinmei [1 ,2 ,3 ]
Liu, Hongxiu [1 ,2 ,3 ]
Li, Yuanyuan [1 ,2 ,3 ]
Zhang, Wenxin [1 ,2 ,3 ]
Zhou, Aifen [5 ]
Xia, Wei [1 ,2 ,3 ]
Xu, Shunqing [1 ,2 ,3 ,4 ]
机构
[1] Huazhong Univ Sci & Technol, Tongji Med Coll, Sch Publ Hlth, Key Lab Environm & Hlth, Wuhan 430030, Peoples R China
[2] Huazhong Univ Sci & Technol, Tongji Med Coll, Sch Publ Hlth, Minist Environm Protect, Wuhan 430030, Peoples R China
[3] Huazhong Univ Sci & Technol, Tongji Med Coll, Sch Publ Hlth, State Key Lab Environm Hlth, Wuhan 430030, Peoples R China
[4] Hainan Univ, Sch Environm Sci & Engn, Haikou 570228, Peoples R China
[5] Women & Children Med & Healthcare Ctr Wuhan, Wuhan 430015, Peoples R China
基金
中国国家自然科学基金;
关键词
Child neurodevelopment; First-trimester fetal size; Intrauterine accelerated growth; Cohort study; BRAIN; RISK; ASSOCIATION; PREGNANCY; OUTCOMES; LENGTH; AGE;
D O I
10.1186/s12916-024-03390-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Early pregnancy is a critical window for neural system programming; however, the association of first-trimester fetal size with children's neurodevelopment remains to be assessed. This study aimed to explore the association between first-trimester fetal size and children's neurodevelopment and to examine whether intrauterine accelerated growth could compensate for the detrimental effects of first-trimester restricted growth on childhood neurodevelopment. Methods The participants were from a birth cohort enrolled from March 2014 to March 2019 in Wuhan, China. A total of 2058 fetuses with crown to rump length (CRL) (a proxy of first-trimester fetal size) measurements in the first trimester and neurodevelopmental assessment at age 2 years were included. We measured the first-trimester CRL and defined three fetal growth patterns based on the growth rate of estimated fetal weight from mid to late pregnancy. The neurodevelopment was assessed using the Bayley Scales of Infant Development of China Revision at 2 years. Results Each unit (a Z score) increase of first-trimester CRL was associated with increased scores in mental developmental index (MDI) (adjusted beta estimate = 1.19, (95% CI: 0.42, 1.95), P = 0.03) and psychomotor developmental index (PDI) (adjusted beta estimate = 1.36, (95% CI: 0.46, 2.26), P < 0.01) at age 2 years, respectively. No significant association was observed between fetal growth rate and PDI. For children with restricted first-trimester fetal size (the lowest tertile of first-trimester CRL), those with "intrauterine accelerated growth" pattern (higher growth rates) had significantly higher MDI (adjusted beta estimate = 6.14, (95% CI: 3.80, 8.49), P < 0.001) but indistinguishable PDI compared to those with "intrauterine faltering growth" pattern (lower growth rates). Main limitations of this study included potential misclassification of gestational age due to recall bias of the last menstrual period and residual confounding. Conclusions The current study suggests that restricted first-trimester fetal size is associated with mental and psychomotor developmental delay in childhood. However, in children with restricted first-trimester fetal size, intrauterine accelerated growth was associated with improved mental development but had little effect on psychomotor development. Additional studies are needed to validate the results in diverse populations.
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页数:11
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